scholarly journals Nonprescription Antimicrobial Use in a Primary Care Population in the United States

2016 ◽  
Vol 60 (9) ◽  
pp. 5527-5532 ◽  
Author(s):  
Roger Zoorob ◽  
Larissa Grigoryan ◽  
Susan Nash ◽  
Barbara W. Trautner
Keyword(s):  
United States ◽  
Primary Care ◽  
Random Sample ◽  
Latin American ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Race Ethnicity ◽  
Intended Use

ABSTRACTCommunity antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, “leftover” antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

scholarly journals 2070. Assessing Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A National Survey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S698-S698
Author(s):  
Rachel M Zetts ◽  
Andrea Garcia ◽  
Jason Doctor ◽  
Jeffrey Gerber ◽  
Jeffrey A Linder ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
National Survey ◽  
Antibiotic Stewardship ◽  
Primary Care Physicians ◽  
Antibiotic Use ◽  
The United States ◽  
Incentive Program ◽  
Data Feedback

Abstract Background At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship can improve prescribing and minimize the threat of antibiotic resistance. We assessed primary care physicians’ (PCPs) perceptions of antibiotic resistance, inappropriate antibiotic use, and the need for and impact of antibiotic stewardship activities. Methods We conducted a national survey of 1,550 internal and family medicine physicians and pediatricians recruited from a medical market research panel. Quotas were established to recruit participants by geographic region and specialty. For sample representativeness, survey weights were generated according to these characteristics using the American Medical Association’s Masterfile. Results Among respondents, 94% agreed that resistance is a problem in the United States, but only 55% felt it was a problem for their practice; 65% of respondents agreed they had seen an increase in resistant infections in their patients over the past 5 years. Responses about inappropriate antibiotic use were similar: 91% agreed that it was a problem, but 37% agreed that it is a problem in their practice. Additionally, 60% felt they prescribed antibiotics more appropriately than their peers. For antibiotic stewardship, 91% felt it was appropriate for office-based practices, but 53% believed that discussions with patients on the appropriate use of antibiotics is sufficient to address the problem. The majority of respondents indicated they were likely, very likely, or extremely likely to implement stewardship interventions in response to feedback or incentives from payers or health departments. The activities with the strongest likelihood to spur stewardship adoption included the state health department publishing local resistance patterns (82%), a payer creating a stand-alone incentive program for stewardship (80%), or a payer including it in a broader quality incentive program (76%). Conclusion PCPs feel that antibiotic resistance, inappropriate prescribing, and stewardship are important in the United States, but not for their own practices. This disconnect poses a challenge for the success of outpatient stewardship programs. Incentive or data feedback activities may help encourage stewardship uptake. Disclosures All authors: No reported disclosures.

Prevalence of Total Daily Walking Among US Adults, 2002–2003

2008 ◽  
Vol 5 (3) ◽  
pp. 337-346 ◽  
Author(s):  
Jared P. Reis ◽  
Caroline A. Macera ◽  
Barbara E. Ainsworth ◽  
Deborah A. Hipp
Keyword(s):  
United States ◽  
Body Mass Index ◽  
Random Sample ◽  
Leisure Time ◽  
The United States ◽  
Time Activity ◽  
Representative Random Sample ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Weekly Frequency

Background:Walking for exercise is a popular leisure-time activity pursuit among US adults; however, little information is available about total daily walking.Methods:A nationally representative random sample of 10,461 US adults (4438 men and 6023 women) was surveyed via telephone between 2002 and 2003. Weekly frequency and daily duration of walking for all purposes in bouts of at least 10 min were measured. Regular walking was defined as walking ≥5 d/wk, ≥30 min/d.Results:Overall, 49% of adults (51% of men and 47% of women) were regular walkers, and approximately 17% reported no walking. Regular walking was significantly higher in employed adults and decreased with increasing age in women and body mass index in both sexes. Total walking was significantly higher among adults with lower levels of educational attainment and did not vary significantly by race/ethnicity.Conclusions:These results affirm the popularity of walking in the United States.

The Role of Income and Race/Ethnicity in Experiences with Medical Care in the United States and United Kingdom

2008 ◽  
Vol 38 (4) ◽  
pp. 671-695 ◽  
Author(s):  
Jason Schnittker ◽  
Mehul Bhatt
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
United Kingdom ◽  
Health Insurance ◽  
Medical Care ◽  
Health Care Systems ◽  
The United States ◽  
System Level ◽  
Race Ethnicity

Inequalities in experiences with medical care are well-known in the United States, but little is known about the shape of such inequalities in other countries. This study compares a broad spectrum of experiences in the United States and United Kingdom. Furthermore, it focuses on two of the most important dimensions of inequality, race/ethnicity and income, and two of the most widely discussed system-level factors, health insurance and emphasis on primary care. Two general conclusions are reached. First, there are broad income-based inequalities in medical care in both the United States and United Kingdom. These inequalities persist even after controlling for health insurance, including private medical insurance in the United Kingdom. Race is also related to experiences with medical care, although the effects of race are more particular and contingent than are those for income. In particular, the mapping of racial/ethnic inequality differs considerably between the United States and United Kingdom, reflecting their different sociocultural climates. Second, the health care system, especially primary care, plays a limited role in ameliorating inequalities in care, but plays a strong role in elevating the average level of quality within a country. Because inequalities in medical care reflect broader social processes, they are durable across very different health care systems and contexts.

scholarly journals Stroke Hospitalizations Before and During COVID-19 Pandemic Among Medicare Beneficiaries in the United States

Stroke ◽  
2021 ◽  
Author(s):  
Quanhe Yang ◽  
Xin Tong ◽  
Sallyann Coleman King ◽  
Benjamin S. Olivari ◽  
Robert K. Merritt
Keyword(s):  
United States ◽  
Patient Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Percent Reduction ◽  
Stroke Patients ◽  
Race Ethnicity ◽  
National Emergency

Background and Purpose: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). Methods: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. Results: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1–April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7–October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%–23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%–12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, −16.0%–1.7%) in New Hampshire to 36.2% (95% CI, 24.8%–46.7%) in Montana. Conclusions: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1–June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state.

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