Hip fracture in elderly patients resulted in increased death, debility, and destitution. Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures, subsequent death, debility, and destitution for older adults.
More research is necessary to inform physician behavior on whether prophylactic PEG tube placement is warranted in the treatment of HNC.
Low antihypertensive medication adherence is common. Over recent years, the impact of low medication adherence on increased morbidity and healthcare costs has become more recognized, leading to interventions aimed at improving adherence. We analyzed a 5% sample of Medicare beneficiaries initiating antihypertensive medication between 2007 and 2012 to assess whether reductions occurred in discontinuation and low adherence. Discontinuation was defined as having no days of antihypertensive medication supply for the final 90 days of the 365 days following initiation. Low adherence was defined as having a proportion of days covered <80% during the 365 days following initiation among beneficiaries who did not discontinue treatment. Between 2007 and 2012, 41,135 Medicare beneficiaries in the 5% sample initiated antihypertensive medication. Discontinuation was stable over the study period (21.0% in 2007 and 21.3% in 2012; p-trend=0.451). Low adherence decreased from 37.4% in 2007 to 31.7% in 2012 (p-trend<0.001). After multivariable adjustment, the relative risk of low adherence for beneficiaries initiating treatment in 2012 versus in 2007 was 0.88 (95% confidence interval 0.83–0.92). Low adherence was more common among racial/ethnic minorities, beneficiaries with Medicaid buy-in (an indicator of low income), and those with polypharmacy, and was less common among females, beneficiaries initiating antihypertensive medication with multiple classes or a 90 day prescription fill, with dementia, a history of stroke, and those who reached the Medicare part D coverage gap in the previous year. In conclusion, low adherence to antihypertensive medication has decreased among Medicare beneficiaries however rates of discontinuation and low adherence remain high.
Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related comorbidities, it remains underutilized. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barriers to bariatric surgery have been identified including limited patient and referring physician knowledge as well attitudes regarding the effectiveness and safety of bariatric surgery. However, the role of insurance coverage and benefit design as a barrier to access to care has received less attention to date. Bariatric surgery is cost-effective compared to non-surgical treatments among individuals with extreme obesity and type II diabetes mellitus. While it may not result in cost-savings among all bariatric surgery eligible patients, for certain patient subgroups, bariatric surgery may be cost neutral compared with traditional treatment options. In addition, longer term outcomes of bariatric surgery suggest decreased or stable costs in the long run. The purpose of this review paper is to synthetize the existing knowledge on why bariatric surgery remains largely underutilized in the United States with a focus on health insurance benefits and design. In addition, the review discusses the applicability of value-based insurance design (VBID) to bariatric surgery. VBID has been previously applied to bariatric surgery coverage with a use of incentive-based cost-sharing adjustments. Its application could be further extended, since the postoperative clinical outcomes and costs vary among the different sub-groups of bariatric surgery eligible patients.
The behaviors of nonphysician health care staff in the clinical setting can potentially contribute to patients' perceptions of discrimination and lowered patient satisfaction. Future interventions to reduce health care discrimination should include a focus on staff cultural competence and customer service skills.
BackgroundChronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community‐based cohort of blacks.Methods and ResultsAnalyses included 1829 participants without hypertension at baseline (Exam 1, 2000–2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005–2008) or Exam 3 (2009–2012). Each follow‐up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported “a lot” or “extreme” stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow‐up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age‐, sex‐, and time‐adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04–1.37) and 1.37 (1.20–1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001).ConclusionsIn a community‐based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.
Objectives-The purpose of this paper is to analyze the social organization of caring as gendered work as it relates to meal preparation and consumption activities surrounding older adult cancer patients and their caregivers.Methods-Qualitative methods consisting of in-depth, semi-structured, face-to-face interviews with 30 older cancer patients (17 women and 13 men aged 70 to 90) and their caregivers were conducted separately. Participants were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancer.Results-Major findings were that both patients and caregivers experienced distress surrounding food preparation and mealtime activities, and these varied according to the gender of both patients and caregivers and the relationship that existed between patients and caregivers. Of particular Mailing address for correspondence and reprints: Julie L. Locher PhD MSPH, University of Alabama at Birmingham, CH19, Room 218F, Birmingham, AL 35294-2041, 205.934.7542, 205.975.5870, Jlocher@uab.edu. Conflict of InterestNone of the authors has a conflict of interest to disclose. NIH Public Access Author ManuscriptPsychooncology. Author manuscript; available in PMC 2011 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript note, female patients experienced distress over not being able to fully participate in meal planning and cooking activities that were central to their self-identity. Related to this, male spouses experienced frustration over not being able to engage in cooking activities that met their wives' expectations. Female caregivers expressed tremendous discontent that the one they were caring for did not eat like they "should."Discussion-Matters related to the organization of meals and food consumption activities may be a source of significant distress for patients and caregivers. Further research and greater attention from health care providers are warranted to evaluate the extent of such distress.
Background Data from before the 2000s indicate the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP)≥140/90 mmHg. Over the past several decades, BP declined and hypertension control has improved. Methods We estimated the percentage of incident CVD events that occur at SBP/DBP<140/90 mmHg in a pooled analysis of three contemporary US cohorts: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), and the Jackson Heart Study (JHS) (n=31,856; REGARDS=21,208; MESA=6,779; JHS=3,869). Baseline study visits were conducted in 2003–2007 for REGARDS, 2000–2002 for MESA, and 2000–2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or non-fatal stroke, non-fatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study. Results Over a mean follow-up of 7.7 years, 2,584 participants had incident CVD events. Overall, 63.0% (95%CI: 54.9%–71.1%) of events occurred in participants with SBP/DBP<140/90 mmHg; 58.4% (95%CI: 47.7%–69.2%) and 68.1% (95%CI: 60.1%–76.0%) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP<140/90 mmHg among those <65 years (66.7% 95%CI: 60.5%–73.0%) and ≥65 years (60.3% 95%CI: 51.0%–69.5%), women (61.4%; 95%CI: 49.9%–72.9%) and men (63.8%; 95%CI: 58.4%–69.1%), and for whites (68.7%; 95%CI: 66.1%–71.3%), blacks (59.0%; 95%CI: 49.5%-68.6%), Hispanics (52.7% 95%CI: 45.1%–60.4%) and Chinese-Americans (58.5%; 95%CI: 45.2%–71.8%). Among participants taking antihypertensive medication with SBP/DBP<140/90 mmHg, 76.6% (95% CI: 75.8%–77.5%) were eligible for statin treatment but only 33.2% (95%CI: 32.1%–34.3%) were taking one and 19.5% (95%CI: 18.5%–20.5%) met the Systolic Blood Pressure Intervention Trial eligibility criteria and may benefit from a SBP target goal of 120 mmHg. Conclusions While higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP<140/90 mmHg. Although absolute risk and cost-effectiveness should be considered, additional CVD risk reduction measures for adults with SBP/DBP<140/90 mmHg at high risk for CVD may be warranted.
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