Advertisement
Predicting Adherence After Emergency Department Visits

Predicting Adherence After Emergency Department Visits

Millions of Americans who use the ED each year are subsequently referred for outpatient care and follow-up with other physicians or clinics and prescribed necessary medications following their ED visit. Adherence with recommendations from ED providers is critical to ensuring that proper treatment of the initial condition be continued upon discharge. Adherence is also critical for identifying potential misdiagnoses and managing possible treatment failures and complications. Despite its importance and cost to the healthcare system, studies suggest that compliance with recommendations by ED patients in the United States is frequently poor. Research has provided little insight on factors that may help predict non-compliance with recommendations from ED physicians. “In the emergency setting, clinicians may benefit from developing a better understanding about why patients don’t always follow recommendations from their physicians,” says Camille Broadwater-Hollifield, PhD, MPH.   Taking a Closer Look In a study published in the American Journal of Emergency Medicine, Dr. Broadwater-Hollifield and colleagues sought to determine predictors of adherence to medical recommendations after an ED visit. They conducted a prospective, observational study at an urban medical center that involved 422 ED patients. Participants provided baseline demographic data as well as information about their insurance status, whether or not they had a primary care physician (PCP), and the impact of costs of care on their ability to follow medical recommendations. Patients were contacted at least 1 week after their initial ED visit and answered questions about adherence to medical recommendations from ED personnel. According to the results, nearly 90% of study participants self-reported that they had complied with at least one recommendation made during their ED visit. “Patients who...
Medication Non-Adherence in Diabetes: A Look at Costs

Medication Non-Adherence in Diabetes: A Look at Costs

Oral medications and insulin are cornerstones of diabetes man­agement, but as many as one-third of patients with the disease fail to derive optimal benefit from therapy due to medication non-adherence (MNA). Studies have also linked MNA with higher disease-related, inpatient, and emergency department utilization and costs. Unfortunately, many MNA analyses focusing on cost have been limited by small sample size, an absence of precise adherence measures, or cross-sectional design, among other limitations. In an issue of Diabetes Care, my colleagues and I published an article designed to overcome previous research limitations and add to our existing knowledge on the effects of MNA on cost. In our study, we used a multivariate, generalized, linear, mixed model in order to account for shared correlations among cost variables. We then estimated the inpatient, outpatient, and pharmacy-related costs in a group of more than 740,000 veterans in the United States with type 2 diabetes over a 5-year period. Inpatient Costs: A Key Driver According to our findings, the costs of MNA among patients with diabetes are quite large and appear to be mostly driven by inpatient expenditures. All annual cost categories increased by about 3% per year. MNA was associated with 37% lower pharmacy costs and 7% lower outpatient costs but 41% higher inpatient costs. The potential cost savings that might be achieved from improving medication adherence are substantial. Based on sensitivity analyses, improving adherence for MNA patients would lead to annual estimated cost savings that range between $661 million and $1.16 billion. Wanted: More Successful Interventions The findings from our study are significant to both health services researchers and healthcare policy makers....
Compliance

Compliance

“Why aren’t you taking your cholesterol medication?”  I asked the woman.  With the coronary disease I diagnosed a year ago, my discovery that she had not taken her medication was very troubling. “It made me tired,” she replied matter-of-factly.  ”And besides, the cardiologist said the stress test was negative, so my heart is fine!” I ordered the stress test after her heart calcium score was significantly elevated, revealing significant atherosclerosis.  She totally misunderstood the results, and I needed to fix that problem.  So I pulled out my secret weapon: a good analogy. “The purpose of the calcium score test was to see if you had termites in your home”  I explained.  ”I found them.  The negative stress test just said that the termites hadn’t eaten through your walls.  It’s good news that your walls aren’t falling down, but they will if we don’t stop the termites.” Her eyes opened wide comprehension: the termites were eating her walls.  She was living on borrowed time. “Would you take a medication if it didn’t have side effects?” I asked. She quickly nodded.  Of course she would.  From now on she would be a compliant patient. Compliance is good.  Noncompliance is bad.  It’s something I learned very early in my training: patients who do what their doctors say are compliant (good), and those who don’t follow instructions are noncompliant (bad).  If you are lucky as a doctor, you have compliant patients.  They are the best kind.   They obey their doctors.  They are submissive.  Noncompliant patients are bad; they are a bunch of deadbeats. Please hold your nasty comments; I don’t really believe my patients...
Group Education & Older Diabetics

Group Education & Older Diabetics

Studies suggest that group-based diabetes education efforts can improve short- and long-term disease control among younger patients, but few analyses have explored the effect of these programs on older adults. Unfortunately, older adults are often underrepresented in diabetes edu­cation interventions because subtle changes in functional, cognitive, and psychosocial status can affect diabetes self-care. Many clinicians are reluctant to refer older patients to group education because they believe they may require more individual attention. In a secondary analysis study published in Diabetes Care, we examined whether community-dwelling older adults aged 60 to 75 with type 1 or type 2 diabetes would benefit from self-management interventions similarly to younger and middle-aged adults. We also tested if older adults benefited from group versus individual self-management interventions. Comparing Benefits of Diabetes Intervention In our analysis, patients were randomly assigned to one of three self-management interventions from diabetes educators that were delivered separately to those with type 1 or type 2 disease: 1. Highly structured group: Five group sessions were conducted over 6 weeks. Patients were taught how food, medication, and exercise affected A1C and actions they could take when levels were out of range. Between classes, patients set daily goals and practiced problem solving 2. Attention control group: Five group sessions were conducted over 6 weeks, but the sessions followed a manual-based standard diabetes education program. 3. Control group: One-on-one sessions were delivered for 6 months. During sessions, patients could receive any type of information they requested. According to our results, A1C levels improved equally in the older and younger groups at 3, 6, and 12 months with all interventions and for those...
Page 1 of 3123
[ HIDE/SHOW ]