This document summarizes a study on racial and ethnic differences in medication adherence among patients newly prescribed antihypertensive medications. The study found that after controlling for factors like income and health status, black, Asian, and Hispanic patients were more likely than white patients to not fill their initial prescription or refill later prescriptions. However, differences in long-term adherence between white and non-white patients decreased when the model accounted for medication costs and use of mail-order pharmacies. The authors conclude that improving access to medications may help reduce persistent gaps in medication use between racial and ethnic groups.
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a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
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Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
This two-part class will begin by highlighting collaborative pain care in Primary Care using real-life scenarios that address the complex issues and needs of returning Veterans and then move on to address how to apply a nuts-and-bolts approach within a Patient Aligned Care Team in the VA.
Carle Palliative Care Journal Club for 7/3/18Mike Aref
Journal club review of "Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial" by D. Hui et. al. in JAMA. 2017 Sep 19;318(11):1047-1056.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
Pregnant women with anxiety and other mood disorders more likely to report us...Δρ. Γιώργος K. Κασάπης
Reinforcing previous data on the subject, a new study of pregnant women in California finds that those who have anxiety and other mental health disorders are most likely to also reporting cannabis use during their pregnancy. Looking at data from nearly 200,000 pregnancies across Kaiser Permanente Northern California health facilities, researchers found that 6% of the women self-reported cannabis use while pregnant. Those who said they used cannabis were, on average, younger than 25, Hispanic, and twice as likely to have anxiety, depression, or both these disorders. Although California's laws permit recreational and medicinal marijuana use, physicians are still contending with how best to talk to women about pot use during pregnancy.
Determining Prognosis in Cancer and Non-cancer DiagnosisVITAS Healthcare
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Presented by Michael Horberg, MD, MAS, FACP, FIDSA,
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[ppt] RCpsych - Failing medical care of psychiatric patients (vMar11)Alex J Mitchell
This is a 30min talk given at the RCPsych liaison conference 2011 on the topic of the failing (suboptimal) medical care provided to psychiatric patients by physicians and psychiatrists. Available in free full text PPT for a limited period.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
Pregnant women with anxiety and other mood disorders more likely to report us...Δρ. Γιώργος K. Κασάπης
Reinforcing previous data on the subject, a new study of pregnant women in California finds that those who have anxiety and other mental health disorders are most likely to also reporting cannabis use during their pregnancy. Looking at data from nearly 200,000 pregnancies across Kaiser Permanente Northern California health facilities, researchers found that 6% of the women self-reported cannabis use while pregnant. Those who said they used cannabis were, on average, younger than 25, Hispanic, and twice as likely to have anxiety, depression, or both these disorders. Although California's laws permit recreational and medicinal marijuana use, physicians are still contending with how best to talk to women about pot use during pregnancy.
Determining Prognosis in Cancer and Non-cancer DiagnosisVITAS Healthcare
This helps physicians, nurses, case managers and social workers understand the trajectories of dying from cancer and non-cancer diagnoses, including heart, lung, kidney and liver disease, stroke, HIV/AIDS, dementia and neurodegenerative diseases. Aided by a better grasp of the decline-related domains involved in poor prognosis, disease progression and disease end stages, attendees will be better positioned to identify patients and residents who are appropriate for hospice care.
Palliative care is about providing well-being and the highest quality of life to patients with serious, progressive, chronic life-limiting illness, including during the dying process.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
Presented by Michael Horberg, MD, MAS, FACP, FIDSA,
Executive Director Research, Mid-Atlantic Permanente Medical Group, Director, HIV/AIDS Kaiser Permanente, at the 2012 National Chlamydia Coalition meeting.
What is the correlation between CNS active medication and fall risk for the geriatric community and how should one best prevent fall injuries from occurring for those taking such medication?
Non-adherence of CML patients - Results of the global survey of the CML Ad...jangeissler
"Non-adherence of CML patients - Results of the global survey of the CML Advocates Network", presented by Giora Sharf, Co-founder, CML Advocates Network and Director, Israeli CML Patients’ Organization, for the International CML Foundations' "Virtual Education Program"
[ppt] RCpsych - Failing medical care of psychiatric patients (vMar11)Alex J Mitchell
This is a 30min talk given at the RCPsych liaison conference 2011 on the topic of the failing (suboptimal) medical care provided to psychiatric patients by physicians and psychiatrists. Available in free full text PPT for a limited period.
PYA Principal Kent Bottles, MD, who is also Chief Medical Officer of PYA Analytics, presented before healthcare information technology (IT) professionals at the Summit of the Southeast—Driving the Future of Technology held at Nashville Music City Center, September 16-17, 2014. Dr. Bottles’ presentation covered population health.
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Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
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Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE
Disparities in Antihypertensive Medication Adherence ADAMS
1. Antihypertensive Medication Adherence
among Newly Treated Patients:
Opportunities for Disparities Reduction?
Alyce S. Adams, PhD
Connie Uratsu, RN 18th Annual HMO
Wendy Dyer, MS Research Network
David Magid, MD, MPH Conference
Patrick O’Connor, MD, MA, MPH April 29-May 2, 2012
Arne Beck, PhD Seattle, WA
Melissa Butler, PhD
P. Michael Ho, MD, PhD
Julie A. Schmittdiel, PhD
2. Acknowledgements
INSTITUTIONS
Kaiser Permanente Division of Research, Oakland, CA; Institute for Research,
Kaiser Permanente, Denver, CO; Kaiser Permanente Center for Health
Research Southeast, Atlanta, GA; HealthPartners Research Foundation,
Minneapolis, MN; Denver VA Medical Center, Denver, CO
FUNDERS
National Heart, Lung, and Blood Institute and the National Institute for
Mental Health as a supplement to the HMO Research Network Cardiovascular
Disease Network [3U19HL091179-04S1].
National Institute for Diabetes, Digestive and Kidney Diseases Health Delivery
Systems Center for Diabetes Translational Research [P30DK092924]
(Adams, Schmittdiel, O’Connor)
OTHER
Dr. Alan Go (critical edits), Ms. Karen R. Hansen (manuscript preparation)
4. Conceptual Framework
Predisposing Factors
•Beliefs about risks and
Mediators
benefits of medicines
Primary
Health Status
Income •Medication Coverage Non-Adherence
•Patient-Provider Relationship
Race/Ethnicity Education
Geography •Perceived affordability
Whites
•Blacks Rural/Urbanicity
Social Support Enabling Factors
•Hispanics Early
Culture •Health Literacy/Education
•Asians Preferences •Patient self-care skills Non-Persistence
Racism •Medication Affordability
Stress •Medication Tolerability
Perceived Barriers
•Affordability/Ease of Access
•Competing Demands Non-Adherence
•Cognitive Issues/Complexity
5. Research Questions
1. Are racial and ethnic differences in antihypertensive
medication taking behavior consistent over time?
2. What factors contribute to differences in mediation taking
Behavior at different stage of adherence by race and
Ethnicity?
6. Methods
Setting: Kaiser Permanente Northern California
Patients: Adults (≥18 years) with hypertension who were new users of
antihypertensive therapy in 2008
Outcome Measures
Primary non-adherence: failing to fill a prescribed antihypertensive agent within
60 days after it was ordered by physician
Early non-persistence: failing to refill within 90 days of running out of the
first prescription
Non-adherence: not having medication available for 20% or more of days
during the 12 months following initiation of therapy
Modeling: Multivariate logistic regression analysis, with sensitivity analyses
using proc genmod and multiple imputation
8. Stages of Non-Adherence by Race/Ethnicity
45
40
35
30
25
20
15
10
5
0
White (non- Black (non- Asian Hispanic
Hisp) Hisp)
Primary Non-Adherent Early Non-Persistent
Non-Adherent
10. Logistic Regression Model Estimating Non-
Adherence with Antihypertensive Agents
Black (non- Asian (non- Hispanic
Hispanic) Hispanic)
Model 1: Age, Gender 1.73 (1.53-1.96) 1.20 (1.07-1.35) 1.68 (1.51-1.87)
+ smoking status, BMI, SBP 1.71 (1.51-1.94) 1.22 (1.08-1.37) 1.67 (1.51-1.86)
+ household income 1.67 (1.47-1.89) 1.22 (1.09-1.38) 1.65 (1.48-1.83)
+physical comorbidity 1.67 (1.47-1.90) 1.23 (1.09-1.38) 1.65 (1.48-1.84)
+mental health comorbidity 1.67 (1.47-1.90) 1.23 (1.09-1.39) 1.65 (1.48-1.84)
+ physician visits 1.68 (1.48-1.90) 1.23 (1.09-1.39) 1.65 (1.48-1.84)
+medication copay & mail order 1.54 (1.35-1.75) 1.13 (1.00-1.28) 1.48 (1.33-1.65)
pharmacy use
11. Key Findings
• In this setting where patients have more or less equal
access to care, non-white race was associated with
both early non-persistence & non-adherence
• These relationships were robust to the inclusion of
sociodemographic and clinical factors.
• However, the relationship between race/ethnicity and
non-adherence was appreciably attenuated by the
inclusion of medication copay and mail order
pharmacy use.
12. Limitations
• Unmeasured confounders
• beliefs and preferences unlikely to change over time
• limits our understanding of differences and why they
occur
• Logistic regression
• OR may overestimate effects, additional sensitivity
analyses planned
• Missing Data
• Results robust to multiple imputation
• Racial/Ethnic misclassification
• may bias results if the misclassification is correlated
with both race/ethnicity and adherence
13. Conclusions
• Racial and ethnic differences in medication
taking behavior occur early in the course of
treatment.
• System level changes that ease access to
medications may have the potential to
attenuate persistent gaps in the use of
these and other clinically effective therapies.
Sensitivity Analyses: No or very small differences between results from Proc Genmod and when multiple imputation used for missing BMI, systolic, HHincome, medvisits and copay for either model.