Rafia S. Rasu

Health Literacy Impact on National Healthcare Utilization and Expenditure

BACKGROUND Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. METHODS Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. RESULTS The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were

Persistent nonmalignant pain management using nonsteroidal anti-inflammatory drugs in older patients and use of inappropriate adjuvant medications

1284 and

Determinants of Opioid Prescribing for Nonmalignant Chronic Pain in US Outpatient Settings

151, respectively, for basic or below basic and

Impact of polypharmacy on seniors' self-perceived health status

719 and

Lumbar Spine Surgeries and Medication Usage During Hospital Stay: One-Center Perspective

100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about

Macro and Micro Level Usage of Outcomes Research in Pharmacy Practices

172 billion. CONCLUSION Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.

Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study

Objective Due to the high risk of life-threatening side effects, nonsteroidal anti-inflammatory drugs (NSAIDs) are not favored for treating persistent nonmalignant pain in the elderly. We report national prescription trends with determinants of NSAIDs prescription for persistent nonmalignant pain among older patients (age 65 and over) in the US outpatient setting. Methods A cross-sectional analysis was performed using National Ambulatory Medical Care Survey data. Prescriptions for NSAIDs, opioids, and adjuvant agents were identified using five-digit National Ambulatory Medical Care Survey drug codes. Results About 89% of the 206,879,848 weighted visits in the US from 2000 to 2007 recorded NSAIDs prescriptions in patients (mean age =75.4 years). Most NSAIDs users had Medicare (75%), and about 25% were prescribed with adjuvant medications considered inappropriate for their age. Compared to men, women were 1.79 times more likely to be prescribed NSAIDs. Conclusion The high percentage of NSAIDs prescription in older patients is alarming. We recommend investigating the appropriateness of the high prevalence of NSAIDs use among older patients reported in our study.

Use of Statins and the Risk of Incident Diabetes: A Retrospective Cohort Study

Study Objectives Identify prescribing trends for opioid use in non-malignant chronic pain (NMCP) from the National Ambulatory Medical Care Survey (NAMCS). Determine predictors of opioid use based on patient-specific factors. Design This cross-sectional study analyzed NAMCS data from 2000 to 2007. Pain medications prescribed were retrieved using NAMCS drug codes. Multivariate logistic models examined determinants of opioid prescribing among NMCP patients. Subjects Patients included in the study were age 18 years or older with NMCP diagnosis based on ICD-9 codes identified as reason for visits. Results Approximately 690 million weighted outpatient visits related to NMCP were reported in the US between 2000 to 2007. Reported opioid use was 14.3%. Compared with patients age 18 to 34 years, patients age 35 to 49 years were 1.47 times more likely (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.17-1.86) and patients age 65 years or older were 0.61 times less likely (OR = 0.39, 95% CI = 0.27-0.55] to receive opioids. Patient visits from primary care physicians were 1.83 times more likely to report opioids (OR = 1.83, 95% CI = 1.50-2.25) than specialty physicians. Hispanic ethnicity and patients with private insurance were less likely to receive opioids, while patients having five or more medications, publicly funded insurance, the ICD-9 code of general chronic pain, established patients, and the southern prescribing region were more likely to receive opioids. Conclusions Differences exist between those prescribed and not prescribed opioids. Results from this study paired with increased education and further research regarding the appropriate prescribing and monitoring of opioids may help enhance awareness, diminish treatment disparities and improve safe and appropriate use of opioids in the NMCP population.

USE OF STATINS AND THE RISK OF INCIDENT DIABETES: A RETROSPECTIVE COHORT STUDY

Objectives Polypharmacy is common among older patients and is linked to increased risk of adverse health outcomes. This study aimed to explore the association of polypharmacy and self-perceived health status (SPHS) among geriatric patients. Methods This cross-sectional analysis of longitudinal observational research used national survey data from 2005–2008. Multivariate logistic regressions examined the likelihood of having a good/poor SPHS and polypharmacy. Medical Expenditure Panel Survey data provided by Agency for Healthcare Research and Quality were used in this study. Overall, SPHS was assessed using the Medical Expenditure Panel Survey health and well-being variable. Polypharmacy status was defined when patients were taking ≥5 medications. Results The study included a total of 102,309,656 weighted individuals reported from the survey of 4775 actual individuals from 2005–2008. Patients’ mean age was 74.7 years (standard error ± 0.138), and 58.1% were women, 87.3% were white, 55.2% were married, and 37.3% were from the southern region of the United States. Approximately 69.4% of patients reported polypharmacy. The most prevalent disease reported was hypertension (62.7%). We evaluated demographic and clinical characteristics based on SPHS and polypharmacy status. Overall, 78.09% of seniors reported their SPHS as good, whereas 21.91% reported their SPHS as poor. Among polypharmacy users, 72.52% reported good SPHS and 27.48% reported poor SPHS. Among older adults who were nonpolypharmacy users, 90.8% reported good and 9.02% reported poor SPHS. Logistic regression adjusted for demographic and socioeconomic factors showed that nonpolypharmacy users are approximately three times more likely to report their SPHS as good (odds ratio 2.75; 95% confidence interval 2.12–3.57, P < 0.001). Conclusions Nonpolypharmacy users perceived their health status to be better than did polypharmacy users. Interventions to reduce polypharmacy may improve SPHS. One such intervention, medication reconciliation, may have a positive ripple effect on the patient-centered care delivery system.

Risk of Diabetes Among Intensive and Moderate Dose Statin Users with Potential Modifying Effects of Treatment Duration

Background: Pain after spine surgery is usually managed with opioid and nonopioids. The rate of lumbar spine surgeries (LSS) is rising, but current practices on LSS are not known. A current trend in LSS and medication usage by age group is needed to gain a better understanding of how LSS and its pain management vary by age. Objective: The aim of this study was to report current practices of LSS of discectomy, laminectomy, and fusion in patients aged 18 and older and to gain an understanding of medication use for management of LSS. Methods: This retrospective study analyzed data of the University of Kansas Medical Center from 2007 to 2014 of patients (>18 years of age) undergoing laminectomy, discectomy, and fusion. Results: A total of 19 463 patients underwent LSS between 2007 and 2014 at Kansas University hospital. For the purpose of this study, 3115 patients’ medical records were observed. A 50% increase in LSS between 2007 and 2014 was noted. Specifically, more than 2-fold increase in LSS was observed in patients aged 65 years and older. Among those aged 65 years and older, laminectomy was the most commonly performed surgery (69.6%) while discectomy was the most common surgery performed among those aged 18 to 34 (82.9%) and those aged 35 to 44 (72%). The medication use also increased with a highest usage in opioids alone (55%), followed by opioids combined with other analgesics (42.7%), regardless of lumbar surgery type or age. Conclusion: The information of increase in both LSS and the medication usage over the 7 years can be used to gain a better understanding of quality, expenditure, and outcomes following LSS. This knowledge may help health care providers plan patient care and rehabilitation services for older adults, as the trajectory of lumbar spine surgery is likely to rise with growing prevalence of older adults. The information regarding increased opioid utilization may also help clinicians to refine opioid usage and consider alternative approaches to manage acute postoperative pain, in light of the current concerns related to overutilization of opioids.