Mary Maneno

Long-Term Effect of the Women's Health Initiative Study on Antiosteoporosis Medication Prescribing

AIM To describe long-term prescribing patterns of osteoporosis therapy before and after the Womens Health Initiative (WHI) publication. METHODS We conducted a time-series analysis from 1997 to 2005 using nationally representative data based on office-based physician and hospital ambulatory clinic visits. Bivariate and multivariable analyses were conducted using chi-square tests and logistic regression, respectively, and trends in the prevalence of osteoporosis therapies were evaluated per 6-month (semiannual) intervals. Linear regression and graphic techniques were used to determine statistical differences in the prevalence trends between the two periods. RESULTS Overall prevalence of therapeutic or preventive osteoporosis therapy was similar between the WHI periods. However, a significant decrease in estrogen therapy and increases in bisphosphonates, calcium/vitamin D were observed in the period after the WHI publication (p < 0.05). Multiple logistic regression analysis showed older age and white race were associated with a higher likelihood of antiosteoporosis medication (AOM) prescription, and Medicaid insurance type was associated with a lower likelihood of an AOM prescription. Excluding calcium/vitamin D, nonestrogen therapy was more likely to be prescribed in the after-WHI period (office-based physician clinic: [adjusted OR, aOR] 2.49 [2.04-4.04]; hospital-based clinic: aOR 2.42 [1.67-7.50]) Nonestrogen therapy was more prevalent in visits made by older women, women of white race, women with contraindicated conditions for estrogen therapy, and women from the Northeast region. CONCLUSIONS After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.

An evaluation of hepatitis C knowledge and correlations with health belief model constructs among African American "baby boomers".

BACKGROUND Baby boomers (people born between 1945 and 1965) are responsible for three-quarters of Hepatitis C (HCV) infections in the US; however, HCV testing is distinctly underused by them. AIM To assess the status, predictors, and correlates of HCV knowledge among African-American baby boomers (AABBs) in Washington, DC. METHODS A cross-sectional survey among persons aged 46-69 was conducted using audio computer-assisted self-interviewing (ACASI). Data on HCV knowledge, socio-demographics, prior history of HCV testing, health-related characteristics, HCV vulnerability and HCV treatment perceptions were collected. Descriptive statistics was used to describe the study population. Pearson correlations were used to examine linear associations between HCV knowledge and Health Belief Model constructs related to HCV. Linear regression analysis was conducted to assess the predictors of knowledge. RESULTS Out of the 137 participants, about sixty percent (60.6%) were females, mean age 59±6.40; 44.8% had at least a college education. The average knowledge score was low (48.7%). HCV knowledge was significantly correlated with constructs of perceived severity and perceived benefits. Age (β=-0.10; p=0.003), and level of education (β=0.93, p=0.027) were significant predictors. CONCLUSIONS Overall, respondents have a low level of knowledge. The lower level of education and older age were significant predictors of inadequate HCV knowledge. Thus, HCV education among these people may be a vital component in reducing the gaps in HCV knowledge.

The Economic Impact of Herpes Zoster Vaccine Disparities in Elderly United States Blacks

There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over

Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings

180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.

Predictors of hepatitis C testing intention among African American Baby Boomers

Objectives: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. Methods: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). Results: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. Conclusions: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

Pharmacogenomics-guided policy in opioid use disorder (OUD) management: An ethnically-diverse case-based approach☆

Baby Boomers (BBs) are responsible for three-quarters of hepatitis C virus (HCV) infections in the United States; however, HCV testing is distinctly underused by them. A cross-sectional study was conducted to assess the prevalence of HCV testing and to evaluate predictors of HCV testing intention among African–American BBs. The study was guided by the Health Belief Model and theory of reasoned action frameworks. Of the 137 participants included in the study, 44.8% had at least a college education; 13.9% received prior to 1992 blood transfusion. Findings related to HCV testing showed that 32.1% of the participants intended to test for HCV within 6 months and 43.8% had received a previous HCV test. Significant predictors of HCV testing intention within 6 months included having a blood transfusion prior to 1992 [odds ratio (OR) = 8.25, 95% confidence interval (CI): 2.02–33.61], perceptions of benefits (OR = 1.57, 95% CI: 1.13–2.18), severity (OR = 1.39, 95% CI: 1.17–1.65), and subjective norms (OR = 1.42, 95% CI: 1.12–1.79). These predictors of HCV testing intention can be used to develop future HCV testing initiatives for African–American BBs.

Effect of Patient Characteristics,Knowledge and Satisfaction with WarfarinTherapy on Willingness to Switch to aNew Oral Anticoagulant

Introduction Opioid use disorder (OUD) is characterized by a problematic pattern of opioid use leading to clinically-significant impairment or distress. Opioid agonist treatment is an integral component of OUD management, and buprenorphine is often utilized in OUD management due to strong clinical evidence for efficacy. However, interindividual genetic differences in buprenorphine metabolism may result in variable treatment response, leaving some patients undertreated and at increased risk for relapse. Clinical pharmacogenomics studies the effect that inherited genetic variations have on drug response. Our objective is to demonstrate the impact of pharmacogenetic testing on OUD management outcomes. Methods We analyzed a patient who reported discomfort at daily buprenorphine dose of 24 mg, which was a mandated daily maximum by the pharmacy benefits manager. Regular urine screenings were conducted to detect the presence of unauthorized substances, and pharmacogenetic testing was used to determine the appropriate dose of buprenorphine for OUD management. Results At the 24 mg buprenorphine daily dose, the patient had multiple relapses with unauthorized substances. Pharmacogenetic testing revealed that the patient exhibited a cytochrome P450 3A4 ultrarapid metabolizer phenotype, which necessitated a higher than recommended daily dose of buprenorphine (32 mg) for adequate OUD management. The patient exhibited a reduction in the number of relapses on the pharmacogenetic-based dose recommendation compared to standard dosing. Conclusion Pharmacogenomic testing as clinical decision support helped to individualize OUD management. Collaboration by key stakeholders is essential to establishing pharmacogenetic testing as standard of care in OUD management.

PMH20 PATTERNS OF DEMENTIA/ALZHEIMER MANAGEMENT AMONG ELDERLY PATIENTS IN US AMBULATORY CARE

Background: There are limited studies addressing patients willingness to switch to a new anticoagulant from warfarin. The goal of this study was to determine the effect of patient knowledge and satisfaction with warfarin therapy on willingness to switch to a new oral anticoagulation therapy in an urban clinic. Methods: A cross-sectional study was conducted among warfarin-treated patients attending a pharmacist-run urban anticoagulation clinic at Howard University Hospital from August 2014-February 2015. The primary outcome evaluated was willingness to switch to a new oral anticoagulant. Other variables assessed include social demographics, clinic factors, patient knowledge and satisfaction. The modified anti-clot treatment survey (ACTS), the oral anticoagulant knowledge survey (OAKS), and a validated willingness to switch survey were used to measure patient knowledge (high ≥ 75%), satisfaction (Likert scale ≥ 4) and willingness to switch (Likert scale ≥ 4), respectively. Statistical analysis was conducted using (Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A total of 100 patients on warfarin treatment were included. The majority of participants were retired/disabled (59%), mostly African American (86%), and male (55%). The mean willingness to switch score was 21.59 (out of 35). Patients were most willing to switch to an alternative agent which required less follow up (3.55 ± 1.77) and had fewer drug interactions (3.75 ± 1.67). Factors associated with willingness to switch varied based on patient preferences. The only predictor of willingness to switch was low satisfaction (p=0.002). Knowledge was not associated with willingness to switch (p=0.249). Conclusion: Patients in an anticoagulation clinic had low knowledge of their warfarin therapy, were overall satisfied with warfarin treatment, but were willing to consider using a new oral anticoagulant that was more convenient especially if low satisfaction with warfarin. Further studies should be directed toward patient preferences in determining optimal regimen.

National patterns of medication use during pregnancy

employed to predict the probability of having mania-related visits in pre-index or post-index period from treatments and time fixed-effect, controlling for other covariates. RESULTS: The ordinary regression indicated a protective effect on mania-related visits from antidepressant monotherapy compared to mood stabilizer monotherapy (OR = 0.66, 95% CI: 0.49–0.90), without good control of baseline disease severity. Both propensity score weighting and matching generated statistically indifferent outcomes between treatment types. The results of the DD model identified a significant odds-ratio of 2.40 (95% CI: 1.52–3.79), suggesting an adverse outcome of increased mania-related visits with antidepressant monotherapy compared to mood stabilizer monotherapy. CONCLUSIONS: Ordinary regression, propensity score, and DD methods can produce inconsistent outcomes when background characteristics are quite different and/or not all potential confounders can be correctly measured and fully controlled in the model. DD model may be considered in outcome studies when pre-and-post data structure is available.