1
|
Miles J, Treitler P, Hermida R, Nyaku AN, Simon K, Gupta S, Crystal S, Samples H. Racial/ethnic disparities in timely receipt of buprenorphine among Medicare disability beneficiaries. Drug Alcohol Depend 2023; 252:110963. [PMID: 37748421 PMCID: PMC10615876 DOI: 10.1016/j.drugalcdep.2023.110963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Medicare disability beneficiaries (MDBs) have disproportionately high risk of opioid use disorder (OUD) and related harms given high rates of comorbidities and high-dose opioid prescribing. Despite this increased risk, little is known about timely receipt of medication for opioid use disorder (MOUD), including potential disparities by patient race/ethnicity or moderation by county-level characteristics. METHODS National Medicare claims for a sample of MDBs with incident OUD diagnosis between March 2016 and June 2019 were linked with county-level data. Multivariable mixed effects Cox proportional hazards models estimated time (in days) to buprenorphine receipt within 180 days of incident OUD diagnosis. Primary exposures included individual-level race/ethnicity and county-level buprenorphine prescriber availability, percent non-Hispanic white (NHW) residents, and Social Deprivation Index (SDI) score. RESULTS The sample (n=233,079) was predominantly White (72.3%), ≥45 years old (76.3%), and male (54.8%). Black (adjusted hazard ratio [aHR]=0.50; 95% CI, 0.47-0.54), Asian/Pacific Islander (aHR=0.54; 95% CI, 0.41-0.72), Hispanic/Latinx (aHR=0.81; 95% CI, 0.76-0.87), and Other racial/ethnic groups (aHR=0.75; 95% CI, 0.58-0.97) had a lower likelihood of timely buprenorphine than non-Hispanic white beneficiaries after adjusting for individual and county-level confounders. Timely buprenorphine receipt was positively associated with county-level buprenorphine prescriber availability (aHR=1.05; 95% CI, 1.04-1.07), percent non-Hispanic white residents (aHR=1.01; 95% CI, 1.00-1.01), and SDI (aHR=1.06; 95% CI, 1.01-1.10). CONCLUSIONS Racial/ethnic disparities highlight the need to improve access to care for underserved groups. Implementing equity-focused quality and performance measures and developing interventions to increase office-based buprenorphine prescribing in predominantly minority race/ethnicity counties may reduce disparities in timely access to medication for OUD.
Collapse
Affiliation(s)
- Jennifer Miles
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
| | - Peter Treitler
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA; School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Richard Hermida
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Amesika N Nyaku
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kosali Simon
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA; National Bureau of Economic Research, Cambridge, MA, USA
| | - Sumedha Gupta
- Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Stephen Crystal
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA; School of Social Work, Rutgers University, New Brunswick, NJ, USA; School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| |
Collapse
|
2
|
Miles J, Treitler P, Lloyd J, Samples H, Mahone A, Hermida R, Gupta S, Duncan A, Baaklini V, Simon KI, Crystal S. Racial And Ethnic Disparities In Buprenorphine Receipt Among Medicare Beneficiaries, 2015-19. Health Aff (Millwood) 2023; 42:1431-1438. [PMID: 37782874 PMCID: PMC10910625 DOI: 10.1377/hlthaff.2023.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
We examined Medicare Part D claims from the period 2015-19 to identify state and national racial and ethnic disparities in buprenorphine receipt among Medicare disability beneficiaries with diagnosed opioid use disorder or opioid overdose. Racial and ethnic disparities in buprenorphine use remained persistently high during the study period, especially for Black beneficiaries, suggesting the need for targeted interventions and policies.
Collapse
Affiliation(s)
- Jennifer Miles
- Jennifer Miles , Rutgers University, New Brunswick, New Jersey
| | | | | | | | | | | | - Sumedha Gupta
- Sumedha Gupta, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | | | | | - Kosali I Simon
- Kosali I. Simon, Indiana University, Bloomington, Indiana
| | | |
Collapse
|
3
|
Walkup J, Thomas MD, Vittinghoff E, Hermida R, Crystal S, Arnold EA, Dahiya P, Olfson M, Cournos F, Dawson L, Dilley J, Bazazi A, Mangurian C. Characteristics and Trends in HIV Testing Among Medicaid Enrollees Diagnosed as Having Schizophrenia. Psychiatr Serv 2023; 74:709-717. [PMID: 36852552 PMCID: PMC10329993 DOI: 10.1176/appi.ps.20220311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE People with schizophrenia have more HIV risk factors and higher rates of HIV infection than the general U.S. population. The authors aimed to examine HIV testing patterns in this population nationally and by demographic characteristics and presence of high-risk comorbid conditions. METHODS This retrospective longitudinal study compared HIV testing between Medicaid-only enrollees with schizophrenia and without schizophrenia during 2002-2012 (N=6,849,351). Interrupted time series were used to analyze the impacts of the 2006 federal policy change recommending expanded HIV testing. Among enrollees with schizophrenia, multivariable logistic regression was used to estimate associations between testing and both demographic characteristics and comorbid conditions. Sensitivity analyses were also conducted. RESULTS Enrollees diagnosed as having schizophrenia had consistently higher HIV testing rates than those without schizophrenia. When those with comorbid substance use disorders or sexually transmitted infections were excluded, testing was higher for individuals without schizophrenia (p<0.001). The federal policy change likely increased testing for both groups (p<0.001), but the net change was greater for those without schizophrenia (3.1 vs. 2.2 percentage points). Among enrollees with schizophrenia, testing rates doubled during 2002-2012 (3.9% to 7.2%), varied across states (range 17 percentage points), and tripled for those with at least one annual nonpsychiatric medical visit (vs. no visit; adjusted OR=3.10, 95% CI=2.99-3.22). CONCLUSIONS Nationally, <10% of enrollees with schizophrenia had annual HIV testing. Increases appear to be driven by high-risk comorbid conditions and nonpsychiatric encounters, rather than by efforts to target people with schizophrenia. Psychiatric guidelines for schizophrenia care should consider HIV testing alongside annual metabolic screening.
Collapse
Affiliation(s)
- James Walkup
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Marilyn D Thomas
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Priya Dahiya
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Mark Olfson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Francine Cournos
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - James Dilley
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Alexander Bazazi
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| |
Collapse
|
4
|
Treitler P, Samples H, Hermida R, Crystal S. Association of a State Prescribing Limits Policy with Opioid Prescribing and Long-term Use: an Interrupted Time Series Analysis. J Gen Intern Med 2023; 38:1862-1870. [PMID: 36609812 PMCID: PMC10271990 DOI: 10.1007/s11606-022-07991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prescription opioids were a major initial driver of the opioid crisis. States have attempted to reduce overprescribing by enacting policies that limit opioid prescriptions, but the impacts of such policies on new prescribing and subsequent transitions to long-term use are not fully understood. OBJECTIVE To examine the association of implementation of a state prescribing limits policy with opioid prescribing and transitions to long-term opioid use. DESIGN Interrupted time series analyses assessing trends in new opioid prescriptions and long-term use before and after policy implementation. PATIENTS A total of 130,591 New Jersey Medicaid enrollees ages 18-64 who received an initial opioid prescription from January 2014 to December 2019. INTERVENTIONS New Jersey's opioid prescribing limit policy implemented in March 2017. MAIN MEASURES Total new opioid prescriptions, percentage of new prescriptions with >5 days' supply, and transition to long-term opioid use, defined as having opioid supply on day 90 after the initial prescription. KEY RESULTS Policy implementation was associated with a significant monthly increase in new opioid prescriptions of 0.86 per 10,000 enrollees, halving the pre-policy decline in the prescribing rate. Among new opioid prescriptions, the percentage with >5 days' supply decreased by about 1 percentage point (-0.76 percentage points, 95% CI -0.89, -0.62) following policy implementation. However, policy implementation was associated with a significant monthly increase in the rate of initial prescriptions with supply on day 90 (9.95 per 10,000 new prescriptions, 95% CI 4.80, 15.11) that reversed the downward pre-implementation trend. CONCLUSIONS The New Jersey policy was associated with a reduction in initial prescriptions with >5 days' supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.
Collapse
Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy & Aging Research, Rutgers University, New Brunswick, NJ USA
- School of Social Work, Rutgers University, New Brunswick, NJ USA
| | - Hillary Samples
- Institute for Health, Health Care Policy & Aging Research, Rutgers University, New Brunswick, NJ USA
- School of Public Health, Rutgers University, Piscataway, NJ USA
| | - Richard Hermida
- Institute for Health, Health Care Policy & Aging Research, Rutgers University, New Brunswick, NJ USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy & Aging Research, Rutgers University, New Brunswick, NJ USA
- School of Social Work, Rutgers University, New Brunswick, NJ USA
- School of Public Health, Rutgers University, Piscataway, NJ USA
| |
Collapse
|
5
|
Hwong AR, Vittinghoff E, Thomas M, Hermida R, Walkup J, Crystal S, Olfson M, Mangurian C. Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2023; 74:497-504. [PMID: 36226372 PMCID: PMC10104476 DOI: 10.1176/appi.ps.20220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia. METHODS Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates. RESULTS In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001). CONCLUSIONS Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.
Collapse
Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Richard Hermida
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - James Walkup
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| |
Collapse
|
6
|
Treitler P, Crystal S, Hermida R, Miles J. Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates. Innov Aging 2020. [PMCID: PMC7740947 DOI: 10.1093/geroni/igaa057.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.
Collapse
Affiliation(s)
- Peter Treitler
- Rutgers University, New Brunswick, New Jersey, United States
| | - Stephen Crystal
- Rutgers University, New Brunswick, New Jersey, United States
| | - Richard Hermida
- Rutgers University, New Brunswick, New Jersey, United States
| | - Jennifer Miles
- Rutgers University, New Brunswick, New Jersey, United States
| |
Collapse
|
7
|
Treitler P, Crystal S, Hermida R. Diagnosed Opioid Use Disorder Among Older Adults: Complex Comorbidity and Management Challenges. Innov Aging 2020. [PMCID: PMC7741330 DOI: 10.1093/geroni/igaa057.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the face of a widespread opioid epidemic and many policy changes affecting opioid access and management, it is important to understand the prevalence and characteristics of diagnosed opioid use disorder in older people and their implications for effective management of this high-risk population. We examined these issues in an ~40% random sample of Medicare beneficiaries with Part D coverage. In 2017, .8% of beneficiaries ages 65+ were diagnosed with OUD (opioid abuse or dependence diagnoses), an increase from .5% in 2015. The late-2015 transition from ICD-9 to ICD-10 may have contributed to this change, but the rate also increased post-ICD-10 by 9.1% from 2016-2017. The profile of individuals diagnosed with OUD reveals a population with complex comorbidity and multiple health challenges: 45% were diagnosed with major depression, 7% with alcohol disorders, 45% with anxiety, 8% with hepatitis C, 26% with cancer, 38% with COPD and 19% with pneumonia (risk factors for opioid overdose), 56% with diabetes and 27% with heart failure. 97% were diagnosed with pain conditions, 85% received opioid prescriptions, and 38% received benzodiazepine prescriptions. These patients represent complex and potentially competing challenges in concurrent management of pain, opioid use disorder, multi-substance use and opioid use disorder. Development of effective, integrated care models to simultaneously address these interrelated problems in this high-risk population should be informed by a closer focus on their multiple needs and monitoring of the adequacy of health system response.
Collapse
Affiliation(s)
- Peter Treitler
- Rutgers University, New Brunswick, New Jersey, United States
| | - Stephen Crystal
- Rutgers University, New Brunswick, New Jersey, United States
| | - Richard Hermida
- Rutgers University, New Brunswick, New Jersey, United States
| |
Collapse
|
8
|
Miles J, Crystal S, Treitler P, Hermida R. Medically Assisted Treatment of Opioid Use Disorder Among Elderly and Non-Elderly Medicare Beneficiaries. Innov Aging 2020. [PMCID: PMC7742226 DOI: 10.1093/geroni/igaa057.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Although medication for addiction treatment (MAT) is known to be the most effective treatment for opioid use disorder (OUD), these medications are widely underutilized, especially among older adults and racial/ethnic minorities. Of the three main MAT modalities, Medicare covered buprenorphine and naltrexone in 2017; methadone was not covered until 2020. We examined MAT prescribing among elderly compared with non-elderly Medicare beneficiaries. Our sample was drawn from a ~40% random sample of 2017 Medicare beneficiaries with Part D coverage and was comprised of elderly beneficiaries (age 65+) with OUD (N=112,314) or who experienced opioid poisoning (N=9,657), and non-elderly Medicare beneficiaries (the Medicare disability population, age 0-64) with OUD (N=161,423) or opioid poisoning (N=13,591). MAT was underutilized in both Medicare populations, but especially in the elderly population. Of elderly beneficiaries with OUD, 5.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 15.5% and 2.3% among non-elderly. Among elderly beneficiaries with opioid poisoning, 3.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 10.1% and 3.2% in the non-elderly population. Sharp racial/ethnic disparities were identified within each age group. These findings highlight the need to expand access to MAT for Medicare beneficiaries, particularly older adults among whom underutilization is pronounced. Several recent Medicare policy changes have sought to address this issue, but continuing efforts and close monitoring are warranted in an effort to dramatically increase rates of treatment for elderly with opioid use disorder.
Collapse
Affiliation(s)
- Jennifer Miles
- Rutgers University, New Brunswick, New Jersey, United States
| | - Stephen Crystal
- Rutgers University, New Brunswick, New Jersey, United States
| | - Peter Treitler
- Rutgers University, New Brunswick, New Jersey, United States
| | - Richard Hermida
- Rutgers University, New Brunswick, New Jersey, United States
| |
Collapse
|
9
|
Crystal S, Jarrín OF, Rosenthal M, Hermida R, Angell B. National Partnership to Improve Dementia Care in Nursing Homes Campaign: State and Facility Strategies, Impact, and Antipsychotic Reduction Outcomes. Innov Aging 2020; 4:igaa018. [PMID: 32699827 PMCID: PMC7365953 DOI: 10.1093/geroni/igaa018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications. Research Design and Methods Our mixed-methods strategy integrated administrative and clinical data analyses with state and facility case studies. Results Results suggest that substantial change in prescribing is achievable through sustained, data-informed quality improvement initiatives integrating educational and regulatory interventions, supported by public quality reporting. Adequate staffing, particularly of registered nurses, is key to support individualized management of symptoms through nonpharmacological strategies. Case study results suggest that state and facility initiatives during the campaign achieved considerable buy-in for the goal of more conservative prescribing, through a social process of normalization. Reporting and reduction of antipsychotic use was not followed by increases in sedative-hypnotic medication use. Rather, sedative-hypnotic use declined in tandem with antipsychotic reduction, suggesting that increased attention to prescribing patterns led to more cautious use of other risky psychotropic medications. Discussion and Implications Quality improvement initiatives to change entrenched but problematic clinical practices face many barriers to success, including provider-level inertia; perceptions that alternatives are not available; and family and staff resistance. Nevertheless, systemic change is possible through concerted, collaborative efforts that touch prescribing practices at multiple points; integrate educational and regulatory influences; activate local and state champions for improvement; foster reputational influences through public reporting and benchmarking; and support a social process of normalization of preferred care processes as a best practice that is in the interest of patients.
Collapse
Affiliation(s)
- Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick.,School of Social Work, Rutgers, The State University of New Jersey, New Brunswick
| | - Olga F Jarrín
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick.,School of Nursing, Rutgers, The State University of New Jersey, Newark
| | - Marsha Rosenthal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick
| | - Beth Angell
- School of Social Work, Virginia Commonwealth University, Richmond
| |
Collapse
|
10
|
Crystal S, Hermida R, Jarrín OF, Neese-Todd S, Angell B, Rosenthal M. REDUCING ANTIPSYCHOTIC PRESCRIBING IN NURSING HOMES: FACILITATORS AND BARRIERS FOR HIGH-IMPACT STATE INITIATIVES. Innov Aging 2019. [PMCID: PMC6844979 DOI: 10.1093/geroni/igz038.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In conjunction with the National Partnership to Improve Dementia Care in Nursing Homes initiated in 2012, states implemented initiatives to reduce antipsychotic use. All achieved substantial reductions, but improvement varied across states. By 2018, several states had achieved reductions of more than 45%, including several of the largest states. These reductions are noteworthy given the challenging nature of behavioral symptoms of dementia, and difficulties encountered historically and internationally in changing strongly-rooted clinical practices. How were these successful interventions achieved in high-performing state initiatives? What were the barriers encountered and facilitators that helped overcome these barriers? What does this experience suggest for sustainability of change? To address these questions, we draw on a mixed-methods study of antipsychotic prescribing in nursing homes incorporating analyses of prescribing data, state policy case studies, and facility case studies. Successful states integrated large-scale educational initiatives with strong regulatory action, often focusing especially on laggard facilities. Texas’ initiative was particularly noteworthy, achieving a 56.5% reduction across its far-flung network of nearly 100,000 residents and 1,200 facilities. Texas used metrics to identify facilities that achieved notable reductions in antipsychotic prescribing, and encouraged them to share their strategies with “late adopters”. The state deployed a designated Quality Monitoring Program (QMP), distinct from the survey process, to provide on-site technical assistance to laggard facilities, and provided education for all levels of staff and assistance in implementing data-driven improvement strategies. Successful state initiatives achieved considerable buy-in on the need to reduce antipsychotic use, a key factor in achieving successful system change.
Collapse
Affiliation(s)
- Stephen Crystal
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States
| | - Richard Hermida
- Rutgers University, New Brunswick, New Jersey, United States
| | - Olga F Jarrín
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States
| | - Sheree Neese-Todd
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States
| | - Beth Angell
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Marsha Rosenthal
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States
| |
Collapse
|
11
|
Crystal S, Crystal O, Angell B, Hermida R, Rosenthal M. PROGRESS TOWARD SAFER MANAGEMENT OF BEHAVIORAL SYMPTOMS OF DEMENTIA: WHAT ARE THE LEVERS OF CHANGE? Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Jarrin O, Francel Bautista D, Cho C, Tay W, Hermida R. VALUING INVESTMENTS IN NURSING HOME STAFFING AND STAFF EDUCATION FOR RESIDENTS AND PAYERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O.F. Jarrin
- Rutgers, The State University of New Jersey, School of Nursing, Newark, New Jersey,
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - D. Francel Bautista
- School of Nursing, Rutgers, The State University of New Jersey, Devon, Pennsylvania,
| | - C. Cho
- School of Nursing, Rutgers, The State University of New Jersey, Devon, Pennsylvania,
| | - W. Tay
- School of Nursing, Rutgers, The State University of New Jersey, Devon, Pennsylvania,
| | - R. Hermida
- School of Nursing, Rutgers, The State University of New Jersey, Devon, Pennsylvania,
| |
Collapse
|
13
|
Hermida R, Ayala DE, Mojon A, Chayan L, Dominguez MJ, Fontao MJ, Alonso I, Fernandez JR. DECREASING SLEEP-TIME BLOOD PRESSURE DETERMINED BY AMBULATORY MONITORING REDUCES CARDIOVASCULAR RISK IN RESISTANT HYPERTENSION. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-01657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Alonso I, Roca-Cusachs A, Hermida R, Benet T, Sole M, Gudina N, Abasolo S. PREVALENCE OF REVERSE WHITE-COAT HYPERTENSION AS A FUNCTION OF AGE AND GENDER IN TREATED HYPERTENSIVE PATIENT. J Hypertens 2004. [DOI: 10.1097/00004872-200406002-00528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Hermida R, Calvo C, Ayala D, Dominguez M, Covelo M, Lopez J. M.530 Elevated ambulatory pulse pressure in patients with type 2 diabetes mellitus. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Calvo C, Hermida R, Ayala D, Lopez J, Dominguez M, Covelo M. M.480 Effects of atorvastatin on ambulatory blood pressure in hyperlipidemic patients with untreated mild hypertension. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90478-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Hermida R, Calvo C, Ayala D, Dominguez M, Covelo M, Mojon A, Fernandez J, Lopez J. M.528 Administration time-dependent effects of valsartan on ambulatory blood pressure in non-dipper hypertensive patients. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Calvo C, Hermida R, Ayala D, Dominguez M, Covelo M, Lopez J. M.477 Ambulatory blood pressure pattern in patients with resistant hypertension as a function of the circadian time of antihypertensive therapy. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
Hermida R. Influence of parity and age on ambulatory monitored blood pressure during pregnancy. Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
20
|
Hermida R. Blood pressure differences between consecutive days of ambulatory monitoring in hypertensive patients. Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
21
|
Hermida R. Lack of seasonal differences of blood pressure in healthy normotensive young subjects. Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
22
|
Hermida R. Tolerance limits for ambulatorily monitored blood pressure in pregnancy. Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
23
|
Hermida R. Relationship between physical activity and blood pressure in dipper and non-dipper hypertensive patients. Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
24
|
Hermida R. Should ambulatory monitoring replace casual blood pressure measurement as the “gold standard” in the diagnosis of gestational hypertension? Am J Hypertens 2001. [DOI: 10.1016/s0895-7061(01)01363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
Hermida R. Circadian variation in serum atrial natriuretic prohomones and blood pressure in aging male subjects. Am J Hypertens 2000. [DOI: 10.1016/s0895-7061(00)01099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
26
|
Hermida R. Administration-time dependent effects of low-dose aspirin on blood pressure in high risk pregnant women. Am J Hypertens 2000. [DOI: 10.1016/s0895-7061(00)00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
27
|
Hermida R. Changes in the circadian variation of serum lipids with aging in normotensive male subjects. Am J Hypertens 2000. [DOI: 10.1016/s0895-7061(00)01100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
28
|
Halberg F, Zaslavskaya RM, Cornelissen G, Halberg E, Rigo J, Paulin F, Adam Z, Rigo JS, Majioni S, Mello J, Scarpelli PT, Hermida R, Tarkvini B, Cagnioni M, Otsuka K, Watanabe J, Quadence O, Cugini P, Algren A, Tamura K, Bakken E. Blood pressure monitoring according to the “womb to tomb” program with consideration of the chronome in humans. Bull Exp Biol Med 1993. [DOI: 10.1007/bf00836429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Halberg F, Lakatua D, Lodeiro C, Garcia L, Hermida R, Ayala DE, Tarquini B, Haus E, Cornélissen G. Chronobiology, growth hormone and healthy and malignant growth. J Endocrinol Invest 1989; 12:41-7. [PMID: 2681347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronobiology, the computer-aided science (logos) of life (bios) in time (chronos), provides novel concepts, tools and facts for those concerned with mitosis, growth and growth hormone (GH). GH concentrations in human plasma demonstrate a statistically significant circadian rhythm on a 6h as well as on a 24h rest-activity cycle. On a 24h routine of light (L) and darkness (D), alternating at 12h intervals, and in continuous D, circadian mitotic rhythms in mice persist as a feature of growth or regeneration. A circadian cell cycle commences with an increase in phospholipid labeling, followed by an increase in cytoplasmic RNA formation, preceding, in regular sequences, an increase in nuclear DNA formation and the next mitotic peak in those cells that are dividing in a growing or regenerating (reversibly "post-mitotic') rodent liver. About 5-day (presumably estral) and about 7-day (circaseptan) components as well as circadians are resolved as a spectrum of mitotic rhythms in rodent cornea. The effects of hormones such as GH or a synthetic ACTH analogue, ACTH 1-17, depend upon the circadian cell cycle stages when the agent is administered. No effect or statistically significant effect can be the result only of 1) the timing of a fixed dose of GH or 2) of the timing of the samples taken to investigate any effect. For both the timing of administration and the assessment of effects, a multifrequency spectrum of rhythms, if taken into account, can provide (in lieu of a considerable and often formidable source of variation) a new critical dimension of growth and development.
Collapse
Affiliation(s)
- F Halberg
- University of Minnesota, Minneapolis 55455
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Halberg J, Halberg F, Halberg F, Halberg E, Hermida R, Mainardi G, Panero C, Tarquini B, Cornélissen G, Cariddi A. Further steps toward a neonatal chronocardiology. Chronobiologia 1987; 14:297-9. [PMID: 3677926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The study of 53 series of blood pressures at half-hour intervals from clinically healthy full-term newborns during the first days of life reveals various classifiers correlating with a history of high blood pressure: the circadian amplitude of diastolic blood pressure, the 50% range of systolic blood pressure and the standard deviation of heart rate.
Collapse
Affiliation(s)
- J Halberg
- Hennepin County Medical Center, Minneapolis, Minnesota
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Klockars M, Azar HA, Hermida R, Isobe T, Hsu CC, Ansari H, Osserman EF. The relationship of lysozyme to the nephropathy in chloroleukemic rats and the effects of lysozyme loading on normal rat kidneys. Cancer Res 1974; 34:47-60. [PMID: 4588549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|