John Orwat

A randomized trial of telemonitoring heart failure patients.

EXECUTIVESUMMARY The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure. Patients were recruited and randomly assigned for six months to either telemonitoring or standard care. Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station. Utilization of covered services was analyzed for the six‐month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department (ED), urgent care, and primary care. Negative binomial regressions adjusted for gender, age, co‐occurring diabetes, co‐occurring chronic obstructive pulmonary disease, and residence neighborhood were used to analyze units of service, and two‐part (hurdle) multivariable models were used for expenditures. The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring. Results for other covered services were generally consistent with hypothesized direction and magnitude; however, statistical power was reduced because of lowerthan‐expected recruitment rates into the study. Within a managed‐care environment, telemonitoring appears to facilitate better ambulatory management of heart failure patients, including fewer ED visits, which were offset by more frequent primary care and urgent care visits.

Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems

This is a prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS. Data from the HIV Longitudinal Interrelationships of Viruses and Ethanol study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization. An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [95% CI] = 0.19-0.67), as did identifying sexual orientation other than heterosexual (AOR = 0.46, CI = 0.29-0.72) and having social supports that use alcohol/drugs (AOR = 0.62, CI = 0.45-0.83). Positive associations with SAT include presence of hepatitis C antibody (AOR = 3.37, CI = 2.24-5.06), physical or sexual abuse (AOR = 2.12, CI = 1.22-3.69), social supports that help with sobriety (AOR = 1.92, CI = 1.28-2.87), homelessness (AOR = 2.40, CI = 1.60-3.62), drug dependence diagnosis (AOR = 2.64, CI = 1.88-3.70), and clinically important depressive symptoms (AOR = 1.52, CI = 1.08-2.15). While reassuring that factors indicating need for SAT among people with HIV and alcohol problems (e.g., drug dependence) are associated with receipt, nonneed factors (e.g., sexual orientation, age) that should not decrease likelihood of receipt of treatment were identified.

Examining cohort differences and resilience among the aging LGBT community: Implications for education and practice among an expansively diverse population

The aging lesbian, gay, bisexual, and transgender (LGBT) community continues to grow considerably while often being faced with unique and unmet needs separate from younger LGBT cohorts or their non-LGBT counterparts. This article explores some of the differences in attitudes among generational cohort groups regarding coming out decisions; sexual risk and safety; the impact of evolving policies within systems and society; as well as the demonstrated strengths and resiliencies of the aging LGBT community. Implications and suggestions for education, training, and best practices among this expansive and diverse population are considered as well as continued research in the field of LGBT aging.

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior Among Gay and Bisexual Men Who Use Club Drugs

Background: Few studies have examined the impact of minority stress theory (MST) upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women; however, gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. Objective: This study examines sexual risk behavior from the perspective of minority stress theory upon substance-using gay and bisexual men and their partners. Methods: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use, and partner type, controlling for demographics. Results: 396 gay and 54 bisexual respondents, ages 18–67, reported at least one-time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. Conclusions: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.

Factors associated with attendance in 12-step groups (Alcoholics Anonymous/Narcotics Anonymous) among adults with alcohol problems living with HIV/AIDS

BACKGROUND Despite the value of 12-step meetings, few studies have examined factors associated with attendance among those living with HIV/AIDS, such as the impact of HIV disease severity and demographics. OBJECTIVE This study examines predisposing characteristics, enabling resources and need on attendance at Alcoholic Anonymous (AA) and Narcotics Anonymous (NA) meetings among those living with HIV/AIDS and alcohol problems. METHODS Secondary analysis of prospective data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol study, a cohort of 400 adults living with HIV/AIDS and alcohol problems. Factors associated with AA/NA attendance were identified using the Anderson model for vulnerable populations. Generalized estimating equation logistic regression models were fit to identify factors associated with self-reported AA/NA attendance. RESULTS At study entry, subjects were 75% male, 12% met diagnostic criteria for alcohol dependence, 43% had drug dependence and 56% reported attending one or more AA/NA meetings (past 6 months). In the adjusted model, female gender negatively associated with attendance, as were social support systems that use alcohol and/or drugs, while presence of HCV antibody, drug dependence diagnosis, and homelessness associated with higher odds of attendance. CONCLUSIONS Non-substance abuse related barriers to AA/NA group attendance exist for those living with HIV/AIDS, including females and social support systems that use alcohol and/or drugs. Positive associations of homelessness, HCV infection and current drug dependence were identified. These findings provide implications for policy makers and treatment professionals who wish to encourage attendance at 12-step meetings for those living with HIV/AIDS and alcohol or other substance use problems.

A Protection Motivation Theory application to date rape education

Date rape risk communication is a key component of education-based Date Rape Prevention Programs, common across colleges. In such programs, risk assessment in date rape is approached cautiously in order to avoid a tone of “victim blaming.” Since it is important in the assessment of any risk to understand the surrounding social context of the risky situation and the individuals unique relationship with that social context, this study examines Protection Motivation Theory as it applies to handling the risk of date rape without victim blaming. The paper links individual personality and social contexts with risk communication. The study sample comprised 367 undergraduate women enrolled in a large Southern Public University. The study examines the relationships between dating activity, social competency, and type of information provided with the dependents variables of date rape related protection behavior (intent), belief, and knowledge. A factorial multiple analysis of covariance analysis found that the dependent variables had a significant relationship with aspects of social competency and dating activity. The exposure to varying information about date rape was not significantly related to the dependent variables of date rape-related protection behavior (intent), belief, and knowledge. The identification of social competency and dating activity status as protective factors in this study makes a significant contribution to the practice and research efforts in date rape education.

Comparing Rural and Urban Cervical and Breast Cancer Screening Rates in a Privately Insured Population

ABSTRACT Low preventive screening varies by region and contributes to poor outcomes for breast and cervical cancer. Previous comparative urban and rural research on preventive screening has focused on government programs. This study quantified and compared rural and urban preventive cancer screening rates for women who were privately insured. National Quality Forum measures were used to calculate rates for women within rural and urban parts of the same Hospital Referral Region (HRR) using claims data. Mammography screening rates for women age 24 to 69 years were 77.1% in 2011 and 76.1% in 2008. Compared to urban women, mammography screening rates for women visiting rural physicians were lower in 42%, higher in 2% and identical in 56% of HRRs. Cervical cancer screening rates for women age 21 to 64 years were 82.9% in 2011 and 83.5% in 2008. Cervical cancer screening rates among women who saw rural physicians were lower in 55%, higher in 4%, and identical in 42% of HRRs. HRRs where rural areas underperformed urban areas increased between 2008 and 2011 for both screenings. Moderate but notable differences in women’s preventive screening rates between rural and urban physicians highlight the need for practical solutions that increase use of screening services and reduce barriers to services in rural areas.

Class participation as a pedagogical tool in social work education

Abstract Class participation is an essential part of the social work pedagogy. However, active student engagement in classes is inconsistent and varies based on factors such as social backgrounds, educational background, and individual characteristics. Instructors often evaluate participation based on frequency of verbal contributions. Evaluation criteria are often unarticulated or difficult to measure, presenting numerous challenges for instructors and students alike. A model of reflective self-assessment of participation by students, paired with timely instructor feedback is put forth in this paper to mitigate these concerns. The steps in this model include initial self-assessment, goal setting, midterm review, and a final review. The process of continuous self-evaluation and problem-solving is discussed as strategies that aid the process of class participation. Three instructor touch points are suggested: at the goal-setting stage, the midterm review, and the final grade. Throughout the paper, connections to social work practice and social work pedagogy are highlighted. This model has yet to be implemented in a social work school’s curriculum. Challenges in the implementation and resolution of those challenges are also presented. This model suggests ways to enhance opportunities for student engagement and integration into graduate programs, in addition to fostering valuable skills for future practice in the field.

Deferring felony prosecution: a process evaluation of an innovative Cook County State’s Attorney’s Office program

Purpose The Cook County State Attorneys’ Deferred Prosecution Program (DPP) is a pre-trial diversionary program that accepts first-time, non-violent defendants charged with a felony crime. The purpose of this paper is to document the development, implementation, and program patterns of the DPP to better understand the program’s scope and reach in diverting defendants from traditional criminal prosecution. Design/methodology/approach The approach to evaluating Cook County’s DPP is primarily qualitative. Through interviews with program administrators and current and former participants, the authors document the process of creating and implementing such DPP that aims to avoid a felony conviction altogether. The authors provide program participant patterns to shed light on the program’s scope and reach in diverting defendants from traditional felony prosecution. Findings Using data from staff, administrators, and program participants, the authors found that the DPP was developed and implemented through supportive leadership who instilled a culture of collaboration and buy-in. Expanding the program could include increasing the capacity of DPP to include additional participants or having a DPP incorporated into each branch court, instead of the centralized system under which it currently operates. Increasing the capacity and scope of the program could both further decrease criminal court caseloads and most importantly avoid a higher number of stigmatizing felony convictions for first-time non-violent defendants. Practical implications DPPs are cost effective and can be easily implemented within existing systems. Collaboration and buy-in from all stakeholders are crucial to the program’s success. DPP offers opportunities for expansion. Increasing the capacity and scope of the program could both further decrease criminal court caseloads and most importantly avoid a higher number of stigmatizing felony convictions for first-time non-violent felony defendants. Originality/value The main goals of DPP were two-fold. The first was to minimize the level of resources allocated for non-violent offenders in the criminal justice system by diverting such defendants out of the criminal justice system early in the process and reducing the recidivism rates of program participants. The second aimed to provide an option for eligible defendants to avoid a felony conviction, thereby avoiding the collateral consequences associating with a felony conviction.