Nilanjana Dwibedi

Descriptive analysis of workflow variables associated with barcode-based approach to medication administration.

Bedside barcode technology is used during medication administration to ensure patient safety. This study evaluated the workflow variables related to a bedside barcode technology-based medication administration process. A time-and-motion technique was used to assess the observational episodes related to medication administration conducted by registered nurses. In an observational episode, nurses spent adequate time in “documenting medications” and “giving medications.” Nurses were primarily engaged in tasks at the patients bedside.

Multimorbidity and Copd Medication Receipt Among Medicaid Beneficiaries With Newly-Diagnosed Copd

BACKGROUND: Multimorbidity is highly prevalent among patients with COPD. The association between multimorbidity and COPD medication management is not well researched. The aim of this study was to examine the association between multimorbidity and COPD medication receipt among Medicaid beneficiaries with newly diagnosed COPD. METHODS: A retrospective longitudinal dynamic cohort design was used, and data were extracted from Medicaid Analytic eXtract files from 2005 to 2008. Medicaid beneficiaries with newly diagnosed COPD (N = 19,060) were identified using the International Classification of Diseases, 9th Revision, Clinical Modification, for COPD. This code (for commonly co-occurring conditions with COPD) was used to create a multimorbidity variable. These conditions included anxiety, arthritis, bipolar disorder, cardiovascular diseases, depression, diabetes, hypertension, hyperlipidemia osteoporosis, and schizophrenia. Medicaid beneficiaries with newly diagnosed COPD were categorized as: (1) physical multimorbidity only, (2) psychiatric multimorbidity only, (3) both physical and psychiatric multimorbidity, and (4) no multimorbidity. Receipt of COPD medications (short- or long-acting bronchodilators, inhaled corticosteroids) was identified using National Drug Codes. Bivariate relationships between multimorbidity and COPD medication receipt were tested using the chi-square test of independence. The associations between multimorbidity and COPD medication receipt were analyzed with logistic and multinomial logistic regression analyses. RESULTS: Among Medicaid beneficiaries with newly diagnosed COPD, 81.9% had at least one co-occurring chronic condition. After controlling for subject characteristics, adults with multimorbidity were less likely to receive COPD medications compared with those without any inflammation-related multimorbidity. For example, those with physical multimorbidity were less likely to receive short-acting bronchodilators (adjusted odds ratio [OR] 0.76, 95% CI 0.69–0.83), long-acting bronchodilators (adjusted OR 0.84, 95% CI 0.76–0.92), and inhaled corticosteroids (adjusted OR 0.75, 95% CI 0.68–0.82) compared with those with no inflammation-related multimorbidity. CONCLUSIONS: The prevalence of multimorbidity is very high among Medicaid beneficiaries with newly diagnosed COPD. Our findings indicate poor COPD medication management among those with multimorbidity.

Nonadherence to Statins and Antihypertensives and Hospitalizations Among Elderly Medicare Beneficiaries With Incident Cancer

Background: Incident cancer diagnosis may increase the risk of coronary artery disease (CAD)-related hospitalizations, especially in older individuals. Adherence to statins and/or angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs)/β-blockers reduces CAD-related hospitalizations. This study examined the relationship between medication adherence and CAD-related hospitalizations immediately following cancer diagnosis. Patients and Methods: A retrospective observational longitudinal study was conducted using SEER-Medicare data. Elderly Medicare fee-for-service beneficiaries with preexisting CAD and incident breast, colorectal, or prostate cancer (N=12,096) were observed for 12 months before and after cancer diagnosis. Hospitalizations measured every 120 days were categorized into CAD-related hospitalization, other hospitalization, and no hospitalization. Medication adherence was categorized into 5 mutually exclusive groups: adherent to both statins and ACEIs/ARBs/β-blockers (reference group), not adherent to both statins and ACEIs/ARBs/β-blockers, adherent to either statins or ACEIs/ARBs/β-blockers, use of one medication class and adherent to that class, and use of one medication class and not adherent to that class. The relationship between medication adherence and hospitalization was analyzed using repeated measures multinomial logistic regressions. Inverse probability treatment weights were used to control for observed group differences among medication adherence categories. Results: Adherence to both statins and ACEIs/ARBs/β-blockers was estimated at 31.2% during the 120-day period immediately following cancer diagnosis; 13.7% were not adherent to both medication classes during the same period, and 27.4% had CAD-related hospitalizations immediately after cancer diagnosis, which declined to 10.6% during the last 4 months of the postdiagnosis period. In the adjusted analyses, those not adherent to both statins and ACEIs/ARBs/β-blockers were more likely to have CAD-related hospitalization compared with those adherent to both medication classes (adjusted odds ratio, 1.82; 95% CI, 1.72-1.92; P<.0001). Conclusions: Given the complexity of interaction between CAD and cancer, it is important to routinely monitor medication adherence in general clinical practice and to provide linkages to support services that can increase medication adherence.

Parents’ Expectations to Receive Antibiotic Prescriptions for Children

The objective of this study was to evaluate whether parents’ level of expectations would change after manipulating their perceived barriers to visiting doctors without any expectations for antibiotic prescriptions and their perceived benefits of using antibiotics. A prospective experimental study was conducted using a data-collection instrument to manipulate perceived barriers and perceived benefits using four scenarios. Scenarios were developed with the help of pediatricians and by conducting an elicitation survey among parents. Each subject viewed four scenarios. Parents’ expectations to receive an antibiotic prescription associated with each scenario were measured on a scale of 0 (no expectation) to 100 (high expectation); a 100 mm visual-analog scale was used. Data were collected at public places (Houston, Texas, USA) from subjects who had at least one child (age ≤ 5 years) during the study. Descriptive and repeated measures mixed method analyses were performed using SAS v. 9.3 with a .05 significance level. Three hundred surveys were analyzed. The mean age of the sample was 30.3 ± 7 years. The mean general expectation score (before reading any scenario) to receive an antibiotic prescription for children was 53.6 ± 25.7. The repeated measure mixed methods analysis indicated that there was a 12-point reduction (p < .0001) in the expectation score after removing perceived barriers from the situational scenarios, a 16-point decrease (p < .0001) in expectation score was observed after removing perceived benefits, and an 18-point decrease (p < .0001) in expectation score was observed after removing both perceived barriers and perceived benefits.

Effect of Pediatric Influenza on Caregivers’ Burden—A Literature Review

Influenza, or the flu, is a common and potentially serious infection that disproportionally affects children with more than 20,000 yearly hospitalizations in children under the age of 5. A literature review of the caregiver burden associated with pediatric influenza was conducted. Two main types of burdens were identified: economic and noneconomic. Flu treatment costs

Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries

3,990 for pediatric inpatients services and

The dynamic relationships between economic status and health measures among working-age adults in the United States

730 for emergency department (ED) pediatric patients. Caregivers may also face out-of-pocket costs (

Burden of Depression among Working-Age Adults with Rheumatoid Arthritis

178 for inpatients,

Healthcare Utilization and Expenditures in Working-Age Adults with Atrial Fibrillation: The Effect of Switching from Warfarin to Non-Vitamin K Oral Anticoagulants

125 for ED patients, and

Clinical Oral Health Recommended Care and Oral Health Self-Report, NHANES, 2013-2014

52 for outpatients) or those not covered by health insurance. Caregivers can also face indirect costs while caring for their children with the flu. Indirect costs were common, and 75% of pediatric caregivers reported these costs when caring for a sick child. Missed work is the most common indirect cost and is estimated as high as 73 work hours (