Browsing by Author "Aguiniga, Ashlyn"
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Item Diabetes-Related Outcomes of an Interprofessional Chronic Care Management (CCM) Service in Medicare Beneficiaries(2023) Rodriguez, Emmanuel; Wesling, Megan; Nguyenly, Angel; Ebert-Blackburn, Didi; Aguiniga, AshlynPurpose: Patients with type 2 diabetes (T2D) often have coexisting conditions requiring consistent monitoring and preventative measures. Chronic Care Management (CCM) is a Medicare program that aims to improve chronic disease state management, however literature on clinical outcomes is lacking. The purpose of this study is to evaluate the diabetes-related outcomes of an interprofessionally-delivered CCM program in patients where Medicare is the singular payer and secondarily, its financial impact. Methods: Adult Medicare patients with T2D enrolled in CCM between February 2020 and August 2021 were included in this retrospective chart review. Participants were evaluated pre- and post-CCM enrollment using non-parametric tests on 1) clinical measures such as A1C; 2) preventative measures; and 3) involvement of clinical staff such as pharmacists and social workers. Descriptive statistics were used to describe financials. Results: Thirty-three patients were included in the study. Changes in clinical measures included a significant reduction in mean A1C from 8.4% to 7.4% (p=0.012), and a nonsignificant reduction in blood pressure and body mass index. There was also a significant increase in pharmacist and social worker involvement, but no significant changes to preventative measures. A total of $26,673.00 was billed to Medicare, with a reimbursement rate of 44%. Conclusion: The CCM service demonstrated a significant reduction in A1C and a significant increase in pharmacist and social worker access. There were no significant changes in preventative measures, likely due to the overlapping study period and COVID-19 pandemic. Future studies outside of pandemic conditions are needed to further assess these nonsignificant outcomes.Item Evaluation of Create-Your-Own-Adventure Activities on Student Knowledge and Critical Thinking Skills in Second-Year Student Pharmacists(2023) Phillips, Heather; Aguiniga, Ashlyn; Howard, MeredithPurpose: Create-your-own-adventure (CYOA) activities are educational innovations where students choose the "best pathway” of treatment. Current literature suggests increased student perception of knowledge and critical thinking skills with use of CYOA activities; however, evidence that such skills ultimately improve is lacking. The primary objective of this study is to assess changes in knowledge and critical thinking after completing a CYOA activity. Methods: Seventy-five second-year pharmacy students completed a CYOA activity on venous thromboembolism, with a six-question quiz immediately before and after. Questions were mapped to pre-set learning objectives with slight alterations to questions on each assessment. Four questions were then mapped to the final exam which occurred approximately three weeks after the activity. Friedman’s two-way analysis and Cochran’s Q test were used to evaluate differences in scores. Descriptive statistics were used to describe student perceptions and scores on a modified Need for Cognition scale. Results: There was a significant decrease in mean scores for each assessment (68.1% vs. 64.9%, vs. 40.0%; p<0.001). Similar results were found when stratifying scores by question. Of the 48 survey responses, 94% preferred the CYOA activity and perceived increased critical thinking skills. All Need for Cognition items scored >3.5, indicating satisfaction in critical thinking. Conclusions: Although we hypothesized an increase in scores with use of CYOA activities, there was a negative association between the activity and scores. Possible limitations include mapped questions that were too dissimilar, VTE management being too multivariate, and lower student retention of cumulative material on finals. These limitations will be addressed in future CYOA activities.Item Outcomes of a Team-Based Chronic Care Management Service in a Dual-Eligible Medicare and Medicaid Population with Diabetes Mellitus(2023) Nguyenly, Angel; Aguiniga, Ashlyn; Rodriguez, Emmanuel; Ebert-Blackburn, Didi; Wesling, MeganTitle: Outcomes of a Team-Based Chronic Care Management Service in a Dual-Eligible Medicare and Medicaid Population with Diabetes Mellitus Purpose: Patients receiving Medicare and Medicaid benefits (dual-eligible) have a higher prevalence of multiple comorbidities, including diabetes mellitus. This same population is less likely to have routine preventative measures completed and a higher incidence of disease-related complications. The purpose of this study is to evaluate the effectiveness of a team-based Chronic Care Management (CCM) program in achieving health outcomes in dual-eligible patients with type 2 diabetes (T2D) and the financial sustainability of a CCM program. Methods: Dual-eligible patients with T2D meeting CCM enrollment criteria were evaluated in a retrospective, pre-/post- intervention, observational chart review study from March 2019 to August 2021. Statistical analyses using non-parametric tests evaluated clinical outcomes (e.g., hemoglobin A1c), preventative measures and clinical staff encounters. Preliminary financials are reported descriptively. Results: Twenty-six patients were included in the analysis. There was a significant reduction in mean A1c levels (8.15% to 7.34%, p = 0.035). Changes in preventative metrics included a statically significant increase in statin prescriptions (p=0.039) while a non-significant increase in pneumococcal and influenza vaccine rates and depression screenings is noted. $14,721.00 was billed to insurers for the service with a reimbursement rate of 39.6%. Conclusion: This study shows that team-based patient care in a CCM program improves A1c levels and supports achievement of preventative measures. Full realization of intervention impact limited by the lack of in-person access to healthcare services due to shutdowns in response to the global pandemic.Item Right on Target? Analysis of LDL Levels and Medication Use in a Very High-Risk ASCVD Population(2024-03-21) Xavier, Christy; Aguiniga, AshlynPurpose: The American College of Cardiology (ACC) released an expert consensus pathway in 2022, introducing a new low-density lipoprotein (LDL) goal < 55 for very high-risk individuals with atherosclerotic vascular disease (ASCVD) and highlighting the need for additional non-statin therapies to achieve that goal and reduce the risk of recurrent cardiovascular (CV) events, hospitalization, and death. This study seeks to investigate whether this LDL target is being achieved and the antihyperlipidemic medications used in a very high-risk ASCVD primary care population at the UNTHSC Family Medicine Clinic. Methods: This is a retrospective chart review using the NextGen electronic record to evaluate patients at the UNTHSC Family Medicine Clinic. Living adults with very high-risk ASCVD were included. Very high-risk was defined as multiple major ASCVD events (myocardial infarction [I25.2, I22] or stroke [I63, Z86.73]) or one major ASCVD event and multiple high-risk conditions (heart failure [I50], diabetes [E10-E13], hypertension [I10-16], chronic kidney disease [N18], age > 65 years old, and current tobacco use). Demographics such as gender, race/ethnicity, insurance, and medications were also collected. Very high-risk ASCVD patients were then stratified based on LDL goal achievement and analyzed using Chi-square analysis, independent sample T-test, and descriptive statistics using SPSS. Results: Of the identified very high-risk ASCVD patients (n = 199), 60 (30.2%) had achieved an LDL goal < 55 mg/dL. The average LDL achieved in this group was 44.2 + 10.8 mg/dL vs. 98.6 + 44.0 mg/dL for non-achievers. All those who achieved an LDL goal < 55 mg/dL were on at least one antihyperlipidemic medication. Of those who achieved an LDL goal < 55 mg/dL, 49 (81.7%) were on a high-intensity statin, 8 (13.33%) were on ezetimibe, 6 (10%) were on fish oil, and 3 (5%) were on a PCSK9 inhibitor. No patients were prescribed bempedoic acid or inclisirin. For non-achievers, 81 (58.2%) were on a high-intensity statin, 10 (7.2%) were on ezetimibe, 14 (10.1%) were on fish oil, and only one (0.72%) patient was on a PCSK9 inhibitor. Twenty (14.4%) of the non-achievers were not on any antihyperlipidemic agents. This subset of patients had a much higher average LDL (108.1 + 33.3 mg/dL), and 20% had a history of multiple ASCVD events. LDL goal achievers were slightly older (average age 68.2 + 9.9 years vs. 65.5 + 10.5 years), male (60% vs. 33.6%), and commercially insured compared to non-achievers. Conclusions: A majority of very high-risk ASCVD patients at the UNTHSC Family Medicine Clinic are not currently achieving the LDL goal < 55 mg/dL. Additionally, non-statin therapies are not being widely used to augment statin therapy. Further investigation is needed to determine potential barriers and limitations to achieving this lower LDL target.Item Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States(2024-03-21) Collins, Dallas; Kelly, Brittany; Aguiniga, Ashlyn; Pinnamraju, Jahnavi; Sambamoorthi, UshaTitle Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States Authors Dallas Collins, Brittany Kelly, Ashlyn Aguiniga, Jahnavi Pinnamraju, Usha Sambamoorthi Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1) contribute to glycemic control and weight loss in patients with type 2 diabetes mellitus (T2DM). Although obesity is an important determinant of GLP-1 use, research studies have suggested racial, ethnic, and socioeconomic inequities in GLP-1 use may also exist. The purpose of this study is to determine associations of obesity and social determinants of health (SDOH) with GLP-1 use in a large, nationally representative sample of US households. Methods This is a cross-sectional analysis of adults (age > 18 years) with T2DM using pooled data from multiple years of the Medical Expenditure Panel Survey (2016, 2018, and 2020). The MEPS is a nationally representative survey of civilian non-institutionalized households in the US. Diabetes was identified from both medical conditions and household files. GLP-1 use was extracted from prescription drug event files using the multum classification therapeutic sub-sub class codes. Obesity was measured using body mass index categories using the CDC standards. We restricted our analysis to adults without missing data on body mass index. Rao-Scott chi-square tests were used to assess the unadjusted associations of categorical variables with GLP-1 use. Multivariable logistic regression with survey weights was conducted to analyze the association of obesity and SDOH variables (education, poverty, health insurance, metro area, and marital status) after controlling for gender, age, and health conditions. All analyses were conducted with SAS 9.4 survey procedures. Results There were 7,298 participants representing ~27.3 million US adults with T2DM. Overall, 7.7% of adults reported using GLP-1 and 55.2% had obesity. A higher percentage of obese adults reported GLP-1 use compared to normal and underweight adults (10.2% vs. 4.2%). Those with college education had higher rates of GLP-1 use compared to those with less than high school education (10.2 vs. 4.0%). Multivariable fully adjusted logistic regression confirmed that obesity was associated with higher odds of GLP-1 use (AOR=2.44, 95% CI= 1.58-3.76 p < 0.001) and lower less than high school (AOR=0.40, 95% CI=0.25-0.62 p <0.001) and high school education (AOR=0.72, 95% CI= 0.52-0.99, p=0.0434) were associated with lower odds of GLP-1 use. Conclusion Approximately one in 14 adults used GLP-1, with obesity being an important correlate. Our study findings suggest that socioeconomic status may act as a barrier to a medication with established benefits and may contribute to exasperating inequalities in diabetes care leading to disparities in health outcomes of adults with diabetes. Cohort studies may be needed to better understand the association of SDOH with GLP-1 use.