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Siaton BC, Hogans BB, Frey-Law LA, Brown LM, Herndon CM, Buenaver LF. Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument. FRONTIERS IN PAIN RESEARCH 2024; 5:1254792. [PMID: 38455875 PMCID: PMC10918012 DOI: 10.3389/fpain.2024.1254792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Pain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging-Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives. Methods Mixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement. Results Scoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: "major medical", i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min. Conclusion This study, developing and pilot testing our "Pain in Aging-Educational Assessment of Need" (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed.
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Affiliation(s)
- Bernadette C. Siaton
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
| | - Beth B. Hogans
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Laura A. Frey-Law
- Department of Physical Therapy and Rehabilitative Science, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Lana M. Brown
- Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Christopher M. Herndon
- Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, United States
- Department of Family and Community Medicine, St. Louis University School of Medicine, St. Louis, MO, United States
| | - Luis F. Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Hogans B, Siaton B, Sorkin J. Diagnostic rate estimation from Medicare records: Dependence on claim numbers and latent clinical features. J Biomed Inform 2023; 145:104463. [PMID: 37517509 PMCID: PMC10576984 DOI: 10.1016/j.jbi.2023.104463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/27/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE International Classification of Disorders version 10 (ICD-10) codes contribute heavily to healthcare data. Medicare claims and other data-sources are used to constitute study populations and appraise healthcare processes. How variability in claims-per-beneficiary impacts diagnostic determinations is inadequately understood. The objective of this study is so assess distributional properties of Medicare claims, and examine claim rates impact on code utilization and rate determinations. METHODS The study population was Medicare beneficiaries aged 75-79.99 with claim(s) in the 5% standard analytical Carrier and Outpatient files, alive and participating in Medicare part B for all 12 months of 2017. Medicare beneficiary files were processed to create records containing all ICD-10 codes specified, key demographics, Part B and vital status, and the total claims for each 2017 beneficiary. Claim number cohorts were characterized. RESULTS Beneficiaries meeting inclusion criteria totaled 221,625, these having 7,617,503 claims; 96.4% had between 1 and 120 claims. Median claims were 24 for males (females 25); modal claims were 11 (13). Average distinct codes per beneficiary increased with claims number. The assignment of ICD-10 codes, i.e., 'diagnostic rate estimates' (DRE), increased as claim numbers increased for most codes among those most commonly utilized. For some conditions, mostly benign and age-related, DREs plateaued as claim numbers increased. For other conditions, typically associated with clinical acuity, e.g., chest pain, DREs increased steeply with claims. CONCLUSIONS Older adult Medicare beneficiaries aged 75-80 exhibited varying claims activity over the course of a year. Although DRE dependence on claim numbers varies across ICD-10 codes, rate estimates are higher for beneficiaries with claim numbers above the median.
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Affiliation(s)
- Beth Hogans
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States; Department of Neurology, Johns Hopkins School of Medicine, Meyer 6-113, Baltimore, MD 21205, United States.
| | - Bernadette Siaton
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States; Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - John Sorkin
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States; Division of Geriatrics, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Ali M, Siddiq MAB, Pranto NK, Amran NH, Akter M, Munny MA, Hossain MI, Khan SS, Mehedi MMH. Prevalence and predictors of musculoskeletal health complaints among sedentary, monotonous urban workers: A survey in Bangladesh. PLoS One 2023; 18:e0282922. [PMID: 37083655 PMCID: PMC10120926 DOI: 10.1371/journal.pone.0282922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Monotonous and sedentary work is significantly associated with the worst health of workers. There is a scarcity of data investigating the musculoskeletal health of sedentary workers working in low-income and middle-income settings. This study aimed to measure the prevalence and predictors of musculoskeletal health complaints (MHC) among Bangladeshi shopkeepers. METHODS This cross-sectional study was conducted in Dhaka, Bangladesh. Data from 1553 Bangladeshi shopkeepers aged 18 years and above were analyzed. MHC was measured using the musculoskeletal subscale of the subjective health complaints scale. The descriptive analysis helped to compute MHC prevalence and compare the prevalence across groups. Regression analysis revealed the predictors of MHC for the shopkeepers. RESULTS The prevalence of MHC among shopkeepers was 58.0%. The prevalence of low back pain was the highest (55.5%), followed by neck pain (48.0%) and upper back pain (43.5%). Regression analysis identified sex (aOR 1.301, CI 0.996 to 1.700), age (aOR 1.405, CI 1.047 to 1.886), body mass index (aOR 0.495, CI 0.397 to 0.617), and substance abuse (aOR 1.998, CI 1.136 to 3.514) as independent predictors of MHC among the shopkeepers. Furthermore, significantly higher odds of MHC have been found among tobacco users (OR 1.234, CI 1.009 to 1.510). CONCLUSION This study revealed a high prevalence of MHC and unhealthy lifestyles among shopkeepers in Bangladesh. Shopkeepers should be provided with better health literacy to follow healthy lifestyles and prevent MHC among this cohort.
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Affiliation(s)
- Mohammad Ali
- Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College and Hospital, Uttara Model Town, Dhaka, Bangladesh
- Hasna Hena Pain, Physiotherapy and Public Health Research Center (HPRC), Uttara Model Town, Dhaka, Bangladesh
| | - Md Abu Bakar Siddiq
- Department of Physiotherapy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Nujaim Khan Pranto
- Department of Physiotherapy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Naheean Hossain Amran
- Department of Physiotherapy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Marium Akter
- Care for Stroke & Geriatric Disabilities, Mohammadpur, Dhaka, Bangladesh
| | - Marjan Akter Munny
- Bangladesh Institute of Health Sciences (BIHS), Darussalam, Dhaka, Bangladesh
| | - Md Imran Hossain
- Department of Physiotherapy, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Saffat Sabbir Khan
- Office of the Upazilla Health and Family Planning Officer, Gazipur Sadar, Gazipur, Bangladesh
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Bazargan M, Loeza M, Ekwegh T, Adinkrah EK, Kibe LW, Cobb S, Assari S, Bazargan-Hejazi S. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7246. [PMID: 34299695 PMCID: PMC8306928 DOI: 10.3390/ijerph18147246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. METHODS We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. RESULTS Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. DISCUSSION Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Margarita Loeza
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Tavonia Ekwegh
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | | | - Lucy W. Kibe
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, UCLA, Los Angeles, CA 90095, USA
- Department of Psychiatry, CDU, Los Angeles, CA 90059, USA
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