Objective: To estimate the burden of osteoarthritis (OA) among noninstitutionalized adults (!18 years of age) in the US. Design: Weighted nationally representative data from the 2015 Medical Expenditure Panel Survey were used to estimate OA prevalence in noninstitutionalized adults and compare adults with OA to those without OA for clinical (pain interference with activities [PIA], functional limitations), humanistic (health-related quality-of-life [HRQoL]) and economic outcomes (healthcare costs, wage loss). Productivity/wage loss was estimated among employed working-age adults (18e64 years). Multivariable regression analyses examined the associations between OA and outcomes. Results: In 2015, 10.5% (25.6 million) of noninstitutionalized US adults reported having any OA. Regression analyses indicated that adults with OA were significantly more likely than those without OA to report moderate (adjusted odds ratios [AOR] 1.99; 95% confidence interval [CI] 1.65e2.40] or severe PIA (AOR 2.59; 95% CI 2.21e3.04), any functional limitation (AOR 2.51; 95% CI 2.21e2.85), and poorer HRQoL on the SF-12 version 2 Physical Component Summary score (adjusted beta [standard error] À3.88

Objectives The objective of this study is to assess West Virginia (WV) pharmacists’ stocking and dispensing practices of opioid-related medications and to identify the educational needs relating to providing naloxone in community pharmacies. Design A cross-sectional, anonymous, 49-item survey was created and validated to assess the educational needs of WV community pharmacists. Setting and participants The data collection instrument was administered to 266 pharmacists currently licensed in WV at six continuing education events throughout the state from March 1st, 2016 to June 15th, 2016. Outcome measures Pharmacists’ educational needs were determined using the Extended Parallel Process Model, which has four main constructs: perceived severity, perceived susceptibility, response efficacy, and self-efficacy. Pharmacists’ stocking and dispensing of opioids and related medications were also assessed. Results Pharmacists completed 157 surveys. They were mostly male (56.1%), full-time employees (67.5%), worked mostly in community pharmacies (69.4%), and had a mean age of 50.19 years (SD=13.62). The newly-adapted opioid perceived efficacy and perceived severity of opioid adverse events scales were tested for reliability and validity. Only 20.4% of the community pharmacists surveyed felt comfortable selling naloxone over-the-counter. As for the other opioid-related medications, only 53.3% stocked buprenorphine and 74.8% stocked buprenorphine/naloxone. Conclusion As the most accessible health care providers, community pharmacists are acutely aware of how the opioid epidemic affects their communities. Some pharmacists in WV are hesitant to stock and dispense opioids and opioid-dependence medications. Although this may decrease the flow of potentially abused drugs into the community, it may also restrict access to necessary therapy from patients with opioid use disorder. Furthermore, pharmacists in WV are not yet comfortable stocking and dispensing naloxone. Tailored educational materials can help in controlling the pharmacists’ fear and reinforce the benefits of over-the-counter naloxone use.

ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

IntroductionOur objective was to determine the relationship between polypharmacy (treatment with prescription drugs from 6 or more drug classes concurrently) and health-related quality of life (HRQoL) among US adults with arthritis.MethodsWe conducted a retrospective cohort study that used 2-year longitudinal data from the Medical Expenditure Panel Survey to analyze a cohort of 6,132 adults aged over 21 years with arthritis. Measures of HRQoL were the summary scores from the mental component summary (MCS) and physical component summary (PCS) of the 12-item short-form health survey. Unadjusted and adjusted regression models were used to evaluate the association between polypharmacy and HRQoL measures. We used SAS, version 9.4, (SAS Institute Inc) to conduct all analyses.ResultsIn unadjusted analyses, adults with arthritis taking prescription drugs from 6 or more drug classes concurrently had significantly lower MCS and PCS scores (β, −3.11, P < .001 and β, −10.26, P < .001, respectively) than adults taking prescription drugs from fewer than 6. After controlling for the demographic characteristics, number of mental and physical chronic conditions, and baseline MCS and PCS scores, adults taking prescription drugs from 6 or more drug classes concurrently had significantly lower PCS scores (β, −1.68, P < .001), than those taking prescription drugs from fewer than 6. However, no significant difference in MCS scores was found between adults taking prescription drugs from 6 or more drug classes concurrently and those taking prescription drugs from fewer than 6 (β, −0.27, P = .46).ConclusionPolypharmacy is significantly associated with lower PCS scores among adults with arthritis. Because polypharmacy can lead to drug–drug and drug–disease interactions, health care providers need to consider the risk and adopt a cautious approach in prescribing multiple drugs to manage chronic conditions and in choosing therapies to improve HRQoL among adults with arthritis.

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BackgroundA lack of gold standard treatment for autism spectrum disorders (ASD), no clear ASD management guidelines, and lack of evidence-based pharmacological interventions other than aripiprazole and risperidone elevate the risk of off-label prescribing and adverse effects among individuals with ASD, more so among adults.ObjectiveThe aim of this study was to identify and compare the types of prescription drug use, rates of polypharmacy, and characteristics associated with polypharmacy among adults with and without ASD in a retrospective cross-sectional analysis of a three-state Medicaid Analytic eXtract database (2000–2008).MethodsAdults aged 22–64 years with ASD (ICD9-CM code: 299.xx) were propensity score-matched to ‘no ASD’ controls by age, sex, and race. General polypharmacy (≥6 unique classes of prescription drugs in a year) and psychotropic polypharmacy (≥3 unique prescription drug classes of psychotropic medications within a 90-day period) were the main study outcomes. Chi-square tests for rates, t tests for mean number of claims, and multivariate logistic regressions for likelihood of prescription drug use and polypharmacy were run.ResultsAnnually, almost 75% of adults with ASD had >20 prescription drug claims compared with 33% of adults without ASD. Around 85% of adults with ASD used at least one psychotropic drug class compared with 42% of adults without ASD. Highly common psychotropics were antipsychotics (66%ASD vs 20%noASD), anticonvulsants (59%ASD vs 20%noASD), and anxiolytics/hypnotics/sedatives (21%ASD vs 11%noASD). Other than psychotropics, many adults with ASD used medical prescription drugs such as antimicrobials (47%), dermatologic agents (48%), respiratory agents (38%), gastrointestinal agents (31%), alternative medications (25%), antiparkinsonian agents (22.6%), antihyperlipidemics/statins (7.3%), and immunologics (2.0%). Rates of general (48%ASD vs 32%noASD) and psychotropic polypharmacy (19%ASD vs 6%noASD) were significantly higher in the ASD group.ConclusionPrescription drug use and polypharmacy rates among adults with ASD are substantially higher than those in an age-, sex-, and race-matched cohort of adults without ASD. Adults with ASD frequently use therapeutic treatments other than psychotropics. Healthcare providers, who usually report low confidence in treating patients with ASD, should play an active role in constant monitoring of prescription drug use patterns and patient response to interventions. Prescribers and caregivers are encouraged to make decisions after weighing the benefits and risks associated with a pharmacological treatment. Further investigations into the common use of any alternative treatments that can affect a patient’s response to core treatments should also be conducted.Electronic supplementary materialThe online version of this article (doi:10.1007/s40801-016-0096-z) contains supplementary material, which is available to authorized users.

Objectives To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self‐management (DSM) in a primary care setting. Methods The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site‐related information of the physicians were also collected. Key findings Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent <20 min on face‐to‐face visits. Approximately, 95% of physicians considered self‐care activities such as regular moderate exercise, following a recommended diet, regular blood glucose testing, proper insulin administration and adherence to oral medication as extremely important. Practice‐related aspects such as patient–physician communication, patient health literacy and patient follow‐up were unanimously considered extremely important, and performance on these measures was rated positively. Interestingly, 66% of physicians felt responsible to some extent for their patient's failure to reach type 2 DSM goals. Physician perceived barriers that contributed to clinical inertia included cost of medications, lack of patient motivation and knowledge, non‐compliance with diet and medications, polypharmacy and lack of time and social support. Conclusions The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self‐management and improved clinical outcomes in type 2 diabetes population.

Purpose. The purpose of this study was to determine the concordance of self-reported responses to oral health questions versus clinically evaluated recommended need for oral healthcare by calibrated dentists to determine usefulness of the questions for epidemiological studies. We additionally examined other factors associated with concordant self-reports versus clinical evaluations. Materials and Methods. We used a cross-sectional study design with 4,205 participants, ages 30 years and above, who had complete oral health self-perception data and dental referral data in the NHANES 2013-14. Calibrated dentists completed clinical oral healthcare assessments. The assessments were dichotomized to (1) recommendation for immediate care and (2) routine oral health care. Self-reported oral health needs were measured with 6 items (an overall oral health self-perception question, oral pain within the previous year, impact on job/school, suspected periodontal disease, tooth appearance, and tooth mobility). The key item of interest was the overall oral health self-perception question. Results. Concordance with clinically evaluated recommended need for oral healthcare varied from 52.0% (oral pain) to 65.4% (overall oral health self-perception). Many subgroup differences were observed. Conclusions. The overall self-perception of oral health and the clinical evaluation of oral healthcare need were substantially concordant; other self-reported measures were moderately concordant. This is useful information and points to the need for a minimum set of measures that can provide actionable information and capture the need for clinical dental care.