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Al-Qerem W, Jarab A, Eberhardt J, Alasmari F, Hammad A, M Alkaee S, H Alsabaa Z. Health Literacy and Medication Adherence Among Patients with Type 2 Diabetes in Jordan: A Cross-Sectional Study. Patient Prefer Adherence 2024; 18:2019-2026. [PMID: 39345761 PMCID: PMC11439359 DOI: 10.2147/ppa.s484135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
Background Improving health literacy has been found to play a significant role in enhancing medication adherence in patients with type 2 diabetes. Purpose The present study aims to evaluate health literacy and its association with medication adherence among diabetic patients in Jordan. Patients and Methods This cross-sectional study included 400 diabetic patients, predominantly female (68.8%), with a median age of 58 years, attending the endocrinology outpatient clinic at Albasheer Hospital in Amman, Jordan, between August and December 2023. Patients were recruited using convenience sampling, including those aged 18 and older, literate, diagnosed with T2DM for at least one year, and on at least one medication for T2DM. Sample size was calculated based on the Events Per Variable (EPV) criterion to ensure sufficient power for logistic regression analysis. Data were collected using two validated instruments: the Jordanian Diabetic Health Literacy Questionnaire (JDHLQ), assessing health literacy, and the Medication Adherence Report Scale (MARS-5), measuring medication adherence. A binary logistic regression model was constructed to identify variables associated with adherence levels. Results The study enrolled 400 diabetic patients (females =68.8%). While most of the participants (70.3%) reported high adherence levels, results revealed a window for health literacy improvement as the median for the JDHLQ score was 22 (ranging from 18 to 25) out of a maximum possible score of 32. More than half of the participants replied "never" to "I forget to take my medications", followed by "I stop taking my medications for a while". Conclusion The binary regression model revealed that a higher JDHLQ score significantly increased the odds of a high adherence level. The significant association between improved health literacy and medication adherence necessitates the implementation of educational campaigns for enhancing literacy and hence medication adherence among patients with type 2 diabetes.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Anan Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Judith Eberhardt
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudia Arabia
| | - Alaa Hammad
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Safa M Alkaee
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Zein H Alsabaa
- Department of Pharmacy, Faculty of Pharmacy, Petra University, Amman, Jordan
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Stöber A, Marijic P, Kurz C, Schwarzkopf L, Kirsch F, Schramm A, Leidl R. Does uptake of specialty care affect HRQoL development in COPD patients beneficially? A difference-in-difference analysis linking claims and survey data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1561-1573. [PMID: 36637677 PMCID: PMC10550862 DOI: 10.1007/s10198-022-01562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is an evidence gap on whether the choice of specialty care beneficially affects health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). This study analyzes how newly initiated pulmonologist care affects the generic and disease-specific HRQoL in COPD patients over a period of 1 year. METHODS We linked claims data with data from two survey waves to investigate the longitudinal effect of specialty care on HRQoL using linear Difference-in-Difference models based on 1:3 propensity score matched data. Generic HRQoL was operationalized by EQ-5D-5L visual analog scale (VAS), and disease-specific HRQoL by COPD assessment test (CAT). Subgroup analyses examined COPD patients with low (GOLD AB) and high (GOLD CD) exacerbation risk. RESULTS In contrast to routine care patients, pulmonologists' patients (n = 442) experienced no significant deterioration in HRQoL (VAS - 0.0, p = 0.9870; CAT + 0.5, p = 0.0804). Models unveiled a small comparative advantage of specialty care on HRQoL (mean change: CAT - 0.8, VAS + 2.9), which was especially pronounced for GOLD AB (CAT - 0.7; VAS + 3.1). CONCLUSION The uptake of pulmonologist care had a statistically significant, but not clinically relevant, beneficial impact on the development of HRQoL by slowing down overall HRQoL deterioration within 1 year. Including specialty care more appropriately in COPD management, especially at lower disease stages (GOLD AB), could thus improve patients' health outcome.
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Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany.
- Pettenkoffer School of Public Health, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.
| | - Pavo Marijic
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Christoph Kurz
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institut Fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Anja Schramm
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Wang Y, Zhou C, Liu C, Liu S, Liu X, Li X. The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design. Front Public Health 2022; 10:1012690. [PMID: 36262226 PMCID: PMC9574199 DOI: 10.3389/fpubh.2022.1012690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023] Open
Abstract
Background Inappropriate use of antibiotics has become a major driver for the spread of antimicrobial resistance globally, particularly common in China. Antimicrobial stewardship programs are effective in optimizing antimicrobial use and decreasing the emergence of multi-drug-resistant organisms, and the pharmacist has performed a leading role in this program. Objective To evaluate the impact of antimicrobial stewardship programs driven by pharmacists on antibiotic consumption and costs and the appropriateness of antibiotic use. Methods A single-center retrospective quasi-experimental design was conducted in two independent hepatobiliary surgery wards and two independent respiratory wards in a county-level tertiary general hospital in Jiangsu, China. Each intervention group was served with antimicrobial stewardship programs with prescriptions audit and feedback, antibiotics restriction, education, and training. The propensity score matching method was employed to balance confounding variables between the intervention group and control group, and a difference-in-differences analysis was used to evaluate the impact of antimicrobial stewardship programs. The primary outcome was measured by scores of rationality evaluation of antibiotics. Results The DID results demonstrated that the implementation of the antimicrobial stewardship programs was associated with a reduction in the average length of hospital stay (coefficient = -3.234, p = 0.006), DDDs per patient (coefficient = -2.352, p = 0.047), and hospitalization costs (coefficient = -7745.818, p = 0.005) in the hepatobiliary surgery ward, while it was associated with a decrease in DDDs per patient (coefficient = -3.948, p = 0.029), defined daily doses per patient day (coefficient = -0.215, p = 0.048), and antibiotic costs (coefficient = -935.087, p = 0.014) in the respiratory ward. The program was also associated with a decrease in rationality evaluation scores (p < 0.001) in two wards. Conclusion The result reveals that the implementation of the antimicrobial stewardship programs is effective in reducing the length of hospital stay, decreasing antibiotics consumption and costs, and improving the appropriateness of antimicrobial use such as decreasing irrational use of cephalosporins, reducing combinations, and improving timely conversion. However, great attention ought to be paid to the improper use of broad-spectrum antibiotics. The government is responsible for providing sustainable formal education for pharmacists, and more funding and staff support to promote antimicrobial stewardship programs.
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Affiliation(s)
- Ying Wang
- Department of Infection Management, The First Affiliated Hospital of Soochow University, Suzhou, China,School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Chongchong Zhou
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Chengying Liu
- Department of Respiratory Medicine, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Shuanghai Liu
- Department of Hepatobiliary Surgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Xiaoliang Liu
- Department of Infection Management, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China,Xiaoliang Liu
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Xin Li
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Almohammed OA, Alsalem AA, Almangour AA, Alotaibi LH, Al Yami MS, Lai L. Antidepressants and health-related quality of life (HRQoL) for patients with depression: Analysis of the medical expenditure panel survey from the United States. PLoS One 2022; 17:e0265928. [PMID: 35442954 PMCID: PMC9020683 DOI: 10.1371/journal.pone.0265928] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2022] [Indexed: 12/25/2022] Open
Abstract
Background Despite the empirical literature demonstrating the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and health-related quality of life (HRQoL) remains controversial. This study investigates the effect of antidepressant medication use on patient-reported HRQoL for patients who have depression. Methods A comparative cohort, secondary database analysis was conducted using data from the United States’ Medical Expenditures Panel Survey for patients who had depression. HRQoL was measured using the SF-12 and reported as physical and mental component summaries (PCS and MCS). A cohort of patients that used antidepressant medications were compared to a cohort of patients that did not. Univariate and multivariate difference-in-differences (D-I-D) analyses were used to assess the significance of the mean difference of change on the PCS and MCS from baseline to follow-up. Results On average, 17.5 million adults were diagnosed with depression disorder each year during the period 2005–2016. The majority were female (67.9%), a larger proportion of whom received antidepressant medications (60.5% vs. 51.5% of males). Although use of antidepressants was associated with some improvement on the MCS, D-I-D univariate analysis revealed no significant difference between the two cohorts in PCS (–0.35 vs. –0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405). The multivariate D-I-D analyses ensured the robustness of these results. Conclusion The real-world effect of using antidepressant medications does not continue to improve patients’ HRQoL over time. Future studies should not only focus on the short-term effect of pharmacotherapy, it should rather investigate the long-term impact of pharmacological and non-pharmacological interventions on these patients’ HRQoL.
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Affiliation(s)
- Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Abdulaziz A. Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama H. Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Leanne Lai
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie, Florida, United States of America
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Peña-Sánchez JN, Osei JA, Rohatinsky N, Lu X, Risling T, Boyd I, Wicks K, Wicks, M, Quintin CL, Dickson A, Fowler SA. OUP accepted manuscript. J Can Assoc Gastroenterol 2022; 6:55-63. [PMID: 37025513 PMCID: PMC10071297 DOI: 10.1093/jcag/gwac015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Rural dwellers with inflammatory bowel disease (IBD) face barriers to accessing specialized health services. We aimed to contrast health care utilization between rural and urban residents diagnosed with IBD in Saskatchewan, Canada. Methods We completed a population-based retrospective study from 1998/1999 to 2017/2018 using administrative health databases. A validated algorithm was used to identify incident IBD cases aged 18+. Rural/urban residence was assigned at IBD diagnosis. Outpatient (gastroenterology visits, lower endoscopies, and IBD medications claims) and inpatient (IBD-specific and IBD-related hospitalizations, and surgeries for IBD) outcomes were measured after IBD diagnosis. Cox proportional hazard, negative binomial, and logistic models were used to evaluate associations adjusting by sex, age, neighbourhood income quintile, and disease type. Hazard ratios (HR), incidence rate ratios (IRR), odds ratios (OR), and 95% confidence intervals (95% CI) were reported. Results From 5,173 incident IBD cases, 1,544 (29.8%) were living in rural Saskatchewan at IBD diagnosis. Compared to urban dwellers, rural residents had fewer gastroenterology visits (HR = 0.82, 95% CI: 0.77-0.88), were less likely to have a gastroenterologist as primary IBD care provider (OR = 0.60, 95% CI: 0.51-0.70), and had lower endoscopies rates (IRR = 0.92, 95% CI: 0.87-0.98) and more 5-aminosalicylic acid claims (HR = 1.10, 95% CI: 1.02-1.18). Rural residents had a higher risk and rates of IBD-specific (HR = 1.23, 95% CI: 1.13-1.34; IRR = 1.22, 95% CI: 1.09-1.37) and IBD-related (HR = 1.20, 95% CI: 1.11-1.31; IRR = 1.23, 95% CI: 1.10-1.37) hospitalizations than their urban counterparts. Conclusion We identified rural-urban disparities in IBD health care utilization that reflect rural-urban inequities in the access to IBD care. These inequities require attention to promote health care innovation and equitable management of patients with IBD living in rural areas.
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Affiliation(s)
- Juan Nicolás Peña-Sánchez
- Correspondence: Juan Nicolás Peña-Sánchez, MD, MPH, PhD, Room 3232—E-Wing Health Sciences, 104 Clinic Place, Saskatoon, SK S7N5E5, Canada, e-mail:
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | | | - Xinya Lu
- Health Quality Council, Saskatchewan, Canada
| | | | | | | | | | | | | | - Sharyle A Fowler
- Department of Medicine, College of Medicine, University Saskatchewan, Canada
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Zielonka TM. Awareness of Polish physicians regarding the impact of air pollution on health. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:478-485. [PMID: 34096478 DOI: 10.1080/19338244.2021.1935677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The air quality in Poland is the worst in Europe. The aim of the study was to assess the awareness of Polish physicians about the impact of air pollution on health, the sources of their knowledge and how this knowledge is used in clinical practice. The study was based on a voluntary and anonymous questionnaire and included 94% of doctors from a hospital in Warsaw. Only 25% of physicians think that their knowledge of the impact of air pollution on health is sufficient. The main sources of this knowledge were the internet and TV. Only 5% of physicians know what air pollution concentrations are acceptable, 17% follow the levels of air pollution in their region and 3% inform their patients when air pollution exceeds permissible limits. The older and noninterventional physicians inform patients more often about these dangers. The knowledge of physicians on air pollution is not sufficient and they need professional education in this area.
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Barth N, Kellerer C, Schneider A. [Narrative patterns in asthma and the challenge to accept the need for patient education]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 163:13-19. [PMID: 34016566 DOI: 10.1016/j.zefq.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The benefits of patient education in bronchial asthma in terms of reducing hospitalization and incapacity to work are well documented. However, only about a quarter of patients take advantage of training offers. Therefore, this qualitative study with asthma patients examines how to sharpen the motivation to participate in training programs. METHODS In order to investigate narrative patterns of chronic illness in asthma patients, we conducted 14 problem-centered narrative (telephone) interviews. The collected data were evaluated in accordance with system-theoretical analysis. This methodology allows for the interviews to be examined for their narrative patterns. The central question was how the patients we interviewed succeeded in constructing normality in the interviews. RESULTS From the analysis of the interviews, we were able to develop four types of narrative patterns: the chronic illness as a crisis (1), as a passion (2), as an odyssey (3), and as homeostasis (4). Within these forms of narration, the transition from normal to pathological is told in a specific and exemplary manner. The results of our study can be seen as a contribution to the dynamization and differentiation of trajectories of chronic disease. DISCUSSION We identified significant differences in the experienced trajectories of the disease. Patients are dealing with chronic disease in different styles, which have individual "pressure points" where motivation for adherence is created in the first place. The results show that the patient's knowledge structures unfolding in the narrative patterns should not be viewed as health illiteracy. CONCLUSION These typologies of the normal and the pathological do not only provide a key to understanding the life-world (Lebenswelt) of chronically ill people, but also to the question of what motivates chronically ill patients to participate in patient trainings. This in-depth understanding could help us to improve motivational discussions with these patients.
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Affiliation(s)
- Niklas Barth
- Institut für Allgemeinmedizin und Versorgungsforschung, KIinikum rechts der Isar, TU München, München, Deutschland; Institut für Soziologie, LMU München, München, Deutschland.
| | - Christina Kellerer
- Institut für Allgemeinmedizin und Versorgungsforschung, KIinikum rechts der Isar, TU München, München, Deutschland
| | - Antonius Schneider
- Institut für Allgemeinmedizin und Versorgungsforschung, KIinikum rechts der Isar, TU München, München, Deutschland
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Islam MS, Morshed MS, Young GJ, Noor-E-Alam M. Robust policy evaluation from large-scale observational studies. PLoS One 2019; 14:e0223360. [PMID: 31603910 PMCID: PMC6788711 DOI: 10.1371/journal.pone.0223360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Under the current policy decision making paradigm we make or evaluate a policy decision by intervening different socio-economic parameters and analyzing the impact of those interventions. This process involves identifying the causal relation between interventions and outcomes. Matching method is one of the popular techniques to identify such causal relations. However, in one-to-one matching, when a treatment or control unit has multiple pair assignment options with similar match quality, different matching algorithms often assign different pairs. Since all the matching algorithms assign pairs without considering the outcomes, it is possible that with the same data and same hypothesis, different experimenters can reach different conclusions creating an uncertainty in policy decision making. This problem becomes more prominent in the case of large-scale observational studies as there are more pair assignment options. Recently, a robust approach has been proposed to tackle the uncertainty that uses an integer programming model to explore all possible assignments. Though the proposed integer programming model is very efficient in making robust causal inference, it is not scalable to big data observational studies. With the current approach, an observational study with 50,000 samples will generate hundreds of thousands binary variables. Solving such integer programming problem is computationally expensive and becomes even worse with the increase of sample size. In this work, we consider causal inference testing with binary outcomes and propose computationally efficient algorithms that are adaptable for large-scale observational studies. By leveraging the structure of the optimization model, we propose a robustness condition that further reduces the computational burden. We validate the efficiency of the proposed algorithms by testing the causal relation between the Medicare Hospital Readmission Reduction Program (HRRP) and non-index readmissions (i.e., readmission to a hospital that is different from the hospital that discharged the patient) from the State of California Patient Discharge Database from 2010 to 2014. Our result shows that HRRP has a causal relation with the increase in non-index readmissions. The proposed algorithms proved to be highly scalable in testing causal relations from large-scale observational studies.
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Affiliation(s)
- Md Saiful Islam
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Md Sarowar Morshed
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Gary J. Young
- Center for Health Policy and Healthcare Research, Northeastern University, Boston, Massachusetts, United States of America
- D’Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, United States of America
- Bouvè College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Md. Noor-E-Alam
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, United States of America
- Center for Health Policy and Healthcare Research, Northeastern University, Boston, Massachusetts, United States of America
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Su D, Chen YC, Gao HX, Li HM, Chang JJ, Jiang D, Hu XM, Lei SH, Tan M, Chen ZF. Effect of integrated urban and rural residents medical insurance on the utilisation of medical services by residents in China: a propensity score matching with difference-in-differences regression approach. BMJ Open 2019; 9:e026408. [PMID: 30782944 PMCID: PMC6377539 DOI: 10.1136/bmjopen-2018-026408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In this study, we aim to evaluate the effect of urban and rural resident medical insurance scheme (URRMI) on the utilisation of medical services by urban and rural residents in the four pilot provinces. SETTING AND PARTICIPANTS The sample used in this study is 13 305 individuals, including 2620 in the treatment group and 10 685 in the control group, from the 2011 and 2015 surveys of China Health and Retirement Longitudinal Study. OUTCOME MEASURES Propensity score matching and difference-in-differences regression approach (PSM-DID) is used in the study. First, we match the baseline data by using kernel matching. Then, the average treatment effect of the four outcome variables are analysed by using the DID model. Finally, the robustness of the PSM-DID estimation is tested by simple model and radius matching. RESULTS Kernel matching have improved the overall balance after matching. The URRMI policy has significantly reduced the need-but-not outpatient care and significantly increased outpatient care cost and inpatient care cost for rural residents, with DID value of -0.271, 0.090 and 0.256, respectively. After robustness test, the DID competing results of four outcome variables are consistent. CONCLUSIONS URRMI has a limited effect on the utilisation of medical and health services by all residents, but the effect on rural residents is obvious. The government should establish a unified or income-matching payment standard to prevent, control the use of medical insurance funds and increase its efforts to implement URRMI integration in more regions to improve overall fundraising levels.
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Affiliation(s)
- Dai Su
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Ying-chun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Hong-xia Gao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Hao-miao Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Jing-jing Chang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Di Jiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Xiao-mei Hu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Shi-han Lei
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Min Tan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Zhi-fang Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
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Dong W, Gao J, Zhou Z, Bai R, Wu Y, Su M, Shen C, Lan X, Wang X. Effects of China's urban basic health insurance on preventive care service utilization and health behaviors: Evidence from the China Health and Nutrition Survey. PLoS One 2018; 13:e0209890. [PMID: 30596751 PMCID: PMC6312240 DOI: 10.1371/journal.pone.0209890] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Lifestyle choices are important determinants of individual health. Few studies have investigated changes in health behaviors and preventive activities brought about by the 2007 implementation of Urban Resident Basic Health Insurance (URBMI) in China. This study, therefore, aimed to explore whether URBMI has reduced individuals’ incentives to adopt healthy behaviors and utilize preventive care services. Methods Data were drawn from two waves of the China Health and Nutrition Survey. Respondents were categorized according to their insurance situation before and after the URBMI reform in 2006 and 2011. Propensity score matching and difference-in-differences methods were used to measure levels of preventive care and behavior changes over time. Estimations were also made based on gender, self-reported health, and income. Results We found that URBMI implementation did not change residents’ utilization of preventive care services or their smoking habits, drinking habits, or other risky behaviors overall. However, the likelihood of sedentariness did increase by five percentage points. Females tended to be more sedentary while males were less likely to drink soft drinks. Residents with poor self-reported health exercised less while those who reported good health were more likely to be sedentary. Low- and middle-income residents were likely to be sedentary while middle-income people tended to smoke after becoming insured. Conclusion Since URBMI implementation, some unhealthy behaviors like sedentariness have increased among those who were newly insured, and different subgroups have reacted differently. This suggests that the insurance design needs to be optimized and effective measures need to be adopted to help improve people’s lifestyle choices.
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Affiliation(s)
- Wanyue Dong
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail:
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ruhai Bai
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yue Wu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Min Su
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Lan
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiao Wang
- International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou, Jiangsu, People’s Republic of China
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Holt T, Sari N, Hansen G, Bradshaw M, Prodanuk M, McKinney V, Johnson R, Mendez I. Remote Presence Robotic Technology Reduces Need for Pediatric Interfacility Transportation from an Isolated Northern Community. Telemed J E Health 2018; 24:927-933. [PMID: 29394155 DOI: 10.1089/tmj.2017.0211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Providing acutely ill children in isolated communities access to specialized care is challenging. This study aimed to evaluate remote presence robotic technology (RPRT) for enhancing pediatric remote assessments, expediting initiation of treatment, refining triaging, and reducing the need for transport. METHODS We conducted a pilot prospective observational study at a primary/urgent care clinic in an isolated northern community. Participants (n = 38) were acutely ill children <17 years presenting to the clinic, whom local healthcare professionals had considered for interfacility transportation (IFT). Participants were assessed and managed by a tertiary center pediatric intensivist through a remote presence robot. The intensivist triaged participants to either remain at the clinic or be transported to regional/tertiary care. Controls from a pre-existing local transport database were matched using propensity scoring. The primary outcome was the number of IFTs among participants versus controls. RESULTS Fourteen of 38 (37%) participants required transport, whereas all controls were transported (p < 0.0001). Six of 14 (43%) transported participants were triaged to a nearby regional hospital, while no controls were regionalized (p = 0.0001). All participants who remained at the clinic stayed <24 h, and were matched to controls who stayed 4.9 days in tertiary care (p < 0.001). There was no statistically significant difference in hospital length of stay between transported participants and controls (6.0 vs. 5.7 days). CONCLUSIONS RPRT reduced the need for specialized pediatric IFT, while enabling regionalization when appropriate. This study may have implications for the broader implementation of RPRT, while reducing costs to the healthcare system.
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Affiliation(s)
- Tanya Holt
- 1 Division of Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Nazmi Sari
- 2 Department of Economics, College of Arts and Science, University of Saskatchewan , Saskatoon, Canada
| | - Gregory Hansen
- 1 Division of Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Matthew Bradshaw
- 1 Division of Critical Care, Department of Pediatrics, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Michael Prodanuk
- 3 Department of Pediatrics, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Veronica McKinney
- 4 Northern Medical Services, Department of Family Medicine, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Rachel Johnson
- 4 Northern Medical Services, Department of Family Medicine, College of Medicine, University of Saskatchewan , Saskatoon, Canada
| | - Ivar Mendez
- 5 Department of Surgery, College of Medicine, University of Saskatchewan , Saskatoon, Canada
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Kurpas D, Szwamel K, Mroczek B. Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 910:71-85. [PMID: 26820726 DOI: 10.1007/5584_2015_203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits.
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Affiliation(s)
- Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland. .,Opole Medical School, 68 Katowicka St., 45-060, Opole, Poland.
| | - Katarzyna Szwamel
- Independent Public Healthcare Center, Hospital Emergency Ward and Admissions, 2 Roosevelta St., 47-200, Kędzierzyn- Koźle, Poland
| | - Bożena Mroczek
- Department of Humanities in Medicine, Faculty of Health Sciences, 11 Gen. Dezyderego Chłapowskiego St., 70-103, Szczecin, Poland
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Ye T, Sun X, Tang W, Miao Y, Zhang Y, Zhang L. Effect of continuity of care on health-related quality of life in adult patients with hypertension: a cohort study in China. BMC Health Serv Res 2016; 16:674. [PMID: 27894298 PMCID: PMC5125036 DOI: 10.1186/s12913-016-1673-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background Continuity of care is widely considered a principle of primary care that decreases healthcare utilization and mortality. However, the effect of continuity of care on health-related quality of life (HRQoL) for adult patients with hypertension remains unclear. Methods To further evaluate the effect of continuity of care, we implemented a cohort study among hypertensive patients aged over 35 years (n = 1200) in six townships in Qianjiang District, Chongqing, China, between 2012 and 2014. The study ultimately included 1079 participants. The continuity of care index was calculated using claim-based longitudinal data obtained from hypertension follow-up service records. The baseline and endline survey-based data, tested by the SF-36 scale, were used to assess HRQoL. To control selection bias and examine the effect of continuity of care, a kernel-based propensity score matching difference-in-differences (DID) method was used. Additionally, descriptive statistics, chi-squared test, and Mann–Whitney nonparametric test were used to summarize characteristics, evaluate proportional differences, and analyze statistical differences, respectively. Results Our results showed that patients in the high continuity of care group presented greater improvement in both Physical Component Summary (PCS, DID = 5.192 ± 1.970, p < 0.001) and Mental Component Summary (MCS, DID = 7.900 ± 1.815, p = 0.008) than those in the low continuity of care group. Moreover, patients in the high continuity of care group showed significant improvement in physical functioning, role-physical, general health, role-emotional, and mental health. Conclusions Our findings indicate that a long-term physician-patient relationship may improve HRQoL in patients with hypertension. However, more unified measurement tools are needed to evaluate continuity of care. Further studies should include more study settings.
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Affiliation(s)
- Ting Ye
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Xiaowei Sun
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Wenxi Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yudong Miao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China.
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