Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Lau DT [original query] |
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End-of-life care planning and bereavement practices among adult day services centers, 2018
Lendon JP , Caffrey C , Lau DT . Am J Hosp Palliat Care 2024 41 (3) 262-269 Introduction: This study describes the end-of-life (EOL) care planning and bereavement practices among adult day services centers (ADSC) when an ADSC participant is dying or has died. Methods: Data are from the 2018 National Study of Long-term Care Providers' biennial survey of ADSCs. Respondents were asked about the following 4 practices: 1) honoring the deceased in some public way in this center; 2) offering bereavement services to staff and participants; 3) documenting in the care plan what is important to the individual at the end of life (EOL), such as the presence of family or religious or cultural practices; and 4) discussing spiritual needs at care planning conferences. ADSC characteristics included US Census region, metropolitan statistical area status, Medicaid authorization, electronic health records (EHR) use, for-profit status, employment of aides, services provision, and model type. Results: About 50% to 30% of ADSCs offered the EOL care planning or bereavement services. Honoring the deceased was the most common practice (53%), followed by bereavement services (37%), discussing spiritual needs (29%), and documenting what is important at EOL (28%). Fewer ADSCs in the West had EOL practices relative to the other regions. The EOL planning and bereavement practices were offered more often in ADSCs that used EHRs, accepted Medicaid, employed an aide, provided nursing, hospice, and palliative care services, and were categorized as medical models, compared with ADSCs without these characteristics. Conclusion: These results highlight the importance of understanding how ADSCs provide EOL and bereavement care to participants who are near EOL. |
Data related to social determinants of health captured in the National Health and Nutrition Examination Survey
Lau DT , Ahluwalia N , Fryar CD , Kaufman M , Arispe IE , Paulose-Ram R . Am J Public Health 2023 113 (12) 1290-1295 Health equity is defined as “attainment of the highest level of health for all people” and encompasses fair and just opportunities for everyone to be as healthy as possible.1 Health equity research examines the existence of health disparities and their underlying factors, which can be categorized into broad determinants of health, including genetics, behavior, environmental influences, medical care, and social factors.2 The last category, also known as social determinants of health (SDOH), includes social and structural factors, such as racism and discriminatory practices and policies.3 Healthy People 2030 categorizes SDOH into five domains4: education access and quality, economic stability, health care access and quality, social and community context, and neighborhood and built environment. Evidence shows that SDOH influence a wide range of health outcomes5,6 and nutritional status.7 Exposures to adverse SDOH, such as food deserts and unsafe neighborhoods, are inequitably experienced by subgroups that vary by race and ethnicity, socioeconomic status, and other characteristics historically associated with discrimination or exclusion. Variation among groups in access to resources and their differential vulnerability to adverse exposures result in health disparities.8 |
COVID-19 Pandemic Impact on the National Health Care Surveys.
Ward BW , Sengupta M , DeFrances CJ , Lau DT . Am J Public Health 2021 111 (12) 2141-2148 While underscoring the need for timely, nationally representative data in ambulatory, hospital, and long-term-care settings, the COVID-19 pandemic posed many challenges to traditional methods and mechanisms of data collection. To continue generating data from health care and long-term-care providers and establishments in the midst of the COVID-19 pandemic, the National Center for Health Statistics had to modify survey operations for several of its provider-based National Health Care Surveys, including quickly adding survey questions that captured the experiences of providing care during the pandemic. With the aim of providing information that may be useful to other health care data collection systems, this article presents some key challenges that affected data collection activities for these national provider surveys, as well as the measures taken to minimize the disruption in data collection and to optimize the likelihood of disseminating quality data in a timely manner. (Am J Public Health. 2021;111(12):2141-2148. https://doi.org/10.2105/AJPH.2021.306514). |
Advance directives state requirements, center practices, and participant prevalence in adult day services centers: Findings from the 2016 National Study of Long-Term Care Providers
Lendon JP , Caffrey C , Lau DT . J Gerontol B Psychol Sci Soc Sci 2020 76 (8) 1673-1678 OBJECTIVES: Adult day service centers (ADSCs) may serve as an entree to advance care planning. This study examined state requirements for ADSCs to provide advance directives (AD) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. 80.8% of ADSCs provided AD information. 41.3% of participants had documented ADs. There were significant associations between state requirement, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements. |
Is prescribing by PAs and NPs comparable to physician prescribing
Lau DT . JAAPA 2019 32 (2) 52 PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.(1). |
Advancing the field of public health surveillance and survey methods
Lau DT . Am J Public Health 2017 107 (6) 822 50 YEARS AGO | Surveillance for Environmental Pollutants | The New York State Health Department has studied various environmental continuous monitoring installations throughout the country with the objective of developing an effective, comprehensive environmental surveillance system based on the best engineering thought and electronic and telecommunication developments. . . . The system will be composed of 50 continuous air monitors, 60 continuous water monitors, and 300 to 400 manual stations. . . . A surveillance system of the magnitude described should be adequate to yield significant information. . . . However, the possibility has not been precluded that it may be necessary to place some type of continuous measuring detector at every important source of pollution. | From AJPH, October 1967 | 25 YEARS AGO | Laboratory Surveillance for Occupational Lead Exposure | Public health agencies in several states have described surveillance programs for occupational lead exposure using biological monitoring data. The experience in these states provides useful lessons about program design and operation. . . . The New Jersey experience demonstrates the utility of laboratory-based surveillance systems for occupational lead exposure. . . . Although some high-risk industries . . . are common to many states, state specific, laboratory based surveillance systems identify industries important in one state but not in others. . . . Improvements are needed if these surveillance systems are to provide accurate data for assessing progress toward the Public Health Service objective . . . by the year 2000. | From AJPH, February 1992 | Surveillance data are the most important source of information and support for public health intervention on a local and global scale. In this June issue, I am delighted to announce that AJPH is introducing a new section called Surveillance and Survey Methods. | The new AJPH section will publish peer-reviewed articles that describe the latest designs and methodological novelties that established programs have adopted to improve data collection, analysis, and dissemination to meet public health surveillance objectives. Surveillance and survey programs of interest range from those that gather data on major life events and disease onset and progression to those that track health care access, quality, and utilization over time. | This section welcomes three types of articles: Design Description, Methods Research, and Perspectives. Design Description articles describe major design and methodological updates that established public health surveillance and survey programs have implemented. These articles should describe the program’s approaches in data collection, processing, reporting, and dissemination. Often times, surveillance programs are redesigned and updated on the basis of testing and evaluation. |
Concomitant opioid and laxative use in older adults in hospice care in the United States: 2007
Lau DT , Dwyer LL , Shega JW . J Am Geriatr Soc 2016 64 (11) e160-e165 OBJECTIVES: To examine laxative use by individuals in hospice who were taking opioids during the last week of life. DESIGN: Retrospective cross-sectional. SETTING: 2007 National Home and Hospice Care Survey. PARTICIPANTS: Individuals in hospice aged 65 and older who were taking opioids during the last week of life (N = 2,825). MEASUREMENTS: Hospice staff were asked the names of all medications and drugs that participants were taking 7 days before and on the day of death while in hospice, including any standing, routine, or as-needed medications." Medications "used" included medications taken and as-needed medications provided in case a symptom developed. Opioids included all opioid-combination drugs. Laxatives included fibers, lubricants, stimulants, and suppositories. RESULTS: Forty-one percent of participants had cancer as the primary hospice diagnosis, 13% heart disease, 12% debility, 11% dementia, 8% lung disease, and 15% other. Overall, 52% of opioid users used a laxative in the last week of life; the proportions of opioid and laxative users did not differ according to diagnosis. Racial minorities taking opioids had lower odds than white participants (odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.33-0.99) of using laxatives. Participants taking opioids enrolled in hospice for 7 days or less had lower odds of using laxatives than those enrolled for more than 7 days (OR = 0.65, 95% CI = 0.37-0.95), as did those in hospice inpatient, hospital, or other settings (OR = 0.45, 95% CI = 0.43-0.93) than those in long-term care settings. Participants using five or fewer medications had lower odds of using laxatives than those using six to 10 (OR = 6.01, 95% CI = 3.88-9.32) or 11 to 25 medications (OR = 13.80, 95% CI = 8.74-21.80). CONCLUSION: In 2007, slightly more than half of older adults in hospice who were taking opioids used laxatives during the last week of life. Recent quality indicators from the Centers for Medicare and Medicaid Services recommend laxative treatment when opioid therapy is initiated to prevent opioid-induced constipation and are intended to improve laxative use in individuals in hospice treated with opioids. |
Toward a more complete picture of outpatient, office-based health care in the U.S
Lau DT , McCaig LF , Hing E . Am J Prev Med 2016 51 (3) 403-9 The healthcare system in the U.S., particularly outpatient, office-based care, has been shifting toward service delivery by advanced practice providers, particularly nurse practitioners (NPs) and physician assistants (PAs). The National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, is the leading source of nationally representative data on care delivered by office-based physicians. This paper first describes NAMCS, then discusses key NAMCS expansion efforts, and finally presents major findings from two exploratory studies that assess the feasibility of collecting data from NPs and PAs as sampled providers in NAMCS. The first NAMCS expansion effort began in 2006 when the NAMCS sample was expanded to include community health centers and started collecting and disseminating data on physicians, NPs, PAs, and nurse midwives in these settings. Then, in 2013, NCHS included workforce questions in NAMCS on the composition and clinical tasks of all healthcare staff in physician offices. Finally, in 2013-2014, NCHS conducted two exploratory studies and found that collecting data from NPs and PAs as sampled providers in NAMCS is feasible. However, modifications to the current NAMCS procedures may be necessary, for example, changing recruitment strategies, visit sampling procedures, and physician-centric survey items. Collectively, these NCHS initiatives are important for healthcare research, practice, and policy communities in their efforts toward providing a more complete picture of the changing outpatient, office-based workforce, team-based care approach, and service utilization in the U.S. |
Medications that older adults in hospice care in the United States take, 2007
Dwyer LL , Lau DT , Shega JW . J Am Geriatr Soc 2015 63 (11) 2282-9 OBJECTIVES: To describe medications that older adults in hospice with cancer, dementia, debility, heart disease, and lung disease take during the last week of life. DESIGN: Retrospective cross-sectional study. SETTING: Nationally representative sample of 695 U.S. hospices in the 2007 National Home and Hospice Care Survey. PARTICIPANTS: Individuals aged 65 and older with a primary diagnosis of cancer (49%), dementia (12%), debility (14%), heart disease (16%), or lung disease (10%) who received end-of-life care during their last week of life (N = 2,623). MEASUREMENTS: Medication data were obtained from hospice staff, who were asked, "What are the names of all the medications and drugs the patient was taking 7 days prior to and on the day of his or her death while in hospice? Please include any standing, routine, or PRN medications." RESULTS: The unweighted survey response rate was 71%. The average number of medications taken was 10.2. The most common therapeutic classes were analgesics (98%); antiemetic and antivertigo medications (78%); anxiolytics, sedatives, and hypnotics (76%); anticonvulsants (71%); and laxatives (53%). Approximately one-quarter of the individuals took proton pump inhibitors, anticoagulants, and antidepressants, and fewer than 20% took antacids and antibiotics. A smaller percentage of individuals with dementia and debility than of those with cancer took opioid analgesics. Individuals with heart disease were more likely than individuals in the other clinical cohorts to take diuretics, and those with lung disease were more likely than those in the other clinical cohorts to take bronchodilators. A higher percentage of individuals with dementia and with debility than with cancer and lung disease took antidepressants. CONCLUSION: People continue to receive disease-focused therapies at the end of life rather than therapies exclusively for palliation of symptoms, suggesting that treatments may vary according to the person's primary diagnosis. |
Next-generation sequencing reveals large connected networks of intra-host HCV variants.
Campo DS , Dimitrova Z , Yamasaki L , Skums P , Lau DT , Vaughan G , Forbi JC , Teo CG , Khudyakov Y . BMC Genomics 2014 15 Suppl 5 S4 BACKGROUND: Next-generation sequencing (NGS) allows for sampling numerous viral variants from infected patients. This provides a novel opportunity to represent and study the mutational landscape of Hepatitis C Virus (HCV) within a single host. RESULTS: Intra-host variants of the HCV E1/E2 region were extensively sampled from 58 chronically infected patients. After NGS error correction, the average number of reads and variants obtained from each sample were 3202 and 464, respectively. The distance between each pair of variants was calculated and networks were created for each patient, where each node is a variant and two nodes are connected by a link if the nucleotide distance between them is 1. The work focused on large components having > 5% of all reads, which in average account for 93.7% of all reads found in a patient. CONCLUSIONS: Most intra-host variants are organized into distinct single-mutation components that are: well separated from each other, represent genetic distances between viral variants, robust to sampling, reproducible and likely seeded during transmission events. Facilitated by NGS, large components offer a novel evolutionary framework for genetic analysis of intra-host viral populations and understanding transmission, immune escape and drug resistance. |
Characteristics of adults in the hepatitis B research network in North America reflect their country of origin and hepatitis B virus genotype.
Ghany M , Perrillo R , Li R , Belle SH , Janssen HL , Terrault NA , Shuhart MC , Lau DT , Kim WR , Fried MW , Sterling RK , Di Bisceglie AM , Han SH , Ganova-Raeva LM , Chang KM , Suk-Fong Lok A . Clin Gastroenterol Hepatol 2014 13 (1) 183-92 BACKGROUND & AIMS: Chronic hepatitis B virus (HBV) infection is an important cause of cirrhosis and hepatocellular carcinoma worldwide; populations that migrate to the US and Canada might be disproportionately affected. The Hepatitis B Research Network (HBRN) is a cooperative network of investigators from the United States and Canada, created to facilitate clinical, therapeutic, and translational research in adults and children with hepatitis B. We describe the structure of the network and baseline characteristics of adults with hepatitis B enrolled in the network. METHODS: The HBRN collected data on clinical characteristics of 1625 adults with chronic HBV infection who are not receiving antiviral therapy from 21 clinical centers in North America. RESULTS: Half of the subjects in the HBRN are male, and the mean age is 42 years; 72% are Asian, 15% are Black, and 11% are White, with 82% born outside of North America. The most common HBV genotype was B (39%); 745 of subjects were negative for the hepatitis B e antigen. The median serum level of HBV DNA when the study began was 3.6 log10 IU/mL; 68% of male subjects and 67% of female subjects had levels of alanine aminotransferase above the normal range. CONCLUSIONS: The HBRN cohort will be used to address important clinical and therapeutic questions for North Americans infected with chronic HBV and to guide health policies on HBV prevention and management in North America. |
Formal and informal support of family caregivers managing medications for patients who receive end-of-life care at home: a cross-sectional survey of caregivers
Joyce BT , Berman R , Lau DT . Palliat Med 2014 28 (9) 1146-55 BACKGROUND: Managing medications is a complex responsibility of family caregivers caring for end-of-life patients. This study characterizes caregivers with and without formal/informal support managing medications for patients who receive end-of-life care at home. AIM: To explore factors related to caregivers' support with managing medications for end-of-life home hospice patients. DESIGN: A convenience-sampled, cross-sectional telephone survey. SETTING/PARTICIPANTS: Computer-assisted telephone interviews were administered to 120 caregivers managing medications, who were referred by five Chicago-based home hospice services. We measured caregivers' additional formal (paid) and informal (unpaid) support with managing medications, and caregiver/patient socio-demographic, relational, and health characteristics. RESULTS: While 47 (39%) had no additional support with managing medications, 27 (22.5%) had formal support, 37 (31%) informal, and 9 (7.5%) both. Seven caregivers (19%) with formal and 13 (31%) with informal support reported disagreements concerning treatment plans. Caregivers lacking formal support tended to be racial/ethnic minorities, live with the patient in their home, or report greater emotional burden. Caregivers with formal support tended to report higher education/income, lower mutuality, or care for a patient with over 6 months' hospice enrollment. Caregivers lacking informal support tended to be spousal caregivers, live with the patient, or have experience caring for another dying person. CONCLUSION: Our study suggests that high proportions of caregivers may not have support managing medications for patients receiving hospice care at home. More research should examine whether the observed variations in obtaining support indicate disparities or unmet needs among caregivers. Disagreement about treatment with formal/informal support also warrants further investigation. |
Informing drug development and clinical practice through patient-centered outcomes research
Coon CD , Lau DT . Clin Ther 2014 36 (5) 616-8 In the last 2 decades, the health care field has made an effort to emphasize the patient experience and voice in the quality and value of health care in the United States. US Food and Drug Administration (FDA) guidance on patient-reported outcome (PRO) instruments in obtaining labeling claims, some may argue, is the endeavor that has helped push patient-centered outcomes to the forefront of health care research. Although PRO instruments have been used for years, especially in the field of psychology research, they have gained favor over time as a means for diagnosing medical conditions, assessing treatment efficacy, understanding the burden of illness, and gaining insight into the impact of disease directly from the patient’s own perspective. The concept of patient-centered outcomes allows for health care research to go beyond its traditional model, with a focus on the impact of disease and treatment on a patient’s quality of life from his or her own eyes. | Although the patient’s voice has increasingly been incorporated into pharmaceutical clinical trials and clinical practice, researchers and clinicians are still striving to define and apply ways by which the patient can be the focal point of the health care industry. This special issue of Clinical Therapeutics compiles conceptual and empirical articles that explore and discuss scientific approaches to incorporating the patient’s voice into health care research. Our intention was to continue the dialogue on advancing patient-centered outcomes research to better inform drug development and clinical practice. |
Drug-resistance of a viral population and its individual intra-host variants during the first 48 hours of therapy
Campo DS , Skums P , Dimitrova Z , Vaughan G , Forbi JC , Teo CG , Khudyakov Y , Lau DT . Clin Pharmacol Ther 2014 95 (6) 627-35 Using HCV and IFN-resistance as a proof of concept, we have devised a new methodology for calculating the effect of a drug over a viral population and the resistance of its individual intra-host variants. By means of next-generation sequencing, HCV variants were obtained from sera collected at 9 time-points from 16 patients during the first 48 hours after injection of IFN-a. IFN-resistance coefficients were calculated for individual variants using changes in their relative frequencies, and for the entire intra-host viral population using changes in viral titer during the initial 48 hours. Population-wide resistance and presence of IFN-resistant variants were highly associated with pegIFN-a2a/RBV treatment outcome at week 12 (p = 3.78x10-5 and 0.0114, respectively). This new method allows an accurate measurement of resistance based solely on changes in viral titer or the relative frequency of intra-host viral variants during a short observation time. |
Relationship between persistent pain and 5-year mortality: a population-based prospective cohort study
Shega JW , Andrew M , Kotwal A , Lau DT , Herr K , Ersek M , Weiner DK , Chin MH , Dale W . J Am Geriatr Soc 2013 61 (12) 2135-41 OBJECTIVES: To assess the association between self-reported noncancer pain and 5-year mortality. DESIGN: Cohort. SETTING: Community-dwelling older adults. PARTICIPANTS: Canadian Study of Health and Aging 1996 wave. MEASUREMENTS: Registrar of Vital Statistics-established 5-year mortality. Noncancer pain was assessed using the 5-point verbal descriptor scale, dichotomized into no or very mild versus moderate, severe, or very severe pain. Frailty was the accumulation of health deficits. Cognitive status (Modified Mini-Mental State Examination) and depressed mood (five-item mental health screening questionnaire) were also assessed. Multivariable logistic regression and Cox proportional hazards were used to analyze the relationship between pain and 5-year mortality. RESULTS: Of 5,703 participants, 4,694 (82.3%) had complete data for analysis; 1,663 of these (35.4%) reported moderate, severe, or very severe pain, and 1,343 (28.6%) had died at 5-year follow-up. Four hundred ninety-six of those who died (29.8%) reported moderate, severe, or very severe pain and 847 (27.9%) no or very mild pain. Multivariate logistic analysis found that individuals with moderate, severe, or very severe pain had lower odds of 5-year mortality than those with no or very mild pain (odds ratio = 0.78, 95% confidence interval (CI) = 0.66-0.92; P < .001). The risk of death was lower in persons reporting moderate or greater pain than in those with no or very mild pain (HR = 0.85, 95% CI = 0.75-0.96; P = .01). An interaction between pain and sex explained this effect. Men with pain were not significantly more likely than men without pain to die (HR = 1.00, 95% CI = 0.84-1.19; P = .99), whereas women without pain (HR = 0.54, 95% CI = 0.47-0.63; P < 0.01) and women with pain (HR = 0.40; CI = 0.33-0.47; P < .01) had less risk of death than men without and with pain, respectively. CONCLUSION: Older women with pain were less likely to die within 5 years than older women without pain, men in pain, or men without pain. |
Showcasing pharmaceutical economics, outcomes, and health policy: an update in clinical therapeutics
Lau DT . Clin Ther 2013 35 (4) 354-5 Sound scientific evidence is in demand as part of health care decision making to demonstrate the effectiveness, quality, and safety of health care services, particularly pharmacotherapies, in real-world, routine clinical settings. As health care spending continues to rise, empirical analyses of costs and the relative value of treatment alternatives have gained prominence in informing prescribing and reimbursement decisions, while scrutiny over their analytical approaches for scientific rigor also has increased. In light of the continuing need for better evidence-based medicine, this special issue of Clinical Therapeutics showcases a collection of diverse, yet related, articles addressing the current state and future issues on pharmaceutical economics, treatment utilization, health outcomes, and drug-related health policy. | Despite the abundance of published health economic evaluations in recent decades, the International Society of Pharmacoeconomics and Outcomes Research Task Force on Quality Improvement in Cost-Effectiveness Research (chaired by Don Husereau) has found no guidelines, requirements, or checklists on health economic research. Along with several other peer-reviewed scientific journals, Clinical Therapeutics is co-publishing the society's task force report on the Consolidated Health Economic Evaluation Reporting Standards, a checklist and explanatory guidance document that is intended to help improve the reporting of health economic evaluations. (10.1016/j.clinthera.2013.03.003). |
Colorectal cancer knowledge, attitudes, screening, and intergenerational communication among Japanese American families: an exploratory, community-based participatory study
Lau DT , Machizawa S , Demonte W , Cameron KA , Muramatsu N , Henker RD , Chikahisa F , Tanimura M . J Cross Cult Gerontol 2012 28 (1) 89-101 Adults of Japanese descent (Nikkei) in the United States have higher risk for colorectal cancer (CRC) than their white counterparts. Family norms toward CRC screening may influence screening behaviors of Nikkei adults. This community-based participatory research study explores if mailing educational pamphlets to Nikkei families can influence CRC knowledge, attitudes, and screening adherence; and trigger intergenerational communication about CRC. Among 56 parent-offspring dyads contacted, 24 were eligible (e.g., no prior CRC screening/diagnosis) and were randomized into 3 cohorts defined by the "target recipient(s)" of study pamphlets about CRC screening: parent only, offspring only, and both parent and offspring. Among the 19 completed dyads (79.2 % = 19/24), results showed that CRC knowledge of most pamphlet recipients increased in all cohorts; however, some misinformation and attitudinal barriers persisted. Although some parent-offspring communication about CRC increased after mailing pamphlets to offspring, only spousal communication occurred after mailing pamphlets to parents. Additional benefits were not observed in increasing parental screening intent/behavior after mailing pamphlets to both parent and offspring. At the end, among the 10 parents who reported developing CRC screening intent or having scheduled a CRC screening, 8 attributed to study pamphlets and 2 to communication with their offspring. Self-reported barriers preventing screening and parent-offspring communication about CRC were identified. This exploratory study describes preliminary findings that will inform future research aimed to promote CRC screening and reduce racial/ethnic disparities at the community level by enhancing intergenerational communication among Nikkei families. |
Inappropriate medication in home health care
Lau DT , Dwyer LL . J Gen Intern Med 2012 27 (5) 490; author reply 491 We read with interest the study by Bao and colleagues examining the use of Beers-defined potentially inappropriate medications among older patients receiving home health care (HHC) services in the United States.1 Ensuring proper medication use especially in older adults remains a public health priority, and the authors argue that HHC patients may be at high risk for using ineffective or unsafe medications likely due to their often complex medication regimens and multiple physician prescribers. The study analyzes the 2007 National Home and Hospice Care Survey (NHHCS), a nationally representative survey of U.S. home health and hospice care agencies that collected data on current HHC patients and hospice care discharges.2 Bao and colleagues restricted their analysis to HHC patients who were age 65 or older and used at least one medication (n = 3,124). The authors, however, did not differentiate between patients receiving and patients not receiving end-of-life (EOL) care. According to NHHCS, we calculated that 15% (weighted) of HHC patients in their study had a medical prognosis indicating a six-month-or-less life expectancy and received “palliative, end of life, or terminal care instead of active or curative treatment.” | It is important for the Bao et al. study to distinguish between HHC patients who did and who did not receive EOL care. While the 2003 Beers list is commonly used to define medications to avoid among older patients3 (albeit not without controversy), there is no clear consensus about which medications are unsuitable for older patients receiving EOL care. The validity of the Beers list as a prescribing quality indicator to assess EOL treatment is disputable in principle and evidence.4 Research has argued that short-acting benzodiazepines, gastrointestinal antispasmodics, anticholinergics, and antihistamines that are on the Beers list may be clinically appropriate for older patients receiving EOL care whose goal of care is to manage pain and other distressing symptoms.5 Furthermore, although long half-life benzodiazepines generally should be avoided in older patients according to Beers, withdrawing a long half-life benzodiazepine may pose unnecessary, significant risk for major withdrawal symptoms in older patients receiving EOL care.6 Consequently, the examination of inappropriate medication use among HHC patients without differentiating between those receiving and those not receiving EOL care raises concerns about the Bao et al. study findings and their suggested policy and practice implications. In general, applying the Beers list to examine medication appropriateness in older adults should be performed judiciously in settings where EOL care is provided. |
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