Mayur M. Amonkar

Determinants of Adult Influenza and Pneumonia Immunization Rates

OBJECTIVES To determine national adult immunization rates for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases. DESIGN Retrospective, cross-sectional, random national sample data from the Centers for Disease Control and Preventions 1999 Behavioral Risk Factor Surveillance System survey. Data extraction and analysis were conducted using SPSS and STATA, with adjustments made for weighted data. PARTICIPANTS Individuals aged 65 years and older and individuals aged 50 to 64 years (for influenza only). RESULTS Immunization rates in the 65 and older age group were 66.7% for influenza and 53.8% for pneumonia; immunization rate for influenza in the 50 to 64 age group was 35.6%. Predisposing factors such as race (white) and education (high school and above) positively influenced immunization status. Enabling factors such as income, health insurance, and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study populations. Health care coverage (odds ratio [OR] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group; OR = 1.80 for influenza in the 50 to 64 years age group) and physician visit in the last year (OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group; OR = 1.86 for influenza in the 50 to 64 years age group) were strong positive predictors of vaccination status. Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates. CONCLUSION Understanding the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospective recipients of immunization services.

Compliance rates and predictors of cancer screening recommendations among Appalachian women.

High rates of morbidity and mortality in the Appalachian region of the country warrant examination of the preventive care behavior of its residents. This study determined compliance rates for breast and cervical cancer screening recommendations for women residing in Appalachian states and identified predictors of such compliance using the Behavioral Risk Factor Surveillance System data (1995-97). Healthy People 2000 goals were used as benchmarks for progress. Appalachian women have made good progress toward goals pertaining to breast and cervical cancer screening. Compliance with other preventive services, having insurance coverage, residing in urban areas, better self-reported health, and higher education were independently associated with increased odds of compliance with annual-screening recommendations. Risk factors of obesity and smoking were associated with decreased odds of compliance. Findings should be useful to health care providers, policy makers, and researchers in their efforts to educate, encourage, and promote preventive care behavior among residents of Appalachia.

Immunization Predictors in Rural Adults Under 65 Years of Age

The specific study goal was to identify predictors of influenza and pneumonia immunizations in rural adults 18 to 64 years of age in Appalachia. The survey data used were collected from 931 adults from eight rural counties as part of a larger study. Information collected included influenza and pneumonia vaccination status, demographic and insurance coverage information, and immunization-related knowledge and beliefs. Immunization rates were 41.3 percent for influenza and 19.9 percent for pneumonia. Logistic regression analysis indicated that perceived disease susceptibility, perceived benefit, perceived harm, and insurance coverage for immunizations were significant predictors of both types of immunization, with insurance coverage being the strongest predictor. The findings can be used in development of promotional campaigns for increasing immunizations in this underserved rural population.

The Economic Burden of Barrett's Esophagus in a Medicaid Population:

OBJECTIVE: To estimate the overall healthcare expenditures of patients with Barretts esophagus in the West Virginia Medicaid population. METHODS: West Virginia Medicaid—paid claims data for the period January 1, 1995, to December 31, 1999, were used for the study. The population included all individuals eligible for West Virginia Medicaid during the study period except for Medicare eligible– And Medicaid managed—care recipients. A prevalence-based approach was used to determine the cost of illness for Barretts esophagus. RESULTS: The total cost of illness for Barretts esophagus more than tripled, from

Developing Profiles of Postmenopausal Women Being Prescribed Estrogen Therapy to Prevent Osteoporosis

182 399 in 1995 to

Assessing Predictors of Influenza and Pneumonia Vaccination in Rural Senior Adults

623 864 in 1999, with approximately a 4 1/2-fold increase in medical and more than a threefold increase in pharmacy costs. The average cost of treating Barretts esophagus was found to be approximately

Aspirin use for primary and secondary prophylaxis of cardiovascular disease

1207 per patient in 1999. Overall, pharmacy costs accounted for >66% of the total costs. Controlling for age, gender, and number of comorbidities, patients with Barretts esophagus incur 21.2% higher overall costs than patients with gastroesophageal reflux disease and 62.4% higher overall costs than the general Medicaid population. CONCLUSIONS: The increasing prevalence of and resource utilization for Barretts esophagus provide a framework for further analysis and implementation of policies aimed at appropriate allocation of resources for the states Medicaid program.

ASSESSING MANAGED CARE'S ROLE IN PROMOTING PREVENTIVE CARE

Postmenopausal women with estrogen deficiency are at high risk for osteoporosis. Estrogen therapy has been shown to be effective in preventing postmenopausal bone loss and maintaining bone mineral density. The increasing number of women at risk for osteoporosis and the high cost of treating this condition emphasizes the importance of preventing osteoporosis. This study was designed to identify trends and predictors of estrogen use for osteoporosis prevention among postmenopausal women. A retrospective, cross-sectional study was conducted using Behavioral Risk Factor Surveillance System data (1997–1999). Women 35 years and older who had passed menopause or were currently going through menopause were identified from the states including the BRFSS module that asked questions about estrogen use. Results showed an increasing prevalence in estrogen use from 1997 to 1999 for osteoporosis prevention. In 1999, almost a third of the postmenopausal women surveyed used estrogen to prevent osteoporosis. Prevalence was higher among women 45–64 years of age, whites, and those with higher education levels. Physician counseling on the benefits and risks of estrogen therapy was the strongest predictor of estrogen use for prevention of osteoporosis. Insurance coverage and compliance with other preventive behaviors such as mammograms and Pap smears were also strongly associated with greater estrogen use. However, women who were at risk for acute drinking, not married, overweight or obese, and diabetic were all less likely to receive estrogen therapy for osteoporosis prevention. The relationships demonstrated between estrogen use and demographic characteristics, lifestyle behaviors and health care access and utilization factors underline the importance of targeting specific groups of women for promoting its protective effect against osteoporosis.

Assessment of Urologists' Practice Preferences for the Management of Benign Prostatic Hyperplasia in the Veterans Administration Program

Abstract The overall purpose of this study was to identify predictors of influenza and pneumonia vaccination among rural senior adults. A mail survey was conducted in eight rural counties. Reported immunization rate for influenza (81.5%) among respondents was higher as compared to pneumonia (74.7%). Knowing someone with influenza was the strongest predictor of influenza vaccination, and knowing someone with pneumonia was the strongest predictor of pneumonia vaccination. Belief that vaccinations are always beneficial was also a significant predictor. While several of the findings of this study are consistent with factors reported in literature to be significant predictors of immunization behavior for this age group, surprisingly, access was not a significant predictor for this rural sample.

Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population

Background: The benefits of aspirin use for the secondary and primary prevention of cardiovascular disease (CVD) have been demonstrated in several clinical trials. Objective: The purpose of this study was to estimate the prevalence of aspirin use for primary and secondary prophylaxis of CVD and to identify predictors associated with its use. Methods: A retrospective, cross-sectional study was conducted using data from the Behavioral Risk Factor Surveillance System from 1997 to 1999 to identify individuals using aspirin for the primary and secondary prevention of CVD. Logistic regression procedures were used to determine the contribution of various predictors of aspirin use. Results: The prevalence of aspirin use for both primary and secondary prevention of CVD increased from 1997 to 1999. In 1999, the rate of aspirin use for secondary prevention (72.4%) was >3 times the rate of use for primary prevention (19.8%). Use of aspirin for primary and secondary prevention was greater among whites, men, and those aged 65 to 74 years. Better compliance with other preventive care recommendations such as influenza vaccinations, cholesterol screening, and pneumonia vaccination; eating less fat and exercising more; and existing risk factors for CVD such as hypertension and high blood cholesterol were positively associated with aspirin use for primary and secondary prevention of CVD. Conclusions: Aspirin use rates for secondary prevention were higher than the rates for primary prevention because of the strong evidence linking aspirin use with the prevention of recurrence of a cardiovascular event. However, there is still an opportunity to promote the use of an inexpensive and effective drug such as aspirin for the primary prevention of CVD among patients who have risk factors for CVD and no contraindications to aspirin use. Increased adherence to cost-effective preventive measures such as aspirin therapy can contribute significantly to reducing the societal burden of CVD.