2019
Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/21613
Browse
Browsing 2019 by Author "Adams, Ann"
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item Number of interventions identified in the initial comprehensive medical review for HIV patients and its association to patient complexity(2019-03-05) Suzuki, Sumihiro; Clay, Patrick; Adams, AnnBackground: Over the past decades, there has been a marked decrease in HIV infection and morbidity rates, which has resulted in a growing and aging population of people living with HIV (PLWH) worldwide. In comparison to the general population, PLWH experience an increased risk of age-related morbidity. Among these, hypertension, hyperlipidemia, and endocrine disease (including diabetes) have been identified as the three most common comorbidities for this population, not including HIV. Furthermore, previous projections have indicated that the growth of the workforce providing HIV care is not enough to meet the needs of the growing PLWH population. To address the concerns associated with the care of this population, the patient-centered HIV care model designed to enhance medication therapy management (MTM) services provided by community-based pharmacists through partnerships with medical providers, has been suggested as a possible effective strategy. MTM are pharmacist-driven interventions (action plans) that aim to resolve medication-related issues. First, a systematic review of the patient’s entire medication regimen is conducted. After the review, the pharmacist will compile a medical action plan that consists of recommended actions for the patient, his/her care provider(s), or the pharmacist themselves to resolve the issues identified in the medication review process. Previous studies have noted the benefits of MTM for both HIV and certain chronic conditions. Despite this, there appear to be barriers to implementing these services on a regular basis. Surveyed pharmacists often cite lack of time as their top barrier to integrating MTM services within their practices and carrying out the actions plans identified. A few published studies have documented the amount of time that is allocated to providing MTM services, but no study has investigated the amount of time necessary to provide MTM to PLWH, a subpopulation whose needs are unique and complex. As most pharmacies have established industry standards for the time it takes for each intervention, a crucial first step for the regular adaptation of MTM services for PLWH is to quantify the number of interventions that they require to determine the time that would be required to care for these patients. Purpose: The purpose of this research is to determine the relationship between the three most common comorbidities for PLWH (i.e., hypertension, hyperlipidemia, and diabetes) and the number of interventions (as a proxy for time) identified on the comprehensive medication review at the baseline of a patient-centered HIV care model study. Methods: Data for this project were obtained from a patient-centered HIV care model study which was built as a part of a collaboration project between the CDC, Walgreens, and UNTHSC. Patients were recruited into the study across 10 different sites across 8 different states. Regression analysis was conducted for the analysis. Results and Conclusions: The analyses are still being conducted. We expect to find that there is an association between the complexity of the patient, i.e., more comorbidities, and the number of interventions. Such findings will help practitioners determine the amount of time that should be allocated for PLWH.Item Sports Team Participation: Suicidal Ideation Assessment of Adolescents in the U.S.(2019-03-05) Adams, Ann; Thompson, Erika; Dharni, LuvleenSports Team Participation: Suicidal Ideation Assessment of Adolescents in the U.S. Luvleen K. Dharni, MPH(c)1, Ann Adams, MS(c)2, Erika Thompson, Ph.D3 1. Department of Health Behavior and Systems, School of Public Health, UNTHSC 2. Department of Biostatistics and Epidemiology, School of Public Health, UNTHSC 3. Department of Health Behavior and Systems, School of Public Health, UNTHSC Purpose Increasing rates of depression and death by suicide among adolescent populations remains a key public health issue. As such, national health promotion programs have recommended an increase in physical activity as a potential approach to suicide prevention. It is important to explore whether participation or non-participation in sports activity impacts suicide ideation among adolescents. The objective of this study was to assess the association between participation in sports teams and suicidal ideation among US adolescents. Methods The Youth Risk Behavior Surveillance System (YRBSS) 2017 was examined among 9th– 12thgrade students in the United States. The initial inclusion sample size was a total of 14,765 usable observations and after a complete domain analysis, 3,466 participants are excluded for missing values with the final sample size of N=11,299. The outcome variable was suicidal ideation in the last 12 months. The predictor variable was participation in a sports team (yes/no). An adjusted survey-weighted logistic regression analysis in SAS 9.4 was used to assess the participation in sports teams and suicidal ideation adjusting for age, gender, grade level, and race/ethnicity. Results 17.1% of adolescents were found to consider suicidal ideation and 47.8% of those students participated in at least one or more sports team. Those who participated in 0 teams were significantly less likely to consider seriously attempting suicide than those who participated in one or more teams (OR=0.77, 95%CI 0.61,0.96). Females were less likely (OR=0.48, 95%CI 0.40, 0.57) to consider suicide ideation than males. Multiple non-Hispanic were less likely to have suicidal ideations than their white counterparts (OR=0.70, 95%CI 0.50,0.89). Conclusions The findings indicate participation in 0 sports teams may be a protective factor against suicidal ideation when controlling for age, gender, grade level, and race/ethnicity. This may be indicative of student participation in one team or more may be a burden or stressor contributing to adolescents’ mental health status. Next steps could consider assessing the dose of the sports activity and its influence on adolescent’s mental health status.Item Study of trends in opioid prescription for chronic abdominal pain from 2009-2014 using National Ambulatory Medical Care Survey (NAMCS) data(2019-03-05) Adams, Ann; Aryal, Subhash; Maack Rangel, Jessica; Dodgen, LeilaniPurpose: Chronic abdominal pain (CAP) is a common reason for health care visits affecting approximately 25% of adults. Often opioids are prescribed to treat CAP, though there is not much evidence to support this. Opioid use has been connected to increased morbidity and mortality of patients including drug misuse, abuse and exacerbation of abdominal pain. The purpose of this study is to examine national trends in prescriptions of opioids for treating CAP using National Ambulatory Medical Care Survey (NAMCS). Methods: NAMCS data were retrieved from the National Center for Health Care Statistics (2009-2014). The original data were paired into two-year groupings. We conducted stratified analysis and combined analysis for each 2-year period. We categorized patient diagnoses via the clinical classification software (CCS). Patient data were included if they were 18 or older and the reason for visit was CAP (including: Stomach pain, cramps, spasms, generalized lower or upper abdominal pain, and liver, gallbladder, or biliary tract pain). Certain types of abdominal pain were excluded including: pain from injury, infectious/parasitic diseases, neoplasms, diseases of the genitourinary system and pregnancy/childbirth complications. Logistic regression was used to determine trends in the number of visits where opioids were prescribed, and factors related to opioid prescriptions. Results: Visits for 2009-2010, 2011-2012, 2013-2014 were 10.3 million, 9.7 million and 10.2 million respectively. During the same time periods the estimated number of opioid prescriptions for treating CAP were 300 thousand, 400 thousand and 100 thousand respectively. There were no significant differences in the number of opioid prescriptions between time periods (p [greater than] 0.05). Conclusions: Even though an increasing trend for opioid prescriptions was reported in the literature for treating abdominal pain for 1997-1999 (7.9% increase) and 2006-2008 (15.5% increase), this analysis revealed the opioid prescription rate during this study period was not statistically different from year to year. Further analyses will incorporate additional data from the National Hospital Ambulatory Medical Care Survey (collected with NAMCS) which only contains hospital outpatient visits. This will contribute to a more robust, evidence-based analysis about practices in opioid prescribing, and inform the work of clinicians and public health officials working to address the US opioid epidemic today.