Joshua M. Thorpe

Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States.

Objective:The presence of psychologic distress in older adults may be associated with decreased adherence to recommended preventive-care services. This analysis aimed to measure the association between psychologic distress and adherence to United States Preventive Services Task Force (USPSTF)-recommended preventive-care services among older adults in the United States. Design:We undertook a cross-sectional analysis of 3655 U.S. community-dwelling elderly from the 2001 Medical Expenditure Panel (MEPS) survey. Measurements:The presence of psychologic distress was captured by the Mental Component Survey (MCS) of the SF-12. The receipt of 9 preventive care services were captured using MEPS: hypertension screening, influenza vaccination, fecal occult blood testing or sigmoidoscopy, mammography, clinical breast examination, cholesterol screening, prostate-specific antigen test, routine check-up, and dental checkup. Results:Elderly reporting psychologic distress were 30% less likely than nondistressed elderly to receive influenza vaccination (OR = 0.70, 95% CI = 0.55–0.88) and 23% less likely to receive annual dental check-ups (OR= 0.77, 95% CI = 0.61–0.97). Women with psychologic distress were 27% less likely to receive a clinical breast examination (OR = 0.73, 95% CI = 0.57–0.94). Psychologic distress was not significantly associated with screening for hypertension, colon cancer, high cholesterol, or prostrate cancer, mammography, or routine check-ups. Conclusions:Elderly reporting psychologic distress were less likely to adhere to some, but not all, recommended preventive care guidelines. These results suggest that adherence to recommended preventive care guidelines may be improved, indirectly, by improving recognition and treatment of emotional health problems in the elderly.

Facilitating Healthy Coping in Patients with Diabetes: A Systematic Review

Purpose The purpose of this study is to summarize recent literature on approaches to supporting healthy coping in diabetes in 2 specific areas: (1) the impact of different approaches to diabetes treatment on healthy coping and (2) the effectiveness of interventions specifically designed to support healthy coping. Methods A PubMed search identified 129 articles published August 1, 2006, to April 30, 2011, addressing diabetes in relation to emotion, quality of life, depression, adjustment, anxiety, coping, family therapy, behavior therapy, psychotherapy, problem solving, couples therapy, or marital therapy. Results Evidence suggests that treatment choice may significantly influence quality of life, with treatment intensification in response to poor metabolic control often improving quality of life. The recent literature provides support for a variety of healthy coping interventions in diverse populations, including diabetes self-management education, support groups, problem-solving approaches, and coping skills interventions for improving a range of outcomes; cognitive behavior therapy and collaborative care for treating depression; and family therapy for improving coping in youths. Conclusions Healthy coping in diabetes has received substantial attention in the past 5 years. A variety of approaches show positive results. Research is needed to compare the effectiveness of different approaches in different populations and determine how to overcome barriers to intervention dissemination and implementation.

Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data

BackgroundSex and age may exert a combined influence on receipt of preventive services with differences due to number of ambulatory care visits.MethodsWe used nationally representative data to determine weighted percentages and adjusted odds ratios of men and women stratified by age group who received selected preventive services. The presence of interaction between sex and age group was tested using adjusted models and retested after adding number of visits.ResultsMen were less likely than women to have received blood pressure screening (aOR 0.44;0.40–0.50), cholesterol screening (aOR 0.72;0.65–0.79), tobacco cessation counseling (aOR 0.66;0.55–0.78), and checkups (aOR 0.53;0.49–0.57). In younger age groups, men were particularly less likely than women to have received these services. In adjusted models, this observed interaction between sex and age group persisted only for blood pressure measurement (p = .016) and routine checkups (p < .001). When adjusting for number of visits, the interaction of age on receipt of blood pressure checks was mitigated but men were still overall less likely to receive the service.ConclusionMen are significantly less likely than women to receive certain preventive services, and younger men even more so. Some of this discrepancy is secondary to a difference in number of ambulatory care visits.

Medications prescribed in emergency departments for nontraumatic dental condition visits in the United States.

Background:Prior research has documented factors associated with nontraumatic dental condition (NTDC) visits to emergency departments (EDs), but little is known about the care received by patients in EDs for NTDC visits. Objective:We examined national trends in prescription of analgesics and antibiotics in EDs for NTDC visits in the United States. Research Design:We analyzed data from the National Hospital Ambulatory Medical Care survey from 1997 to 2007. We used a multivariable logistic regression model to examine factors associated with receiving analgesics and antibiotics for NTDC visits in EDs. Results:Overall 74% received at least 1 analgesic, 56% received at least 1 antibiotic, and 13% received no medication at all during NTDC visits to EDs. The prescription of medications at EDs for NTDC visits steadily increased over time for analgesics (odds ratio=1.11/y, P<0.0001) and antibiotics (odds ratio=1.06/y, P<0.0001). In the multivariable analysis, self-pay patients had significantly higher adjusted odds of receiving antibiotics, whereas those with nondental reasons for visits and children (0–4 y) had significantly lower adjusted odds of receiving a prescription for antibiotics in EDs for NTDC visits. Children (0–4 y), adults (53–72 y), and older adults (73 y and older) had lower adjusted odds (P<0.001) of receiving analgesics. Conclusions:Nationally, analgesic and antibiotic prescriptions for NTDC visits to EDs have increased substantially over time. Self-pay patients had significantly higher odds of being prescribed antibiotics. Adults over 53 years and especially those 73 years and older had significantly lower odds of receiving analgesics in EDs for NTDC visits.

Trends in Emergency Department Antibiotic Prescribing for Acute Respiratory Tract Infections

BACKGROUND: Injudicious use of antibiotics is associated with the reported rise in antibiotic-resistant bacteria. With an estimated 26 million antibiotics being prescribed annually in the emergency department (ED), the ED represents an important setting for targeting interventions. OBJECTIVE: To provide national estimates of potentially inappropriate antibiotic prescribing during ED visits for acute respiratory tract infections (ARTIs) and examine associations between patient, provider, visit characteristics, and antibiotic prescribing patterns. METHODS: A cross-sectional study was conducted of ED visits for ARTIs, identified from pooled 1995–2000 National Hospital Ambulatory Medical Care Survey data. National estimates, descriptive statistics, and multivariate analyses were used to assess antibiotic prescribing patterns. RESULTS: An estimated 51.3 million ED visits for ARTIs occurred during the study period, 62% of which had an antibiotic prescribed. For a narrowly defined subset of ARTIs, where antibiotic therapy is nearly always inappropriate (eg, nasopharyngitis, ARTI of multiple or unspecified sites, acute bronchitis), the percentage decreased over the 6-year period from 57% to 44% (p < 0.01). For children ED visits, however, the downward trend occurred almost exclusively in urban EDs. Compared with visits in which a resident or intern physician was involved, the odds of antibiotic prescribing for child ED ARTI visits were 2.2 times higher for staff physicians (95% CI 1.3 to 3.6) and 1.8 times higher for nonphysicians with prescribing privileges (95% CI 1.3 to 2.4). CONCLUSIONS: ED antibiotic prescribing for ARTIs has decreased from 1995 to 2000, but still is occurring in well over half of ED visits for ARTI. Further research assessing knowledge and attitudes of patients and providers about antibiotic prescribing is needed.

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

Objective:This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination. Methods:Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination. Results:As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = −0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress. Conclusion:We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.

African-American and white caregivers of older adults with dementia: differences in depressive symptomatology and psychotropic drug use.

Objectives: To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial differences on predisposing, enabling, and need factors associated with use of these agents was also examined.

Receipt of Monitoring of Diabetes Mellitus in Older Adults with Comorbid Dementia

To examine the extent to which receipt of recommended monitoring of diabetes mellitus (DM) differed for participants with and without comorbid dementia, as well as the effect of other comorbidities on monitoring of DM in individuals with comorbid dementia.

Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States.

Objective We examined trends and patient characteristics for non-traumatic dental condition (NTDC) visits to emergency departments (EDs), and compared them to other ED visit types, specifically non-dental ambulatory care sensitive conditions (non-dental ACSCs) and non-ambulatory care sensitive conditions (non-ACSCs) in the United States. Methods We analyzed data from the National Hospital Ambulatory Medical Care survey (NHAMCS) for 1997 to 2007. We performed descriptive statistics and used a multivariate multinomial logistic regression to examine the odds of one of the three visit types occurring at an ED. All analyses were adjusted for the survey design. Results NTDC visits accounted for 1.4% of all ED visits with a 4% annual rate of increase (from 1.0% in 1997 to 1.7% in 2007). Self-pay patients (32%) and Medicaid enrollees (27%) were over-represented among NTDC visits compared to non-dental ACSC and non-ACSC visits (P < 0.0001). Females consistently accounted for over 50% of all types of ED visits examined. Compared to whites, Hispanics had significantly lower odds of an NDTC visit versus other visit types (P < 0.0001). Blacks had significantly lower odds of making NDTC visits when compared to non-dental ACSC visits only (P < 0.0001). Compared to private insurance enrollees, Medicaid and self-pay patients had 2–3 times the odds of making NTDC visits compared to other visit types. Conclusion Nationally, NTDC visits to emergency departments increased over time. Medicaid and self-pay patients had significantly higher odds of making NDTC visits.

Community-based service use by elders with dementia and their caregivers: A latent class analysis

Background: With the increase in the number of older adults with dementia, research efforts have focused on increasing community-based support service (CBSS) use to improve older adult and caregiver outcomes. However, the research on factors that may explain CBSS use has been focused on individual characteristics, and how the care recipient and caregiver as a pair influence CBSS use has not been accounted for. Objective: To classify care recipients with dementia and their caregivers who shared similar patterns of CBSS use and to identify predictors of class membership. Methods: Participants were 1,813 elders with dementia and their caregivers from the National Longitudinal Caregiver Study, a cross-sectional dataset from 1998. A latent class analysis was used to identify classes of CBSS users by examining use of caregiver support group, home aide, home health, adult day care, and respite care. Multinomial logistic regression analysis was used to examine relationships between predisposing, enabling, and need variables and class membership. Results: Three classes, that is, Low Users, Adult Day Users, and Home-Based Users, comprised 80%, 10%, and 10% of the sample, respectively. Adult Day Users reported significantly more enabling resources and greater service need. Predictors of home-based use included care recipient age, activities of daily living limitations, number of skilled nursing facilities in the local county, and the extent of caregiver physical limitations from comorbid conditions. Discussion: Using latent class analysis allows identification of specific subtypes of CBSS users, prevalence of user subtype, and risk factors for underutilization. Determining the long-term outcomes of class membership may identify specific groups at risk, which could inform the design of interventions to improve assessment for and delivery of CBSS.