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Gonzalez T, Nicholas A, Olagbenro M, Feldman SR, Fleischer AB. Race and ethnicity are inadequate predictors of ambulatory visit length and utilization of preventive services. J Natl Med Assoc 2024; 116:131-138. [PMID: 38402107 DOI: 10.1016/j.jnma.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 02/26/2024]
Abstract
Health disparities can be experienced by any disadvantaged group who has limited access to healthcare or decreased quality of care. Quality of care can be measured by physician-patient communication measures such as length of visit, health outcomes, patient satisfaction, or by the services one receives such as screening or health education. This study aims to determine the relationship between length of physician-patient encounter, number of preventive services, ethnicity, and race. This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. Visits with a single diagnosis were selected. Visits with the five most frequent diagnoses were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. The primary outcome is time spent with a physician in minutes and the number of preventive services provided represented by the Preventive Service Index (PSI). Of 255,916 visits, non-white individuals made up 16.2% (95% Confidence Interval 15.9-16.4) while Latinos represented 13.4% (95%CI 13.2-13.6) of individuals. Multivariate analysis revealed minimal differences in visit length in race and ethnic groups regardless of diagnosis. Greater PSI was associated with individuals less than 43 years old (Odds Ratio (OR) 2.0, 95% CI 1.8-2.3, p =< 0.0001), those who reside in metropolitan statistical areas (MSAs) (OR 1.2, 95% CI 1.1-1.4, p = 0.006), non-white individuals (OR 1.2, 95% CI 1.1-1.3, p = 0.004), and those with private insurance (OR 1.3, 95% CI 1.1-1.4, p =< 0.0001). Race and ethnicity do not predict length of time with a physician regardless of diagnosis. Age, race, location within a metropolitan area, and insurance are significant but minimal predictors of receiving preventive services in the rank-order leading five most frequent diagnoses. This large, population-based study highlights improvements in the distribution of healthcare services from previous studies.
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Affiliation(s)
- Tammy Gonzalez
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Andrew Nicholas
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Matthew Olagbenro
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Steven R Feldman
- Wake Forest School of Medicine, 4618 Country Club Road, Winston Salem, NC 27104, USA
| | - Alan B Fleischer
- University of Cincinnati School of Medicine Department of Dermatology, 3230 Eden Ave, Cincinnati, OH 45267, USA
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Gandrakota N, Patel VB, Moore M, Benameur K, Shah MK. Trends in Diet Counseling Among Stroke Versus Non-Stroke Patients: Evidence from the NAMCS, 2011-2016. J Stroke Cerebrovasc Dis 2022; 31:106223. [PMID: 34844125 PMCID: PMC8792666 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Dietary modifications in post-stroke patients facilitated by diet counseling improves post-stroke recovery and stroke recurrence. The extent to which clinicians provide dietary counseling for these patients is unknown. METHODS 2011 to 2016 National Ambulatory Medical Care Surveys (NAMCS) data were used to assess trends in post-stroke diet consultations by age. Multivariate logistic regression models assessed the likelihood of dietary counseling provision among patients with and without stroke. RESULTS The proportion of patients with stroke aged 60-79 who received diet counseling decreased from 18.2% in 2011 to 5.3%, 11.9%, 8.7%, 13.4%, and 15.2% in 2012-2016, respectively. Among patients without stroke aged 60-79, diet counseling rate decreased from 12.9% in 2011 to 7%, 9.5%, 10.5%, 13.5%, and 12% in 2012-2016, respectively. Similar trends were observed among patients with and without stroke aged over 80. CONCLUSIONS The proportion of patients with and without stroke receiving dietary counseling has remained low over the past half-decade. It is likely multifactorial- related to clinician knowledge, patients' receptiveness, and system-level factors of time and reimbursement. Future interventions should explore methods to address barriers to nutrition recommendations for post-stroke patients and patient activation to adopt dietary changes.
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Affiliation(s)
- Nikhila Gandrakota
- Department of Family and Preventive Medicine, PGY-1, Family Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Miranda Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Karima Benameur
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Shah MK, Moore MA, Narayan KMV, Ali MK. Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005-2015. Am J Prev Med 2019; 57:e153-e161. [PMID: 31630765 PMCID: PMC6814385 DOI: 10.1016/j.amepre.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. METHODS Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. RESULTS There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. CONCLUSIONS Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia.
| | - Miranda A Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Guendelman S, Ritterman Weintraub M, Kaufer-Horwitz M. Weight Loss Success Among Overweight and Obese Women of Mexican-Origin Living in Mexico and the United States: A Comparison of Two National Surveys. J Immigr Minor Health 2017; 19:41-49. [PMID: 27002624 DOI: 10.1007/s10903-015-0315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We assessed variations in and correlates of weight-loss success (WLS) among overweight/obese women in Mexico (WIMX) and Mexican-American women (MA). We used cross-national data from 2006 ENSANUT (Mexico) and NHANES (2001-2008) to compare 5061 WIMX with 550 MA's without known metabolic conditions. WLS was defined as losing ≥5 % of body weight over 1 year. MA's were more likely to attain WLS (OR 1.31; 95 % CI 1.01-1.70). WLS among WIMX was higher in those with at least high school, a provider screen of overweight and a lower BMI. Among MA's, an incomplete high school versus primary education reduced the odds of WLS. Among women who lost ≥10 lbs, weight-loss strategies such as eating less were higher among MA's. MA women were more likely than WIMX to attain WLS. Understanding these disparities can help design customized public health interventions that curb the obesity epidemic in these women in both countries.
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Affiliation(s)
- Sylvia Guendelman
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA
| | - Miranda Ritterman Weintraub
- School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA.,Public Health Program, Touro University California, Vallejo, CA, USA
| | - Martha Kaufer-Horwitz
- Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15; Col. Belisario Domínguez Sección XVI, 14080, Tlalpan, Mexico, D.F., Mexico.
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Brekke L, Buysman E, Grabner M, Ke X, Xie L, Baser O, Wei W. The Use of Decomposition Methods in Real-World Treatment Benefits Evaluation for Patients with Type 2 Diabetes Initiating Different Injectable Therapies: Findings from the INITIATOR Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1252-1259. [PMID: 29241884 DOI: 10.1016/j.jval.2017.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 05/03/2017] [Accepted: 05/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets. OBJECTIVES To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics. METHODS Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A1c (HbA1c) and treatment persistence. RESULTS The greater HbA1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA1c of 7.0% to less than 8.0% had higher persistence with LIRA. CONCLUSIONS Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment.
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Affiliation(s)
| | | | | | - Xuehua Ke
- HealthCore, Inc., Wilmington, DE, USA
| | - Lin Xie
- STATinMED Research, Ann Arbor, MI, USA
| | - Onur Baser
- STATinMED Research, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA; School of Economy, Administrative and Social Sciences, MEF University, Istanbul, Turkey
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