School interventions to address sexual orientation discrimination can be important tools for fostering inclusive school climate, and improving student wellbeing. In this study, we empirically evaluated a film-based intervention, Out in Schools, designed to reduce sexual orientation prejudice and foster inclusive school attitudes. Our evaluation mapped data about Out in Schools presentations onto student data from the random cluster-stratified, province-wide 2013 British Columbia Adolescent Health Survey (BCAHS) as well as potential confounding variables of Gay-Straight Alliance clubs (GSAs) and inclusive school policies. Outcome measures included past year sexual orientation discrimination, bullying, suicidal ideation, and school connectedness among lesbian, gay, and bisexual (LGB) and heterosexual (HET) students in grades 8 through 12 (ages 13 to 18; unweighted N = 21,075, weighted/scaled N = 184,821). Analyses used complex samples logistic regression, adjusted for sample design, conducted separately by gender and orientation. We found Out in Schools presentations were associated with reduced odds of LGB students experiencing discrimination, and both LGB and HET girl students being bullied or considering suicide, and increased levels of school connectedness, even after controlling for GSAs and policies. Out in Schools appears to have an additive contribution to reducing orientation prejudice and improving LGB and heterosexual student wellbeing within schools.
IntroductionThis study aimed to assess data relevancy and data quality of the Innovation in Medical Evidence Development and Surveillance System Distributed Database (IMEDS-DD) for diabetes research and to evaluate comparability of its type 2 diabetes cohort to the general type 2 diabetes population.Research design and methodsA retrospective study was conducted using the IMEDS-DD. Eligible members were adults with a medical encounter between April 1, 2018 and March 31, 2019 (index period). Type 2 diabetes and co-existing conditions were determined using all data available from April 1, 2016 to the most recent encounter within the index period. Type 2 diabetes patient characteristics, comorbidities and hemoglobin A1c(HbA1c) values were summarized and compared with those reported in national benchmarks and literature.ResultsType 2 diabetes prevalence was 12.6% in the IMEDS-DD. Of 4 14 672 patients with type 2 diabetes, 52.8% were male, and the mean age was 65.0 (SD 13.3) years. Common comorbidities included hypertension (84.5%), hyperlipidemia (82.8%), obesity (45.3%), and cardiovascular disease (44.7%). Moderate-to-severe chronic kidney disease was observed in 20.2% patients. The most commonly used antihyperglycemic agents included metformin (35.7%), sulfonylureas (14.8%), and insulin (9.9%). Less than one-half (48.9%) had an HbA1cvalue recorded. These findings demonstrated the notable similarity in patient characteristics between type 2 diabetes populations identified within the IMEDS-DD and other large databases.ConclusionsDespite the limitations related to HbA1cdata, our findings indicate that the IMEDS-DD contains robust information on key data elements to conduct pharmacoepidemiological studies in diabetes, including member demographic and clinical characteristics and health services utilization.
Objectives: The purpose of the study was to examine whether Healthcare Common Procedure Coding System (HCPCS) billing codes should be used in conjunction with National Drug Codes (NDCs) to establish insulin exposure episodes. Materials and Methods: We identified insulin claims billed by NDCs or HCPCS codes in FDA’s Sentinel System from 2013 to 2018. We created insulin exposure episodes separately based on NDCs only, HCPCS only, and a combination of both NDC and HCPCS. We considered gaps of <30 days between valid billing codes as continuous exposure. Patients were followed until the earliest of (1) episode end date, (2) death, (3) disenrollment, (4) query end date, and (5) evidence of the opposite exposure defining code type (for cohorts defined by only NDCs or only HCPCS). We examined the median duration of incident episodes, requiring no NDC or HCPCS codes in the 183 days (washout period) before the first billing code and prevalent episodes (no washout period required). For patients with more than 1 treatment episode, we calculated median gap length between episodes. Results: We identified 107,528,855 insulin claims using NDCs or HCPCS. Of these, 98.5% were billed using NDCs. HCPCS were largely billed during emergency and ambulatory visits (52.5% and 38%, respectively). We identified 6,350,872 incident and 12,922,593 prevalent NDC episodes; and 6,821,075 incident and 13,465,108 prevalent NDC-HCPCS episodes. The median length of the first incident NDC. NDC episodes was 110 days (IQR: 60; 212); 31 (IQR: 19; 31) days for HCPCS only and 90 (IQR: 19-31) for NDC-HCPCS episodes. The median gap between the first and second episodes was shorter for incident NDC episodes than HCPCS episodes (NDC: 49 [IQR: 17; 132]; HCPCS: 249 [IQR: 93; 550]). Prevalent episodes showed similar trends. Conclusion: HCPCS insulin codes appeared to indicate either 1 time or sporadic occurrences with long gaps between two codes. HCPCS codes in conjunction with NDC codes increased the number but reduced the median length of insulin episodes. Unless studies investigate the effects of insulin administered in specific settings to identify transient adverse reactions treated with insulin, we do not encourage the use of HCPCS to establish insulin exposure episodes.
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