Browsing by Author "Rasu, Rafia"
Now showing 1 - 16 of 16
- Results Per Page
- Sort Options
Item A Systematic Review of Concomitant Opioid and Sedative or Skeletal Muscle Relaxant Use on Patient Outcomes in Chronic NON-Malignant PAIN(2021) Zerezghi, Semhar; Xavier, Christy; Jodray, Megan; Nelson, Rebecca; Zalmai, Rana; Rasu, RafiaPurpose: Multiple studies show risks with concomitant opioid and benzodiazepine use in the general population, but few discusses effect of opioids with other sedatives, when policies are not in consensus. This review is a comprehensive outlook of current evidence analyzing the impact of concomitant opioid and sedative use in chronic non-malignant pain. METHODS: Literature search strategy using phrase "opioid AND CNS depressants OR benzodiazepine OR sedatives OR gabapentinoids NOT cancer" was conducted in PubMed, Embase, Web of Science, and Scopus. Excluded case reports, reviews, pediatric, duplicates, and non-opioid-related outcome studies(N=43,914) for total 14 articles. RESULTS: 12 studies were retrospective. Overall, concomitant use of sedatives or muscle relaxants with opioids was associated with hospitalizations(N=5), mortality(N=4), motor vehicle accidents(N=1), inappropriate drug utilization(N=4), or anxiety and depression(N=2). Higher dosages of opioids(N=4) corresponded to negative outcomes regardless of concomitant medications. South and increasing age had higher prevalence of concomitant use but was not always associated with negative outcomes. CONCLUSIONS: Considering increased incidence of co-prescriptions and adverse outcomes, policy changes recommending avoidance of concomitant opioid and skeletal muscle relaxant/sedative use are needed. All 14 studies are diverse but showed higher age, higher opioid dose, and South with more coprescription-associated negative outcomes. Overall consistency of negative outcomes needs further investigation of interactions despite limitations. Policymakers, clinicians, and patients should know the risks of concomitant prescribing to solidify current policy recommendations, ensure adequate drug monitoring and co-prescribing controls through prior authorization, reduce number of co-prescriptions, and improve clinical outcomes.Item Analysis of the Impact of an Insulin Savings Model Among Medicare Part D Beneficiaries and Plan Sponsors(2022) King, Alyza; Voloudakis, Michael; Guhad, Ahmed; Stahlnecker, Alvah; Tabor, Pamela; Xavier, Christy; Rasu, RafiaBackground: An estimated one in every three Medicare beneficiaries have diabetes, and over 3.3 million Medicare beneficiaries currently use at least one form of insulin. On average, insulin retail prices can range anywhere between $90 to $1300 per package. Additionally, Medicare beneficiaries may enter various coverage phases throughout a plan year, resulting in variable prices and in some cases, significantly higher copays on insulin from one month to the next. A higher patient copay during the coverage gap phase has been associated with reduced adherence, which can lead to disease progression and worse outcomes. In 2021, the Part D Senior Savings Model was introduced to offer a benefit design that includes predictable member copays during all the coverage phases. Methods: This study was designed as a retrospective analysis comparing post-implementation prescription claims from 2021 to pre-implementation claims from 2020. Inclusion criteria consisted of members enrolled in a Medicare Advantage Plan with a Senior Savings Model benefit design during 2021 and a pharmacy benefit manager aligned model insulin list. Exclusions consisted of members enrolled in a Medicare Prescription Drug Plan (PDP), a plan with a customized insulin drug list, and/or a member receiving Low Income Subsidy. The primary objective was to analyze changes in the number of model insulin utilizers among Medicare Part D beneficiaries and plan sponsors enrolled in the Senior Savings Model during the 2021 plan year. Secondary objectives were to evaluate other changes in model insulin utilization, including days supply and adherence. A financial analysis was also performed looking at changes among model insulins in member copay, total net cost, and total gross cost. Descriptive statistics were used for all study variables. Categorical data, including changes in the number of model insulin utilizers, was analyzed using a chi-square test to identify a P-value with a significance threshold set at 0.05. Quantitative data was evaluated through an unequal variances t-test. Results: The Senior Savings Model was found to significantly reduce member copay amounts, but did not result in adverse utilization of model insulins. The number of members who were optimally adherent did not change, but there was a slight reduction seen in overall adherence. Conclusion: Our findings would suggest that the SSM can improve member experience by reducing member copays but may not significantly impact adherence metrics.Item Assessing Fall Events in Geriatric Cancer Patients who are Prescribed an Opioid and/or Benzodiazepine(2021) Bhachawat, Neal; Rasu, Rafia; Agbor, WalterIRBexempt#2020-013. Purpose: Opioids & benzodiazepines are commonly used in cancer pain treatment however their sedating effects increase a patient's fall risk. BEERS criteria was established to reduce adverse events related to medication use in elderly population. Falls are a leading cause of death in the geriatric population and seniors with cancer confer an estimated 20%increased risk. Objectives:(1)identify the demographics of cancer patients age65+ who experienced a fall,(2)determine fall event trends based on patient-specific factors & medications (3)determine if BEERS criteria was followed. Methods: A cross-sectional study analyzing fall outcomes in cancer patients, age 65+, with analgesic medications used to manage acute/chronic pain. The population data was be compiled from the CDC National Ambulatory Medical Care Survey(NAMCS).Diagnosis was based on ICD9/10 and medication codes. Database findings based on sample of office visits. Results: In the NAMCS database between 2006–2017 was 276,166,738 (weighted freq.) cancer patient visits, age 65+ with 83.16%experiencing a fall. 194,560,411 were taking Benzodiazepine only.31,941,74 5were taking Opioids and 68% were prescribed a benzodiazepine as adjunct therapy. Fall incidence: Opioid group 84.6% (p=.03); Benzodiazepine alone 97.1% (p< .001); Benzodiazepine + opioid 93.2% (p< .001). Of the 83.16% of patients who experienced a fall, majority were white and female; 54% were age 75+; Types of cancers: prostate (12.3%), breast (7.3%), lung (5.2%), colorectal (4.5%) and others (70.7%). Fall incident peaked during 2012-2014 with 41.9% of falls occurring and declined to 8.3% during 2015-2017 (p< 0.001). Conclusion: The fall rates experienced by geriatric cancer patients taking opioids and/or benzodiazepines is far greater than the national average for the general geriatric population: 25%suffering a fall. In 2015 BEERS criteria and FDA advised against concurrent use of benzodiazepines + opioids. Our results indicate clinicians followed these changed guidelines, resulting in a decrease in fall events during data period 2015-2017 and illustrating the crucial role BEERS criteria plays in patient safety.Item ASSOCIATION BETWEEN INABILITY TO OBTAIN NECESSARY PRESCRIPTION MEDICAL CARE AND FUTURE HEALTHCARE EXPENDITURES IN THE MEDICAL EXPENDITURE PANEL SURVEY (2007-2017)(2020) Rasu, Rafia; Karpes Matusevich, AlizaObjectives: Assess the association between the inability to obtain prescription medications and future medical expenditure. Methods: We included participants older than 65yrs from the 2007-2017 Medical Expenditure Panel Survey longitudinal data files. Expenditures were updated to 2017 values using the Personal Consumption Expenditures index. We compared those who did and did not report being unable to get necessary prescription medication in terms of demographics and total logged healthcare expenditure the following year using chi-square and t-tests and linear regression. Results: Our cohort (n=19,566) was predominantly female (57.1%), white (71.3%) and non-Hispanic (85.6%) with a mean age of 73.9 (SD:6.6) and 2.8 comorbidities(SD: 2.1). 360(1.8%) people were unable to obtain prescription medication. In both years of the survey this group had significantly higher adjusted prescription medication (Y1: $4,407 (SD:6,195) vs. $2.688 (SD:5,220) Y2: $4,824 (SD:6,729) vs. $2,915 (SD:5,724)) and healthcare expenditure (Y1: $14,595 (SD:17,970) vs. $10,558 (SD:18,793) Y2: $15,885 (SD:18,334) vs. $11,574 (SD:19,465)). However, being unable to get necessary medications was not significantly associated with total health care costs in the second year of the survey when controlling for baseline covariates and first year healthcare costs. Age, race, ethnicity, education level, perceived health status, number of comorbidities and being uninsured in the second year were correlated. Conclusion: The study points to socioeconomic drivers of healthcare expenditure. It is encouraging that < 2% of older adults report being unable to obtain prescription medication and future research will assess if medication adherence is related to categories of future expenditure.Item Barriers to in-Person Focus Group Participation during the Third-Year of COVID-19 Pandemic: A Case Study of Colorectal Cancer (CRC) Screening in Underrepresented Groups(2023) Kamt, Sulin; Rasu, Rafia; Miller-Wilson, Lesley-Ann; White, Annesha; Chhetri, Shlesma; Hittson-Smith, Rachal; Fernandez, Denise; Sambamoorthi, UshaPURPOSE: In the process of conducting research to understand barriers to colorectal cancer (CRC) screening in underrepresented groups such as Blacks and Hispanics, it became evident that there were also barriers to recruitment in this population. This study assesses the challenges faced in recruitment of focus group participants regarding CRC screening practices among underrepresented groups. Since the COVID-19 pandemic, qualitative research participants have primarily been interviewed through online video or audio interactions. However, as restrictions on in-person interactions have been lifted, in-person focus groups are being increasingly considered. METHODS: The study investigators began recruitment through community health workers in August 2022, when COVID-19 vaccines were available for all adults (age>18 years). Eligible individuals were: age 45-75, Black or Hispanic, with Medicaid or no insurance, and no family history of CRC or diagnosis of certain colon-related diseases. We combined in-person and virtual recruitment strategies, including posting flyers in communities, advertising our study at health fairs, and on social media. Participants would receive a $50 gift card. RESULTS: Fifty-five met the eligibility criteria among 144 respondents, and 45 subjects (29 women and 16 men) agreed to be contacted. An average of 2.5 attempts were made per eligible subject. Unfortunately, we were able to recruit only four women (3 Hispanic and one non-Hispanic black). Traveling to the research site was a barrier to participation. Many subjects (49%) requested virtual participation (online video or audio interactions); some declined because the topic was too sensitive (considered taboo), and eligible men were reluctant to participate in-person. CONCLUSIONS: The requirement of in-person participation affected our recruitment goals, suggesting that COVID-19 has shifted the preferences of research participants to virtual interaction. In response to the eligible participant preferences, the study protocol has been revised to re-contact patients and schedule virtual FG sessions.Item Covid-19 Case and Mortality Trends across Incarcerated Populations in the U.S.(2021) Jodray, Megan; Xavier, Christy; Rasu, RafiaPurpose: Explore case and mortality rate differences across county, state, and federal facilities to identify places most vulnerable to coronavirus disease 19 (COVID-19). Methods: Secondary retrospective cohort analysis utilizing the UCLA's comprehensive COVID-19 research data on cases and mortality trends collected until January 29th, 2021. This data set is collected by UCLA volunteers directly from facility websites. Statistical analysis was conducted using SPSS. Results: Since March 2020, it is reported the total U.S. population of incarcerated residents has had 370,042 cases and 2,185 deaths nationally. County facilities have reported 19,099 (5.16%) cases and 43 (1.97%) deaths. State facilities have reported 305,616 cases and 1,913 deaths and have the highest case fatality ratio compared to all facilities. Federal facilities have reported 45,327 cases and 229 deaths. Out of total incarcerated resident population, Texas had 9.42% and 11.53% of cases and deaths, respectively. Moreover, there is a higher chance of dying from COVID-19 [RR: 5.55, 95%CI (3.36-9.17)] in a county prison compared to a federal prison in Texas. Conclusion: Limited information exists on the incarcerated population effected by COVID-19, especially amid an ongoing pandemic. There appears to be a higher risk of mortality in COVID-19 cases in state facilities compared to federal and in Texas we observed a 5 times higher risk of dying in county versus federal prisons. Identifying at-risk incarcerated populations can help control spread and reduce health gaps.Item COVID-19 Vaccination Disparities and Hesitancy in the United States(2022) Xavier, Christy; Lindley, Bryn; Rasu, RafiaBackground: Currently, 62.8% of Americans are fully vaccinated against COVID-19, which is lower than most first-world countries. Despite the ongoing COVID-19 pandemic and complications, many Americans are still hesitant to vaccinate. Objectives: The purpose of this study is to identify vaccine rates and trends by biological and socioeconomic demographics and determine reasons for vaccine hesitancy in the U.S. Methods: This is a repeated cross-sectional analysis with data on American adults without missing data on vaccine status and vaccine intent (N = 59,989) from the U.S. Census Bureau's Household Pulse Survey (Phases 3.2-3.3, July 21, 2021-February 7, 2022). The Household Pulse Survey is an online randomized survey to get information on how COVID-19 affects American households. The survey is collected every two weeks in phases. Vaccine hesitancy was divided into two groups: 1) probably, not sure, probably not, and definitely not receiving the vaccine, and 2) received the vaccine and definitely will get the vaccine. Chi-square tests and logistic regressions were conducted using replicate weights with SAS. Logistic regressions adjusted for sex, age, race and ethnicity, income, education, Covid-19 infection, health insurance, food insecurity, children under 17 years in the household, remote work, health worker status, functional status, and mental health. Results: During the December 1-13, 2021 survey period, 78.9% had received at least two doses of the COVID-19 vaccine. A majority of the vaccinated (51.6%) received the Pfizer vaccine. Those that were highly educated with a college degree (68.1%) and had a salary of $100,000+ (38.5%) were more likely to be vaccinated. Of those not vaccinated (Wt N = 33,340,678), 87.7% reported that they are unsure, probably, or definitely not (51.5%) get the vaccine. In adjusted analyses, older adults (AOR = 0.85, 95% CI=0.77 - 0.94 for 5-year increments) and health workers (AOR = 0.24, 95% CI = 0.08-0.69) were less likely to be vaccine-hesitant. Those with high school education were more likely to be vaccine-hesitant (AOR = 2.37, 95% CI = 1.44-3.90) compared to college-educated adults. Adults with COVID-19 infection were more likely to be vaccine-hesitant (AOR = 2.24, 95% CI = 1.41-3.57). Mistrust of the vaccine or government (52.1%), side-effects (50.2%), vaccine not needed (32.1%), and the vaccine will not protect me (23.6%) were cited as the top four reasons for vaccine hesitancy. Blacks and Hispanics reported similar reasons. Individuals in the South were more likely to cite distrust in COVID-19 vaccines than any other region. Conclusions: Among unvaccinated, over 50% of adults reported that they are "definitely not getting the vaccine". Vaccine hesitant adults were more likely to distrust the vaccine or the government; they were also concerned about the side effects. Targeted interventions by clinicians, public health officials, and policy makers to educate the public about side effects of the vaccine and increase trust in the health care system may help improve vaccination rates and achieve herd immunity in the US.Item Health Disparities and Risk Patterns of COVID-19 Case, Hospitalization, and Case Fatality in Texas Comparted to the United States of America(2021) Xavier, Christy; Rasu, RafiaPurpose: Explore age, sex, race, and underlying condition distribution with COVID-19-related case, hospitalization, and mortality rates. Methods: Secondary retrospective cohort analysis used CDC's and TDSHS's COVID-19 Data Tracker to obtain hospitalization, intensive care, mortality, and demographic counts of confirmed COVID-19 cases from submitted state and territorial health departments and case reports in U.S.A. and Texas (2020). Statistical analysis was conducted using SPSS. Results: In U.S., there were 12,573,876 COVID-19 cases, 688,911 hospitalizations, 74,933 ICU admissions, and 222,575 deaths compared to 1,551,250 cases and 30,741 deaths in Texas. 48% U.S. cases were male compared to 63.3% in Texas. Females had 19% and 22.5% lower risk of hospitalization and mortality compared to males(P< 0.001). Whites (54.1%) and Hispanics (21.3%) consisted of most cases. Blacks had 2.47 [RR 2.47,95%CI(2.42-2.52)] times higher risk of ICU admission and 16% higher mortality risk. Hispanics had 20% higher ICU risk but 35% [RR 0.647,95%CI(0.638-0.656)] lower risk of death compared to Whites(P< 0.001). Pediatric cases had 80% lower mortality risk; older adults with 15.3% case fatality ratio had 87.31 [RR 87.31,95%CI(84.55-90.16)] times mortality risk compared to adults 20-39 years old. Underlying conditions had 17 times higher risk of mortality compared to no health conditions(P< 0.001). Conclusions: Increasing age, male sex, underlying conditions, and Black race are associated with poorer outcomes in COVID-19. Healthcare professionals should be aware of COVID-19 health disparities and risk factors for poor outcomes to better address public health gaps and promote targeted interventions.Item High disease and medication exposure burden associated with patients on chronic dialysis(2020) Rasu, Rafia; Bhachawat, NealIRBexempt#2018-197.Background:Patients with end stage renal disease(ESRD), in addition to chronic dialysis, also receive multiple drug therapies for co-morbidities;Patients manage on average, 10-12 daily medications in regimens, increasing the risk of drug-related adverse effects and medication nonadherence. We want to determine the most common P2Y12-I taken by patients and other medications frequently used by this group. Methods:A retrospective cohort of ESRD patients started on a P2Y12-I between July 20,2011 and December 31,2014 was identified through United States Renal Data System(USRDS) registry data. Within USRDS, we used Medicare Part A, Part B, and mostly Part D pharmacy claims to accurately capture entire prescription filling number to this patient population. Results:The study cohort was restricted to ESRD patients with a known first service date for dialysis prior to study end date, December 31, 2014. 36,590 patients were followed on average 367days(IQR:147, 1627). Median age for patients receiving P2Y12-I was 64(IQR: 55, 73), 54%male, 41%Caucasians. Patients were on dialysis for 3.8years, taking 7 medications(median:7, IQR:5,10) and had 7 different co-morbidities. Top10 medications routinely used (% of patients): Clopidogrel(95%), Sevelamer(39%), Amlodipine(32%), Carvedilol(30%), Calcium Acetate(28%), Metoprolol(27%), Lisinopril(26%), Atorvastatin(26%) and Cinacalcet HCL(26%). Majority medications were antihypertensive drugs and ion-removing agents. Conclusion:Due to the complex medication regimen and high rate of comorbidities in this population, de-prescribing methods may be the next step moving forwards. The goal of this method is to reduce medication burdens and drug adverse events while improving quality of life through targeted deprescribing methods.Item The Impact of ADA Guideline Changes and Utilization Management on the Use of First-Line Antidiabetic Medication Classes for the Treatment of Type 2 Diabetes Mellitus in a Commercial Population(2024-03-21) Tran, An; Rasu, RafiaPurpose: While metformin has a long track record regarding its efficacy and safety, newer classes like sodium-glucose cotransporter 2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists have also proven to not only be very effective in lowering A1c, but certain agents may provide additional cardiovascular, renal, and weight loss benefits as well. Recent 2023 American Diabetes Association (ADA) guidelines de-emphasized metformin as the de facto first-line pharmacologic agent in favor of selecting first-line agents based on patient-specific factors and treatment goals. Analysis of the prescription claims data can provide insight into the prescribing patterns of these newer agents over the past 2 years for any shifts in therapy in response to the changes in the guidelines. The objectives of this study is to compare the changes in utilization of different first-line antidiabetic classes in the treatment of Type 2 Diabetes Mellitus (T2DM), as monotherapy or combination therapy, in commercial population from January 1, 2021, and June 30, 2023. Methods: This study is a retrospective analysis of prescription claims data identifying utilization of first-line antidiabetic classes. The classes of interest are biguanides, SGLT2, GLP-1, DPP-4, thiazolidinediones (TZD), and sulfonylureas (SU). Insulins and GLP-1 indicated for anti-obesity are excluded. The two study groups are plans with an initial metformin Step Therapy and plans with no utilization management in place. The primary objective will be to assess the changes in the proportion of 30-day supply claims for each class among the total antidiabetic utilizers from 2021 to 2023 between the two study groups. Key secondary objective include the difference in the proportion of non-metformin monotherapy for new antidiabetic utilizers. Another secondary objective is the difference between the proportion of utilizers for different type of combination therapy. Secondary endpoints will be reported as per utilizer per month (PUPM). Results: Work-in-progress, N/A Conclusion: Work-in-progress, N/AItem Leading Predictors and Their Associations with Combination Pain Therapy in Older Adults with Cancer: Application of Machine Learning Approaches(2022) Manning, Sydney E.; Madhavan, Suresh; Rasu, Rafia; Sambamoorthi, UshaOBJECTIVES: Opioid combination therapy is frequently prescribed in older adult cancer survivors despite negative outcomes. The objective of this study was to identify the leading predictors and their associations with opioid combination therapy prescribing after cancer diagnosis using interpretable machine learning approaches. METHODS: This is a retrospective longitudinal cohort of older (> 66 years old) cancer survivors (N = 2,673) diagnosed with primary and incident cancer in 2014 using the Surveillance, Epidemiology, and End Results (SEER) cancer registry linked with Medicare claims. Recursive feature elimination with random forest was used to extract the optimal number of predictors out of 119 likely ones for predictive modeling. eXtreme Gradient Boosting (XGBoost), SHapley Additive exPlanations (SHAP), and global feature importance were used to identify the leading predictors and their associations with opioid combination therapy. SAS 9.4 was used for data management and Python 3.9.7 was used for machine learning model calibration and tuning. RESULTS: Specificity (0.858), sensitivity (0.843), and area under the curve (AUC, 0.85) of our predictive model were high. Thirty-four features were included in the final predictive model. Baseline use of NSAIDs, opioids, benzodiazepines, and gabapentinoids, and chemotherapy, surgery, Complex relationships were observed between zip code percent of Hispanic and Native American residents living below poverty, care fragmentation (FCI), age at diagnosis, and opioid combination therapy. CONCLUSIONS: 1 in 3 older cancer survivors were prescribed opioid combination therapy. Patient-level baseline medication use, biological factors, cancer treatment, and zip code level social determinants were leading predictors of opioid combination therapy. Although observed relationships were complex, further analysis of predictors may help compute individual risk of patients on combination therapy, which in turn may help clinicians and policy makers utilize targeted interventions at the outset and prevent long-term effects of combination pain therapy such as prolonged and inappropriate use.Item Pain Treatment in Elderly Population with Cancer Diagnosis(2020) Rasu, Rafia; Bhachawat, NealIRBexempt#2020-013.Purpose:Cancer incidence increases with age. One prevalent symptom of cancer is chronic pain,which is frequently treated with opioids and other pain medications. As patients age, physiologic changes occur which alter drug pharmacokinetics, making elderly patients susceptible to drug adverse effects. Falls are a leading cause of death in the elderly and seniors taking opioids are 5-times more likely to suffer one. Our goal is to identify pain treatment in elderly cancer patients, note patient-specific factors and any adverse events.Methods:A cross-sectional study analyzing pain prescriptions to manage acute or chronic pain associated with cancer in patients, age 65+. The population data will be compiled from the National Ambulatory Medical Care Survey (NAMCS)database provided by CDC. Diagnosis was based on ICD-9/10codes and medication codes identified by NAMCS for patient visits.Results:Reported in the NAMCSdatabase between2006and2017 was 276,166,738(weighted frequencies) cancer patient visits with pain medication treatment. Data consisted of 71%white, 53%female. There was almost a 2-fold increase in patient visits from the 2006-2008data period(18%), to the 2009-2011data period(31%). Peak trend was in 2009-2011(p value < 0.001). Cancer diagnoses varied but included:6%prostate,2%colon,5%breast, 4%lung cancers. Out of the 276,166,738 visits,3%were taking opioids,8%mixed opioids,2%nsaids,3%apap and 84%other pain medications. Population regionally:37%South,23%Midwest,22%West,18%Northeast(p value< 0.05). Interestingly, 83% experienced a fall as an adverse event. Conclusion:A notable amount of fall events recorded in this population, greater than the CDC estimated national average;we recommend further assessing this risk. Identifed regional variation: South having majority of pain prescriptions and Northeast havingthe fewest.Item Polypharmacy and self-reported health status of older adults with multimorbidities in a rural community(2020) Johnson, Leigh; Rasu, Rafia; O'Bryant, Sid; Shrestha, NisthaPURPOSE: About four in ten elderly Americans suffer from multiple chronic conditions, and 39% are taking more than five medications. Polypharmacy(using ≥five medications) is associated with age, multi-morbidities, and poor self-perceived health status. Psychological and socio-educative factors influence polypharmacy and medication adherence, with limited studies in rural elders. Hence this study aims to examine the self-reported health status among older adults with multi-morbidities in rural areas. METHODS: Project FRONTIER(Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a prospective epidemiological study, using community-based participatory research(CBPR) approach to study factors affecting health in Cochran, Bailey, and Parmer County. All county residents over 40 years and were eligible for inclusion in the study after informed consent. The association between medical history and health-status was examined using logistic regression. Polypharmacy and multi-morbidities were used to predict poor health status. RESULTS: About 689 individuals participated in FRONTIER with a mean age of 68, with 43% Hispanic, and 68.7% female participants. Individuals taking ≥five medications presented 2.69 times higher odds of reporting poor health-status(AOR=2.69,CI=1.85-3.90) compared to those using < 5 medications, after controlling for demographic covariates. Individuals with ≥five co-morbidities presented 4.31 times higher odds of reporting poor health-status(AOR=4.31,CI=2.67-6.95). CONCLUSION: The presence of polypharmacy and multi-morbidities increase the odds of poor self-perceived health status. Future research should examine factors that contribute to polypharmacy among rural elders, as well as the role of patient perspectives and healthcare barriers on medication usage.Item Rates, Trends, and Determinants of Concurrent Prescription of Opioids, Other Central Nervous System Depressants, and Gabapentinoids in Ambulatory Care Settings - Evidence from National Dataset(2020) Howard, Meredith; Rasu, Rafia; Zalmai, RanaPurpose: Studies have analyzed the concomitant use of opioids, CNS depressants, and gabapentinoids (gabapentin and pregabalin) in the elderly and patients with chronic pain. However, use of these medications in the general adult population irrespective of condition has not been studied with current national data. Methods: This was a cross-sectional study using National Ambulatory Medical Care Survey (NAMCS) data from 2007 to 2016. Visits were narrowed to adults(18 and older) with at least one opioid or CNS depressant medication. Within this cohort, weighted/non-weighted frequencies of and factors associated with concurrent use of opioids, CNS depressants, and gabapentinoids were determined. Results: Over one billion weighted visits were identified(Non weighted:44,881) with at least one opioid or CNS depressant. Females(61%) and White race(86%) represented the majority with mean age 56 years(± 16.5). Opioids(65%) were most common followed by CNS depressants(47%) then gabapentinoids(10%). Among patients with an opioid medication, 25% were also on at least one CNS depressant or gabapentinoid. Concurrent use increased from 2011 to 2012(+13.8%) then dropped from 2014 to 2016(-12%). Factors associated with concurrent use of opioids and CNS depressants were White race, tobacco use, visits with PCP compared to non-PCP, and >3 comorbidities. Conclusions: Significant percent of patients(65%) were on opioids when analyzed irrespective of disease or age. Despite concerns of increased overdose and misuse with concurrent opioids, CNS depressant and gabapentinoids, a quarter of our cohort were on at least two of these medications. Future studies are needed to decrease concurrent use of these medications.Item Utilization of Mental Health Prescription Claims in Texas Health Plan Members in Relationship to the Novel Coronavirus Pandemic(2021) Leytman, Michael; Guhad, Ahmed; Stahlnecker, Alvah; Rasu, Rafia; Xavier, ChristyObjective: To evaluate the utilization of mental health disorder prescription claims in relationship to the novel coronavirus pandemic. Methods Design: Retrospective analysis of mental health utilization prescription claims between March 2020 to August 2020 compared to March 2019 to August 2019. Inclusion, ≥ 18 years of age, Prescription claims for anti-anxiety, anti-depressant, anti-psychotic/anti-maniac agents, Health Plan members filling prescriptions within the state of Texas. Exclusions, < 18 years old. Data Collection, Mail and Retail Pharmacy utilization claims data: March 2020 – August 2020 & March 2019 – August 2019, Gender, Fill date, Member age. Statistical Analysis, Chi-Square Test to identify a P-value for the primary endpoint Endpoints " Primary o Difference between the number of mental health utilization prescription claims between March 2020 to August 2020 compared to March 2019 to August 2019 " Secondary o Difference in utilization rate between men and women o Difference in age o Percentage of patients receiving Mail vs Retail claims (pre/post COVID) o Comparing public health infection rate data vs. prescription claim rate (pre/post COVID) Results: For all primary endpoints, statistical significance was observed with p-values < 0.001. Conclusion: Work-In-Progress, N/A ©2020 CVS Health and/or one of its affiliates. All rights reserved. This article contains proprietary information and cannot be reproduced, distributed or printed without written permission from CVS Health. Data use and disclosure is subject to applicable law, corporate information firewalls and client contractual limitations.Item ystematic Review of Focus Group Discussions & Mixed Method Surveys Regarding Colorectal Cancer Screening(2023) Sakowski, Ross; Mathai, Jacob; White, Annesha; Rasu, Rafia; Sambamoorthi, UshaBackground: Colorectal cancer (CRC) screening has a significant potential to decrease mortality from CRC. Many published studies have used either focus groups or structured interviews to identify barriers and facilitators of CRC. However, a systematic review of methods and findings from focus groups is lacking. Objective: The objective of this study was to conduct a systematic literature review that describes the characteristics of focus group participants and synthesize major themes of CRC screening barriers and facilitators. A secondary objective was to identify the impact of barriers related to social determinants of health (SDoH) factors. Methods: A systematic review of qualitative studies was conducted on CRC screening focus groups following ENTREQ guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Our inclusion criteria were as follows: (1) empirical scientific studies with a qualitative focus group or mixed methods study design; (2) that have been published in a peer-reviewed journal; (3) from January 1, 2012, and August 12, 2022; (4) in English; (5) exploring the attitudes, beliefs and behaviors related to adults and colon cancer screening; (6) face-to-face and online format. Keyword searches were conducted in the electronic databases PubMed and SCOPUS. After review, 31 studies contributing to our research questions were found eligible for inclusion. Results: Findings revealed that the number of participants per focus group (where reported) ranged from 2 to 23 participants with a median of 6 participants. There was a range of 20 to 232 total focus group participants per study while the mixed method studies ranged from 25 to 492. Most of the studies utilized education, income level, and access to healthcare as social determinants of health factors. The most commonly reported SDoH variable noted as a barrier to CRC screening was the lack of recommendation or education of a screening by their healthcare provider (15 of 31, 48%) with embarrassment or disgust regarding the procedure as a secondary barrier (11 of 31, 35%). Conclusions: Main themes for barriers and facilitators that emerged from the review were insurance status and awareness of the benefits of screening. Commonly reported concerns for barriers were embarrassment or disgust regarding the procedure and lack of trust in their provider relationship. Previous awareness of this disease through family history was a common facilitator. Opportunities to increase CRC screening arise in ensuring education and access to alternatives that provoke less embarrassment, such as FIT or FOBT tests. Sponsorship: None