Maithili Deshpande

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.

Parents’ perceptions of pharmacists as providers of influenza vaccine to children

OBJECTIVEnTo examine parents experience with the process of obtaining the influenza vaccine and their perceptions about pharmacists providing influenza vaccination services to their children.nnnDESIGNnCross-sectional descriptive study.nnnSETTINGnWisconsin between November 2011 and April 2012.nnnPARTICIPANTSnChildren receiving an influenza vaccination from a Unity Health Insurance (UHI)-covered pharmacy between September and December 2011 were identified from pharmacy claims data, and parents of the children were sent a letter requesting their participation in the study.nnnINTERVENTIONnOnline survey.nnnMAIN OUTCOME MEASURESnParents experience with the process of obtaining the influenza vaccine and their perceptions about pharmacists providing influenza vaccinations to their children.nnnRESULTSn179 parents received a letter from UHI requesting their participation in the study, and the usable response rate for the study was 48%. Parents experience with the process of obtaining the influenza vaccine was positive. A majority of parents did not need an appointment (98%) and visited a pharmacy during the hours of 3:05 pm to 6:00 pm (51%). Approximately 97% of the responding parents felt confident about the pharmacist providing influenza vaccinations to their children.nnnCONCLUSIONnParents appear to be willing to accept pharmacists as an immunization resource for their children.

Asthma medication use among U.S. adults 18 and older

BACKGROUNDnAsthma is a chronic lung disease that currently affects an estimated 25 million Americans. One way to control the disease is by regular use of preventive asthma medications and controlled use of acute medications. However, little is known about adults with asthma and factors associated with their medication use.nnnOBJECTIVEnTo identify factors associated with asthma medication use among U.S. adults aged 18 and older.nnnMETHODSnData were obtained from the 2006 to 2010 Medical Expenditure Panel Survey (MEPS). Medication use outcome variables include: a) daily use of a preventive asthma medication (yes/no) and b) overuse (3+) of acute inhalers in last 3 months (yes/no). The Andersen Behavioral Model of Health Care was used to guide the selection of independent variables. The independent variables were categorized as predisposing, enabling and medical need factors. Logistic regression models were used to examine the relationship between asthma medication use in adults with asthma. Point estimates were weighted to the U.S. non-institutionalized population, and standard errors were adjusted to account for the complex survey design.nnnRESULTSnCompared to Whites, minority adults 18 and older were less likely to use preventive asthma medication daily (Hispanic-OR: 0.72, CI: 0.54-0.96; African American-OR: 0.62, CI: 0.51-0.75 respectively). Similarly, Hispanic adults age 18 and older were at a significantly higher likelihood of overusing rescue medications compared to Whites (OR: 1.47, CI: 1.03-2.11). Non-metropolitan adults age 18 and older were more likely to overuse acute asthma medications than those from Metropolitan Statistical Area (OR: 1.57, CI: 1.15-2.16). Compared to older adults age 65 and over, late mid-life 50-64 year old adults were less likely to use a daily preventive asthma medication (OR: 0.67, CI: 0.54-0.83).nnnCONCLUSIONSnRace, rurality and age were important factors associated with poor asthma medication use in U.S. adults. Although this is a first step toward identifying factors that may influence the use of asthma medications, future studies are needed to develop and implement interventions to overcome issues to improve asthma care.

Asthma medication use among late midlife U.S. Adults.

Abstract Objective: Despite substantial prevalence of asthma, little is known about asthma in late midlife adults (50–64 years). The objective of this study was to examine the factors associated with the use of asthma medications among late midlife adults. Methods: Pooled data were obtained from the 2006 to 2010 Medical Expenditure Panel Survey. Medication use outcome variables include: (a) daily use of a preventive asthma medication and (b) use of more than three canisters of rescue inhalers in last 3 months. The Andersen Behavioral Model of Health Services Utilization was used to guide the selection of independent variables. Descriptive, unadjusted and adjusted logistic regression analyses were performed. Point estimates were weighted to the US civilian population and variance estimates were adjusted to obtain appropriate standard errors. All analyses were conducted using STATA (version 12). Results: A total of 1414 (weighted sample of 15u2009030u2009364) self-reported late midlife asthmatics were identified. About 31% of late midlife adults with asthma were using a preventive medication on a daily basis while 11% reported overusing acute medications. Adjusted analyses found that race, rurality and smoking were related to poor use of asthma medications among late midlife adults. Conclusion: Results suggest that asthma medication use is far from optimal among vulnerable groups of late midlife US adults.

Asthma and health related quality of life in late midlife adults

Background: Health related quality of life (HRQoL) reflects the impact of a chronic disease, such as asthma, from a patient perspective. Late midlife adults (50–64 years) have been identified by the Centers for Disease Control & Prevention as an important population for healthy aging. Objectives: To evaluate the factors associated with HRQoL among late midlife adults with asthma. Methods: This study utilized data from 2012 to 2013 Behavioral Risk Factor Surveillance System Asthma Call Back Survey. Adults with current asthma and 50–64 years of age were included in the study. Independent variables were identified using the Andersen Behavioral Model of Health Services Utilization. HRQoL was defined using 4 domains including self‐rated health, physical health, mental health and activity limitation. Descriptive statistics were used to assess sample characteristics. Bivariate and multivariate logistic regression models were used to examine factors associated with the four HRQoL domains. All analyses were stratified by asthma control status. Appropriate survey weights were used to account for the complex survey design. Results: The final sample consisted of 5857 (Weighted: 4 million) late midlife asthmatics, mostly female (66%) and White (72%). About 42% had fair/poor self‐rated health, 33% had impaired physical health, 23% had impaired mental health, and 24% experienced activity limitation. Multivariate analyses found that Non‐Hispanic African American adults were significantly more likely to report fair/poor self‐rated health compared to Whites (Well‐controlled asthma OR: 2.2, 95% CI: 1.2–4.1). Adults who experienced any cost barrier were significantly more likely to have activity limitations (Poorly controlled asthma OR: 1.6, 95% CI: 1.1–2.3). Adults with a respiratory comorbidity were more likely to report impaired physical health compared to adults without (Well controlled asthma OR: 1.7, 95% CI: 1.01–2.7). Conclusion: Reducing respiratory comorbidities and cost barriers may improve HRQoL in asthmatic late midlife adults.

Exploring factors associated with asthma-related emergency department visits among adults: A path analysis approach

Background Asthma is an expensive chronic lung disease that affects 7% of U.S. adults and results in as many as 1.8 million emergency department (ED) visits each year. Pharmacists play an important role in managing asthma, including assessing control and monitoring disease progression, educating the patient about the disease and associated treatments, and ensuring safe and cost‐effective medication use. However, comprehensive studies that account for the complex relationships between factors impacting asthma‐related ED visits are lacking in the adult asthma population. Objective To explore the complex relationships between asthma control, medication use, co‐morbid conditions, minority status, environment and asthma‐related ED visits using a path analysis approach. Methods and materials Data for this study were obtained from the 2012 Behavioral Risk Factor Surveillance Systems Asthma Call Back Survey. Current asthmatics 18 and older were included in the sample. Path analysis was used to evaluate the direct effects of the independent variables on asthma‐related ED visits, as well as the indirect effects mediated through asthma control, health status, and daily use of inhaled corticosteroids. Results Having controlled asthma (&bgr; = −0.153, p < 0.01) and good health status (&bgr; = −0.133, p < 0.01) were associated with significantly fewer ED visits. Good health status was associated with daily use of inhaled corticosteroids, which in turn was associated with better asthma control. Hispanic ED use was mediated by asthma control (&bgr; = −0.067, p < 0.05), while African American ED use was mediated by health status (&bgr; = 0.050, p < 0.05). Conclusion These findings suggest that there may be race/ethnicity specific factors that may be targeted to reduce asthma‐related ED visits in minority populations.

Spatial analysis of disparities in asthma treatment among adult asthmatics

BACKGROUNDnSpatial analytic techniques can uncover important differences in asthma treatment and identify geographic areas with poor asthma management.nnnOBJECTIVEnTo review geographical differences in asthma treatment in an adult asthmatic population.nnnMETHODSnThis was a retrospective, cross-sectional chart review study (nu202f=u202f519) using Geographic Information System approaches to determine the impact of spatial access to pharmacies and other factors on inappropriate rescue and inadequate controller medication use. Statistical analyses included chi-square test for categorical variables and Kruskall-Wallis test for continuous variables. Logistic regression was used to determine unadjusted and adjusted odds of inappropriate and inadequate pharmaceutical management of asthma based upon distance to pharmacy and other factors. Choropleth maps were constructed to display zip code level variation of asthma management.nnnRESULTSnInappropriate medication users lived further from their preferred pharmacy compared to appropriate users (median distances of 3.02 and 1.96 miles respectively; pu202f=u202f0.01). Inappropriate and inadequate management of asthma varied by zip code, ranging from 5.5 to 17.3% and 25.0-59.6%, respectively. A statistically significant difference in appropriate use by age was found, with nearly 17% of adults age 65 and older overusing their rescue inhaler. Conversely, patients age 18-34 years, 35-49 years, and 50-64 years, used their controller medications inadequately (64.2%, 57.3%, and 48.2%, respectively) compared to 42.5% of patients aged 65 and older. Unadjusted and adjusted analyses showed that former smokers had higher odds of inadequate management of asthma.nnnCONCLUSIONnThe unadjusted findings suggest that distance to pharmacies may play a role in the pharmaceutical management of asthma, though these findings are explained by confounding factors. Future research should continue to explore the effect of spatial access to pharmacies on chronic disease management and the role that maps can play in guiding medication management interventions in a larger sample to allow for more rigorous analysis.

Comparison of Nicardipine with Clevidipine in the Management of Hypertension in Acute Cerebrovascular Diseases

BACKGROUND AND PURPOSEnIn acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke.nnnMETHODSnThis retrospective review compared nicardipine with clevidipine for hypertension in acute stroke patients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour. Efficacy outcomes were: time to goal blood pressure, percent time in goal, blood pressure range, and need for additional antihypertensive agents during the infusion. A composite of in-hospital death, 30-day readmission, rebleeding, ischemic to hemorrhagic conversion, and hematoma expansion were compared. Other clinical outcomes included length of intensive care unit and hospital stay, hypotension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury.nnnRESULTSnMean time to goal blood pressure was 65.5 minutes and 65.8 minutes in the nicardipine and clevidipine group, respectively (Pu2009=u2009.83). No efficacy outcome was significantly different between 2 groups after multivariate analysis.nnnCONCLUSIONSnBoth nicardipine and clevidipine are reasonable antihypertensive agents in stroke, although cost and volume restriction could differentiate preference.

Treatment Patterns in Asthma- Chronic Obstructive Pulmonary Disease Overlap Syndrome

Background: Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is a complex disease entity with limited guidance surrounding medication therapy. Objective: To evaluate a patient population with possible ACOS and their medication regimen based on the Global Initiative for Asthma and Global Initiative for COPD joint statement for ACOS. Methods: This was a retrospective study based at a large clinical practice within a school of medicine. The sample included adults 40 to 85 years old who had an active concurrent diagnosis of asthma and COPD. Patients were considered to have likely inconsistent therapy (only preventive, no rescue medication), inconsistent therapy (neither preventive nor rescue medication), and likely consistent therapy (both preventive and rescue medication or rescue medication alone). Results: A total of 513 patients were included the study. The majority of the sample were female (75%) and white (87.1%), with an average age of 61 years. About 7% of patients had likely inconsistent therapy, whereas 7.7% had inconsistent therapy to control their airway disease. Never smokers were more likely than former smokers to have inconsistent therapy (adjusted odds ratio [OR] = 4.54; CI = 1.86-11.04). Adults 65 years and older were more likely than those aged 40 to 49 years to be in the likely inconsistent therapy group (adjusted OR = 4.01; CI = 1.04-15.34). Patients without any comorbid conditions were more likely than those with 2 or more comorbid conditions to be in the likely inconsistent group (adjusted OR = 3.50; CI = 1.39-8.77). Conclusion: As the disease definition and treatment recommendations evolve, future studies should continue to monitor ACOS treatment patterns and outcomes.