Willie H. Oglesby

Cost savings threshold analysis of a capacity-building program for HIV prevention organizations.

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

Perceptions of and preferences for federally-funded family planning clinics

BackgroundThe Title X family planning program provides affordable access to a range of sexual and reproductive health services, with a priority for low-income people. The disproportionate burden of unintended pregnancy, breast and cervical cancer, and sexually transmitted diseases among minority groups, teens, and young adults in the US underscore the need for affordable access to such services. However, increased access to sexual and reproductive health services, resulting from the Affordable Care Act (ACA) create questions regarding the continued need for this program.MethodsA study was conducted to assess clients’ perceptions of Title X-funded family planning clinics and their preferences for these clinics for a range of sexual and reproductive health services. An anonymous, self-administered, paper-and-pencil survey was administered to 696 clients who received services from one of eight Title X-funded family planning clinics in Northeast Ohio.ResultsThe majority of participants stated very positive perceptions of the Title X-funded clinics; that they “Always” go to the Title X-funded clinic for birth control, STD/HIV testing, and pregnancy testing; and that the Title X-funded clinic was their regular source of health care. Females were more likely than males to prefer the Title X clinic for birth control, physical exams, pregnancy testing, and health information and more teens under the age of 18 preferred to use the Title X clinic for STD/HIV testing, physical exams, pregnancy testing, and health information.ConclusionsFindings indicate that these Title X-funded family planning clinics successfully reached populations in need of sexual and reproductive health services and suggest that these facilities can help play an important role in reducing disparities even after full implementation of the Affordable Care Act. However, more research is needed to fully quantify the need and value of Title X-funded family planning clinics and its relation to the changing health care environment in the US.

Readmission rates in not-for-profit vs. proprietary hospitals before and after the hospital readmission reduction program implementation.

BackgroundThe Patient Protection and Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to penalize hospitals with excessive 30-day hospital readmissions of Medicare enrollees for specific conditions. This policy was aimed at increasing the quality of care delivered to patients and decreasing the amount of money paid for potentially preventable hospital readmissions. While it has been established that the number of 30-day hospital readmissions decreased after program implementation, it is unknown whether this effect occurred equally between not-for-profit and proprietary hospitals. The aim of this study was to determine whether or not the HRRP decreased readmission rates equally between not-for-profit and proprietary hospitals between 2010 and 2012.MethodsData on readmissions came from the Dartmouth Atlas and hospital ownership data came from the Centers for Medicare and Medicaid Services. Data were joined using the Medicare provider number. Using a difference-in-differences approach, bivariate and regression analyses were conducted to compare readmission rates between not-for-profit and proprietary hospitals between 2010 and 2012 and were adjusted for hospital characteristics.ResultsIn 2010, prior to program implementation, unadjusted readmission rates for proprietary and not-for-profit hospitals were 16.16% and 15.78%, respectively. In 2012, following program implementation, 30-day readmission rates dropped to 15.76% and 15.29% for proprietary and not-for-profit hospitals. The data suggest that the implementation of the Hospital Readmission Reduction Program had similar effects on not-for-profit and proprietary hospitals with respect to readmission rates, even after adjusting for confounders.ConclusionsAlthough not-for-profit hospitals had lower 30-day readmission rates than proprietary hospitals in both 2010 and 2012, they both decreased after the implementation of the HRRP and the decreases were not statistically significantly different. Thus, this study suggests that the Hospital Readmission Reduction Program was equally effective in reducing readmission rates, despite ownership status.

Perceptions of Harm and Reasons for Misuse of Prescription Opioid Drugs and Reasons for Not Seeking Treatment for Physical or Emotional Pain Among a Sample of College Students

ABSTRACT Background: Since the early 1990s, the United States has seen a significant increase in the prevalence of prescription opioid misuse. Despite benefits prescription opioids provide, misuse can be fatal. Objectives: The current study was designed to investigate the prevalence of prescription opioid misuse, perceived harm of misuse, and reasons for misuse for physical or emotional pain instead of seeking professional medical or mental health treatment. Methods: Survey data were collected in the fall of 2013 via an online survey to a random sample of 668 students from a public Midwestern university. Results: Lifetime prevalence of prescription opioid misuse was 9.5%. Misusers of prescription opioid drugs generally reported lower ratings of perceived harm as compared to individuals not reporting misuse of prescription opioid drugs. Primary reasons for misuse of prescription opioid drugs was to relieve pain (33.9%), “to feel good/get high” (23.2%) and experimentation (21.4%). Lifetime misuse of a prescription opioid drug for physical or emotional pain was reported by 8.1% and 2.2% of respondents, respectively. Primary reasons for misuse for physical pain included because pain was temporary, immediate relief was needed, and no health insurance/financial resources. Primary reasons for misuse for emotional pain included not wanting others to find out, embarrassment and fear. Conclusions/Importance: Reasons for misuse of prescription opioid drugs vary by type of prescription opioid drug. Reasons for not seeking treatment that ultimately lead to misuse, vary by type of pain being treated and may be important considerations in the effort to stem the misuse of prescription opioid drugs among college students.

Physician-patient communication regarding patients' healthcare costs in the US: A systematic review of the literature

Abstract Background/objectives The increasing cost of healthcare is a major issue for US policymakers and patients and their families. To date, little research has focused on physician–patient communication about healthcare costs. This systematic review identifies themes present in that literature and synthesizes findings. Methods PubMed, CINAHL, PsycINFO, and Communication and Mass Media Complete were searched to identify articles regarding physician–patient communication about healthcare costs. The search yielded 24 articles based on inclusion criteria. Results Empirical findings showed that most physicians and patients were open to discussion about costs; however, few actual conversations were reported across research studies. Most of the research on physician–patient communication about healthcare costs explored issues of non-adherence and identified relevant communication barriers. Research on physician–patient communication about healthcare costs currently lacks evidence-based strategies for increasing and improving these discussions. Conclusions Physicians and patients judge communication about healthcare costs to be important and to have the potential to influence health and financial outcomes; however, discussions between physicians and patients on the topic are rare.

Diagnoses, prevalence, and state-based federal spending for HIV prevention and treatment in the United States, 2006–2009

BackgroundIn response to an article published in 2012 by officials at the US Department of Health and Human Services (DHHS), an independent analysis of state-based federal resource allocation for HIV was conducted to determine if the funding accurately reflected diagnosis and prevalence rates.MethodsTotal state-based federal funding for HIV, state-based funding for HIV prevention, and state-based funding for HIV treatment were compared to state-based HIV diagnosis and prevalence rates from 2006-2009.ResultsTotal state-based federal funding for HIV and funding for HIV prevention and treatment were highly correlated with HIV diagnosis and prevalence rates during the time horizon of the study; however, correlations between state-based HIV prevention funding and state-based HIV diagnosis rates were lower than the correlations between state-based HIV treatment funding and HIV prevalence.ConclusionsOur findings suggest that state-based federal resource allocation for HIV prevention and treatment may be better aligned with HIV diagnosis and prevalence rates than previously reported; however resource allocation for HIV prevention is less aligned than funding for HIV treatment signaling the need to reexamine state-based federal funding for HIV prevention.

Structural Characteristics of Local Health Departments Providing HIV/AIDS Services

Context: HIV infection causes significant health and economic burdens in communities throughout the United States. Despite the large number of research studies focusing on the effectiveness of HIV screening and treatment, little is known about the role that local health departments (LHDs) play in community-based HIV screening and treatment. Objective: In order to better understand HIV screening and treatment activities of LHDs in the US, we examined the structural characteristics of LHDs that do and do not provide these services. Design: This was a cross-sectional study using data from the 2010 National Profile of Local Health Departments. Using regression modeling, we examined the relationship between the provision of HIV screening and/or treatment and various structural characteristics of LHDs. Results: Over two-thirds of LHDs that responded to the survey reported providing HIV screening, and just under one-third (33%) of LHDs provided HIV treatment. LHDs that provided HIV screening and treatment were more likely to be engaged in other community-based activities and provide a broad range of services. In addition, they were significantly more likely to have public practitioners such as public health managers, physicians, epidemiologists, health educators, behavioral health specialists, and public health nurses. These LHDs were also more likely to employ a full time CEO and have a local board of health. Results also indicate that the provision of HIV screening and treatment is likely a function of funding level and size of the population served. Conclusions: HIV screening and treatment services can have a significant impact on community health and overall healthcare expenditures by reducing infection rates and linking the infected to care. Many LHDs are well positioned to provide these needed services and thus, play a major role in sustaining community health; however, the organizational capacity of LHDs to provide these services must be improved.

Psychometric Properties of an HIV Knowledge Scale Administered With Populations at High Risk for HIV Infection

HIV prevention programs targeting men who have sex with men, Blacks, and young adults commonly use measures of HIV knowledge as an important component of demonstrating overall program effectiveness. These scales, however, are rarely subjected to repeated analysis to confirm reliability and validity and the results of psychometric analysis rarely include subpopulation variations. In this study, we administered an adapted version of a previously validated HIV knowledge scale to participants of a large, city-wide HIV prevention program (n = 5,027) and performed psychometric analysis to determine if differences existed across populations. Analysis showed that the HIV knowledge scale performed poorly for men who have sex with men, but very well for transgenders. Results were similar for Blacks, Hispanics, and Whites, very poor for 30- to 39-year-olds, but very well for 60+ year olds. Findings underscore the need for further research on the measurement of HIV knowledge among high-risk populations and the importance of culturally appropriate survey items tailored to each population.

Associations Between School Perceptions and Tobacco Use in a Sample of Southern Middle School Students

Cigarettes are responsible for nearly 443,000 deaths per year in the United States. Eighty percent of adult smokers began smoking before the age of 18. In 2009, 17.2% of high school and 5.2% of middle school youths reported being a smoker. Research on school perceptions suggests that “engaged” students get more from school on all levels, including reduced health risk behaviors. The purpose of this study was to identify which school perceptions are protective against tobacco use in a sample of middle school youths. Results conclude that high levels of educational attachment are significantly associated with low levels of tobacco use.

LGBT Populations and Substance Abuse Research: An Overview

This chapter presents a brief overview of substance abuse in lesbian, gay, bisexual, and transgender (LGBT) populations, with the major focus on methodological issues specific to substance abuse research in LGBT populations. While often studied as a group, LGBT communities contain subpopulations that vary by race/ethnicity, socioeconomic status, age, geography, culture, and other factors. Subpopulations also differ in their risk of substance abuse due to stigma, internalized homophobia, social norms, access, and other factors. Research with LGBT populations presents many distinct challenges. These include, but are not limited to, varied definitions of sexual orientation and related sampling issues. Convenience or poorly advised sampling strategies often result in small, nonrepresentative samples which limit the generalizability of research. Ethical considerations of researching substance abuse in LGBT populations are also paramount, with accepted ethical considerations associated with researching sensitive topics generally, as in the case of substance use and abuse, compounded by issues associated with studies being conducted on populations that are already socially stigmatized and marginalized as a sexual minority. Additional research is clearly needed to fully understand substance use and abuse within the LGBT population, with resources available to further this important area of study.