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Choo, P.W., Rand, C.S., Inui, T.S., and others (2001, June). "Derivation of adherence metrics from electronic dosing records." (AHRQ grant HS07821). Journal of Clinical Epidemiology 54, pp. 619-626.
Electronic medication monitors generally capture the date and time of a dosing event, be it the opening of a vial cap or blister pack, actuation of a metered dose inhaler, or administration of droplets from an eye dropper. None of these devices, however, can actually confirm consumption of the medication in the recommended dose. These authors derived several representative adherence metrics and analyzed their relationship to the underlying dosing event rate. They then used data from a 3-month study of 286 individuals on single-drug antihypertensive therapy to study the statistical properties of several of these adherence metrics. They found that metrics that average the consumption rate over multiple doses may be less sensitive to short-term fluctuations in medication intake. Metrics that are more sensitive to timing variability may be preferable when timing as well as quantity of dosing are of interest.
Eisen, S.V., Shaul, J.A., Leff, H.S., and others. (2001, August). "Toward a national consumer survey: Evaluation of the CABHS and MHSIP instruments." (AHRQ grant HS09205). Journal of Behavioral Health Services Research 28(3), pp. 347-369.
These researchers evaluated the Consumer Assessment of Behavioral Health Survey (CABHS) and the Mental Health Statistics Improvement Program (MHSIP) surveys to identify ways to improve such surveys. The surveys included 3,443 adults in 6 behavioral health plans. The surveys did not differ significantly in response rate or consumer burden. Both surveys reliably assessed access to treatment and aspects of appropriateness and quality of care. The CABHS survey also reliably assessed features of the insurance plan, and the MHSIP survey reliably assessed treatment outcomes. Analyses of comparable items suggested which survey items had greater validity. The researchers compare these surveys with other consumer surveys and make recommendations for survey development, quality improvement, and national policy initiatives to evaluate health plan performance.
Hargraves, J.L., Wilson, I.B., Zaslavsky, A., and others. (2001). "Adjusting for patient characteristics when analyzing reports from patients about hospital care." (AHRQ grant HS09205). Medical Care 39(6), pp. 635-641.
Adjusting for patient characteristics has a small impact on patient reports about hospital care, conclude these authors. They surveyed by telephone a sample of patients hospitalized in 22 hospitals in one city and mailed a survey to hospitalized patients State-wide. Each survey assessed respect for patients' preferences, coordination of care, information exchange between patient and providers, physical care, emotional support, involvement of family and friends, and transition and continuity. The surveys also asked the patients to rate their doctors, nurses, and other hospital staff. Patient age and reported health status were most consistently associated with patient-reported problems. Patient sex and education level also sometimes predicted reports and/or ratings. However, models including these variables explained only 3 to 8 percent of the variation in ratings of hospital care. Nevertheless, the researchers recommend adjusting at least for patient age and health status to alleviate concerns about bias in patient reports of hospital care.
Kelts, E.A., Allan, M.J., and Klein, J.D. (2001, May). "Where are we on teen sex? Delivery of reproductive health services to adolescents by family physicians." (AHRQ grant HS08192). Family Medicine 33(5), pp. 376-381.
Despite efforts to modify adolescents' risky sexual behaviors, more than one-third (35 percent) of high school students report having been sexually active within the past 3 months, and only 57 percent of them report using a condom the last time they had intercourse. Female doctors, younger doctors, and those who regularly discuss confidentiality or have a more positive attitude toward and familiarity with preventive care guidelines are more likely to provide reproductive health screening and counseling during adolescent visits. These are the findings of a survey of 354 New York family physicians with patients aged 15 to 18. On average, family doctors reported asking 79 percent of their adolescent patients about contraceptive use, 73 percent about condom use, 72 percent about sexual relationships, and 61 percent about sexual behaviors. Only 36 percent asked teens when they thought sex was appropriate, and 30 percent discussed sexual orientation. Seventy-six percent discussed adolescents' risk of HIV, 78 percent advised adolescents to use condoms, 21 percent gave handouts about HIV, and 9 percent gave condoms to adolescent patients.
Knight, J.R. (2001, May). "The role of the primary care provider in preventing and treating alcohol problems in adolescents." (AHRQ/NIAAA interagency agreement). Ambulatory Pediatrics 1(3), pp. 150-161.
A recent survey found that substantial numbers of 8th to 12th grade students have begun to drink, and many have gotten drunk at least once. Also, 15 to 31 percent of students had five or more drinks within the 2 weeks before the survey, and some students were daily drinkers. Heavier drinking was strongly associated with use of illicit drugs. Despite persuasive evidence that primary care involvement can be effective, few primary care doctors follow guidelines that recommend yearly screening of all adolescent patients for alcohol problems. The reasons for this are unclear but may include infrequent medical visits by adolescents, insufficient time during visits, lack of physician skills, and perhaps lack of practical and effective medical office screening tools. This article presents a summary of what is currently known about adolescent alcohol use and how it can be addressed in primary care settings. The goal is to translate research evidence into practical office interventions that improve alcohol screening, counseling, and treatment of adolescent drinkers.
Moyer, V.A. (2001, January-February). "Evidence syntheses in child health." Ambulatory Pediatrics 1(1), pp. 53-58.
There is a relative dearth of child health research, even for common childhood conditions. Nonsystematic reviews of child health studies have been shown to be nonreproducible and of low scientific quality, often failing to mention recent advances and continuing to mention treatments that have been shown to be ineffective or harmful, notes this author in a recent commentary. She points out that in contrast, systematic reviews are scientific evaluations of existing studies, which have explicit and reproducible methods, whose results can be critically appraised. Many sources for high-quality evidence syntheses now exist, with considerable support from government agencies, to develop both the methods and the products of such reviews. Evidence syntheses can increase the efficiency and effectiveness of medical practice, but they face many hurdles, particularly in child health. Four barriers are: lack of high-quality primary studies, the difficulty of finding studies that do exist, the variability and usefulness of the outcome measures in child health, and problems with production and dissemination.
Walter, L.C., Brand, R.J., Counsell, S.R., and others. (2001, June). "Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization." (AHRQ grant K02 HS00006). Journal of the American Medical Association 285(23), pp. 2987-2994.
For many elderly patients, an acute medical illness requiring hospitalization is followed by progressive physical decline, resulting in high mortality rates during the year following discharge. Prognostic information can provide the basis for discussions about the goals of care and therapy. This study of patients 70 years of age and older, who were hospitalized for an acute medical illness, identified six characteristics that may be used to predict a patient's risk of dying in the year after discharge: male sex, dependence in activities of daily living, cancer, heart failure, kidney insufficiency, and low albumin level. Each risk factor was given one to five points, and the risk of mortality was based on the sum of the points. The prognostic index was based on analysis of data from two prospective studies with 1-year of followup conducted from 1993 through 1997. The index was developed in 1,495 older adults who were discharged from one Ohio hospital and validated in a separate group of 1,427 patients discharged from another Ohio hospital.
Weinberger, M., Murray, M.D., Marrero, D.G., and others. (2001, May). "Pharmaceutical care program for patients with reactive airways disease." (AHRQ grant HS09083). American Journal of Health-Systems Pharmacy 58, pp. 791-796.
These researchers describe a pharmaceutical care program they have begun at 36 CVS pharmacies for patients with reactive airway disease (RAD, asthma and reversible chronic obstructive pulmonary disease). After participating in baseline interviews, 1,113 patients with RAD are being monitored for 12 months. Primary outcomes being evaluated are peak expiratory flow rate, health-related quality of life, medication compliance, and acute exacerbation of RAD (requiring emergency department visits or hospitalization). Secondary outcomes being measured are patient satisfaction with care and their pharmacists, missed days from school or work, and pharmacists' job satisfaction, job stress, and attitudes toward pharmaceutical care. The researchers believe that pharmacists are ideally positioned to encourage compliance with inhalers and other medications. The program, designed from focus-group sessions with CVS pharmacists and their customers with RAD, has five components: computer display of patient-specific data for patients enrolled in the study, tailored patient education materials, a resource guide to facilitate the implementation of pharmaceutical care, strategies to reinforce and facilitate the program, and pharmacist training in the program.
Zingmond, D.S., Wenger, N.S., Crystal, S., and others. (2001, July). "Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans: Results from a nationally representative sample of HIV-infected adults receiving care." (AHRQ grant HS08578). American Journal of Public Health 91(7), pp. 1117-1120.
About one of every 10 people in the United States who has AIDS is over the age of 50. Although progression of HIV infection is similar across age groups and races, this study found that older minorities were diagnosed later, appeared healthier with fewer symptoms at study entry, and clinically deteriorated faster after study entry than similar-aged whites. The researchers analyzed data from the HIV Cost and Services Utilization Study (HCSUS), a survey of a nationally representative sample of HIV-infected individuals receiving care in the United States. They evaluated circumstances at diagnosis and clinical characteristics at study entry (1996) and 2 years later. Of the 2,864 patients who completed the baseline survey, 286 were at least 50 years of age (half were minority). Older patients were more likely to be diagnosed when ill, especially older minorities who were more than twice as likely to be diagnosed when already ill. At baseline, older patients reported fewer symptoms and lower symptom intensity than younger patients despite similar CD4 counts; older minorities reported significantly fewer HIV-related diseases. After a mean followup period of 14 months, survival, CD4 count, prevalent and incident diseases, total symptoms, and symptom intensity were similar between groups. The researchers note that the short followup time may have been inadequate to observe differences by age and race in disease progression.
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Current as of August 2001
AHRQ Publication No. 01-0045