Nicole M. Marlow

Application of a Value Model for the Prevention and Management of Chronic Musculoskeletal Pain by Physical Therapists

For physical therapists, establishing value of care is vitally important in the management of musculoskeletal pain. Value has become an important outcome measure in health care, largely as the result of payment reform efforts aimed at reducing wasteful spending. Providers who can establish the value of their services and be responsive to changing economic demands will be better positioned to deliver care. Establishing value is typically accomplished through comparative and cost-effectiveness studies. However, these approaches stop short of describing the components and processes that drive quality and costs-a necessary step for improving the value of existing services or developing new ones. The Institute of Medicine has recently called for more effective strategies to prevent and manage high-impact chronic pain. A model to guide the development and evaluation of pain management pathways will position physical therapists to best answer the Institute of Medicines call within an increasingly value-focused health care environment. This perspective article presents a value model for physical therapy that describes how value emerges from interactions among the health care system, health care services organizations, the physical therapist, and the patient. How the model can be used to inform and guide the implementation of value-conscious treatment pathways for the prevention and management of chronic musculoskeletal pain also is discussed.

Variations in coping stages for individuals with chronic kidney disease: Results from an exploratory study with patient navigators

Using a cross-sectional design, we examined coping stages (Kübler-Ross) among patients with end-stage renal disease at nephrology practices incorporating professional social workers as patient navigators, providing person-centered education and support (Nu2009=u2009420). We evaluated associations with behavioral counseling constructs (assess–advise–agree–assist–arrange). Coping stages comprised denialu2009=u200935.24u2009percent, acceptanceu2009=u200924.05u2009percent, depressionu2009=u200921.43u2009percent, bargainingu2009=u200912.86u2009percent, and angeru2009=u20096.43u2009percent. Compared to denial, other coping stages showed increased odds ratios for transplant referral agreement, transplant referral evaluations, understanding treatments, understanding donation procedures, plans to recruit donors, active donor recruitment, and potential living donor(s). Assessment of coping stages, and strategies to influence these, may be key factors in guiding patients to living donor kidney transplantation.

A patient navigator and education program for increasing potential living donors: a comparative observational study.

Person‐centered clinical environments may promote living donation for patients with end‐stage renal disease (ESRD). We implemented an observational study design to explore whether a patient navigator (PN) program with person‐centered education in nephrology practice settings could increase potential living donors (PLDs) and, subsequently, increase living transplantation.

Disability and physical and communication-related barriers to health care related services among Florida residents: A brief report

BACKGROUNDnResearch has not fully characterized barriers to health care faced by persons with disabilities (PWD) which constitutes a critical gap given the increased risk of chronic illness faced by PWD.nnnOBJECTIVEnTo understand the current barriers to seeking health care-related services for PWD in Florida.nnnMETHODSnThe study was based on a random-digit-dial telephone interview survey of respondents aged 18 and over (nxa0=xa01429). Multivariable logistic regression assessed the relationship between disability and physical and communication barriers.nnnRESULTSnOne thousand four hundred and twenty-nine Florida residents participated in the survey. Thirty-three percent of respondents (nxa0=xa0471) reported having a disability. PWD were significantly older (mean age 68 vs. 61) and had lower levels of income and education than persons without disabilities (PWOD) (pxa0<xa00.05). In adjusted analyses, PWD had significantly higher odds of encountering a physical environment barrier (Odds Ratio [OR]xa0=xa016.6 95% CI: 7.9, 34.9), a clinical experience barrier (ORxa0=xa013.9 95% CI: 6.9, 27.9) a communication and knowledge barrier (ORxa0=xa06.7 95% CI: 4.0, 11.3) and a barrier coordinating care (ORxa0=xa05.7 95% CI: 3.4, 9.6) compared to persons without disabilities (PWOD).nnnCONCLUSIONSnPWD disproportionately face health care access difficulties that can impede the receipt of high quality care within and between provider visits. Efforts to reduce physical barriers and improve communication between providers and PWD may improve functional status and quality of life for these patients.

Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators

To examine medication adherence and healthcare costs for combination prescription initiators (duloxetine/milnacipran/venlafaxine with pregabalin) vs. monotherapy initiators (duloxetine, milnacipran, venlafaxine, and pregabalin) among patients with fibromyalgia syndrome (FMS).

Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression

Objective: Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4+ T cells/&mgr;l among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes. Design: Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems. Methods: We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4+ T cells/&mgr;l. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects. Results: In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence intervalu200a=u200a(1.12, 1.20)]. We observed an increase of 39 CD4+T cells/&mgr;l after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models. Conclusion: Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4+ T cells/&mgr;l, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.

Cost-effectiveness analysis of 2 surveillance options for cervical intraepithelial neoplasia 1.

Objective We aim to determine the difference in cost between 2 accepted surveillance strategies for women diagnosed with cervical intraepithelial neoplasia 1 (CIN 1): repeat cytology at 6 and 12 months versus human papillomavirus (HPV) DNA testing at 12 months. Materials and Methods Extracting data from the literature regarding the natural history of HPV infection and CIN 1, we estimated regression, persistence, and progression rates during a 2-year interval. Costs were based on 2011 Medicaid reimbursements for cytology, biopsy interpretation, HPV testing, and the associated office visit or procedure fee. We constructed a decision tree model to estimate the potential cost benefits of using HPV testing, and sensitivity analyses were performed. Treatment costs for high-grade disease were not included because of equal occurrence in both groups. Results In a hypothetical cohort of 100 women with CIN 1 (assumed compliant with 2 y of follow-up), the total cost for cytology-based follow-up was

Comorbidity Subgroups Among Medicare Beneficiaries Seeking Health Care for Musculoskeletal Pain

89,969, whereas the total cost for HPV-based follow-up was

Hearing Impairment and Undiagnosed Disease: The Potential Role of Clinical Recommendations

37,357. This indicates an average cost savings of

Association between race/ethnicity and disability status and receipt of vaccines among older adults in Florida

526 per patient in favor of HPV testing. If we then consider the 234,603 incident cases of CIN 1 in the United Sates per year, preferential use of HPV-based follow-up would save