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Background: Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial., Objective: To evaluate trends, prevalence and determinants of CRN, and its impact on asthma control among US adults with asthma., Methods: Data from 2011 to 2022 National Health Interview Survey were used. Joinpoint regression analysis was used to evaluate trends in the prevalence of CRN. A multivariable logistic regression model was used to identify factors associated with CRN. Two additional multivariable logistic regression models were used to examine associations between CRN and asthma-related adverse events, including asthma attacks and emergency room (ER) visits for asthma., Results: A total of 30 793 adults with asthma were included, representing 8.1% (19.38 million) of the US population. From 2011 to 2022, a declining trend in the prevalence of CRN among US adults with asthma was observed. Approximately every one in six adults with asthma was non-adherent to medications due to cost. Several factors, including demographics and comorbidities, were associated with CRN. Adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted OR, 1.95; 95% CI 1.78 to 2.13) and ER visits for asthma (adjusted OR, 1.63; 95% CI 1.44 to 1.84)., Conclusion: Since asthma is one of the leading chronic diseases, the burden of cost-related non-adherence to medications highlights the need for appropriate policies and social supports to address such problems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: A Health and Disabilities Interprofessional Education (IPE) course was implemented to join three healthcare disciplines together to collaboratively plan, implement, and reflect on professional roles and responsibilities. The goal and purpose of this course was to create an advancement of interprofessional education and practice within health science professions early in their students' programs utilizing innovative teaching methods working directly with individuals with disabilities., Educational Activity and Setting: 72 students were assigned to interprofessional teams of 10-11 people. Through asynchronous and synchronous learning activities, student teams worked together to plan and conduct community-based client interviews., Findings: Quantitative and qualitative evaluation methods were used to explore the impact of interprofessional experiential learning experiences. Qualitative data showed a greater awareness and understanding of the different roles and responsibilities in interprofessional teams as well as a greater appreciation for the value of interacting with persons with disabilities (PWD) during their training. Quantitative data showed a significant change in students' understanding of their roles and responsibilities as a member of an interprofessional team, their confidence with working with PWD in a future healthcare capacity, as well as their understanding of how the social determinants of health may influence the healthcare experience of a PWD., Summary: Interprofessional education and experiential learning opportunities are good ways to facilitate "real" patient care experiences and team roles and responsibilities. This enables healthcare students to practice communication, build relationships, and understand the lived experience of their patients., Competing Interests: Declaration of competing interest The authors attest that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript., (Published by Elsevier Inc.)

Purpose: This study aimed to describe opioid prescription patterns for children with vs. without cerebral palsy (CP)., Methods: This cohort study used commercial claims from 01/01/2015-12/31/2016 and included children aged 2-18 years old with and without CP. Opioid prescription patterns (proportion exposed, number of days supplied) were described. A zero-inflated generalized linear model compared the proportion exposed to opioids in the follow-up year (2016) and, among those exposed, the number of days supplied opioids between cohorts before and after adjusting for age, gender, race, U.S. region of residence, and the number of co-occurring neurological/neurodevelopmental disabilities (NDDs)., Results: A higher proportion of children with (n = 1,966) vs. without (n = 1,219,399) CP were exposed to opioids (12.1% vs. 5.3%), even among the youngest age group (2-4 years: 9.6% vs. 1.8%), and had a greater number of days supplied (median [interquartile range], 8 [5-13] vs. 6 [4-9] days; P < 0.05). Comparing children with opioid exposure with vs. without CP, a greater number of days supplied was identified for older age, Asian race/ethnicity, and without co-occurring NDDs, and a lower number of days supplied was observed for Black race/ethnicity and with ≥1 co-occurring NDDs., Conclusion: Children with CP are more likely to be exposed to opioids and have a higher number of days supplied.

Objective: Fragility fractures are associated with an increased risk of pneumonia, which is a leading cause of death in adults with intellectual disabilities; however, the timing and complications of post-fracture pneumonia are underinvestigated. The objectives of this study were to determine the 30-day pneumonia rate post-fracture and the association of post-fracture pneumonia with mortality and cardiovascular events among adults with intellectual disabilities., Methods: This retrospective cohort study was conducted using Medicare and commercial claims from 01 January 2011 to 31 December 2016. Incidence of pneumonia 30 days after a fragility fracture among adults ≥18 years old with intellectual disabilities (Fx cohort) was compared to the incidence among matched adults with intellectual disabilities without fractures (w/oFx cohort) and the general population of patients with an incident fragility fracture (GP+Fx). For the Fx cohort, Cox regression was used to examine the adjusted association of time-varying pneumonia (within 30 days post-fracture) with mortality and incidence of cardiovascular events 0-30, 31-365, and 366-730 days post-fracture., Results: There was a high-early rate of pneumonia within 30 days post-fracture for young, middle-aged, and elderly adults with intellectual disabilities ( n = 6,183); this rate was 2.2- to 6.1-fold higher than the rate among the w/oFx ( n = 12,366) and GP+Fx ( n = 363,995) cohorts (all P < 0.05). For the Fx cohort, post-fracture 30-day incidence of pneumonia was associated with an increased 30-day rate of mortality (adjusted HR [aHR] = 5.19; 95% confidence interval [CI] = 3.68-7.32), heart failure (aHR = 2.96; 95% CI = 1.92-4.56), and cerebrovascular disease (aHF = 1.48; 95% CI = 0.93-2.35; P = 0.098), with sustained effects to 1 year for heart failure (aHR = 1.61; 95% CI = 1.19-2.17) and 2 years for mortality (aHR = 1.39; 95% CI = 1.06-1.83), and without evidence of effect modification by age., Discussion: Adults with intellectual disabilities are vulnerable to post-fracture pneumonia within 30 days, and complications arising from this, across the adult lifespan, and not only during the elderly years., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Whitney, Erickson and Berri.)

Background/aims/methods: Medication information is available from many sources. This short report provides a simple description of where caregivers of people with intellectual/developmental disability (IDD) obtain medication information, and compares these sources between family caregivers and direct support professionals (DSP)., Procedures/outcomes: Cross-sectional study design using an internet-based survey of caregivers, aged 18 years or older, who provided support to adults with IDD. The primary outcome is the source of medication information reported by caregivers., Results/conclusions: Eighty-nine caregivers responded. Health care professionals were the primary source (87.6 %) of medication information, followed by the internet (77.5 %). There was no difference between caregiver groups for these two sources. The prescription label/information sheet was the next most common source (56.2 %), with significantly more family (76.2 %) versus DSP (38.3 %), p < 0.001. A medication reference was also common (43.8 %), with 28.6 % of family and 57.4 % of DSP, p = 0.006. House manager/nurse was next, with 16.9 %, and television/radio as a source (10.1 %), no difference between groups. Lastly, friends or coworkers were 7.9 %, with no DSP endorsing this option, p = 0.006., Implications: Caregivers obtain medication information from a variety of sources, with health care professionals being the primary source. The internet was also very common, which may be worrisome, due to the wide range of level of quality of information available. Educational interventions should be developed to provide caregivers with tools to be able identify and use legitimate medication information., Competing Interests: Declarations of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Adults with intellectual disabilities have a greater risk for fragility fractures that begin to accumulate early in the adult lifespan, which may contribute to accelerated health declines. The objective was to determine if fragility fractures were associated with an increased 2-year rate of cardiorespiratory diseases among adults with intellectual disabilities., Method: This retrospective cohort study used nationwide administrative claims data from 01/01/2011-12/31/2016 from the Medicare fee-for-service database. 2-year incidence of cardiorespiratory diseases were compared between adults ≥18 years old with intellectual disabilities with (n = 6183) vs. without (n = 67,842) an incident fragility fracture after confounder adjustment using Cox regression., Results: Fracture at the vertebral column, hip, non-proximal femur, tibia/fibula, and multiple sites had an elevated hazard ratio (HR) compared to those with no fracture for pneumonia, respiratory failure, heart failure, and cerebrovascular disease (HR range, 1.15-2.09, all P < 0.05), while humerus and radius/ulna fracture were associated with an elevated HR for congestive heart failure and cerebrovascular disease (HR range, 1.38-1.72, all P < 0.05)., Conclusions: Fragility fractures were associated with an increased incidence of cardiorespiratory diseases among adults with intellectual disabilities., Competing Interests: Declaration of competing interest There are no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Seeking health information online has gained in popularity. However, few studies have investigated seeking health information online among U.S. pregnant women. The aim of this study was to investigate the patterns, trends, and characteristics of pregnant women in the U.S. who seek health information online. We obtained data from the National Health Interview Survey from 2009 to 2018. The study population consisted of women aged 18 to 49 years who self-reported being pregnant. Complex survey weighting and Chi-squared tests were used to evaluate trends and compare characteristics of online users and nonusers. Multivariable logistic regression analyses were used to evaluate characteristics associated with seeking health information online. Significantly more pregnant women sought health information online in 2018 compared to 2009 (72.9 percent, standard error [SE]: 3.3, 95 percent confidence interval [CI]: 66.3 percent-79.5 percent, vs. 60.7 percent, SE: 3.3, 95 percent CI: 54.0 percent-67.4 percent, p  < .01). Pregnant women who were identified as white or Black, who had more education, and who had higher incomes were significantly more likely to report seeking health information online. Healthcare providers should actively initiate conversations to address the safety, accuracy, and reliability of online health information for their pregnant patients.

BACKGROUND: Children with cerebral palsy (CP) may have chronic exposure to polypharmacy to address several medical needs, but there is little research on the topic to inform surveillance methods and clinical practice. OBJECTIVE: To identify the trajectories of medication number and pediatric polypharmacy (≥2 concurrent medications) exposure over 3.5 years among children with CP. METHODS: This cohort study used commercial claims from January 1, 2015, to December 31, 2018 (4-year period). Children with CP, aged 5-18 years by January 1, 2016, and with continuous health plan enrollment for all 4 years, were included and categorized as with or without co-occurring neurological/ RESULTS: Of the 1,252 children with CP, 600 were in the CP only cohort (mean [SD]; age, 11.4 [4.1] years; 46.0% female) and 652 were in the CP + NDDs cohort (age, 11.9 [4.1] years; 41.3% female; 32.7% had ≥2 of the NDDs). For the primary GBTM, 3 trajectory groups were identified for CP only: on average, no prescribed medications (69.7% of the cohort), 1 medication/month (24.8%), and 4 medications/month (5.5%). Five trajectory groups were identified for CP + NDDs: 0 (22.4%), 1 (25.6%), 2 (25.2%), 4 (18.4%), and 6 (8.4%) prescribed medications/month. For the secondary GBTM, 3 trajectory groups were identified for CP only: 80.5% were characterized as negligible probability of polypharmacy exposure, 10.8% as low probability, and 8.7% as high probability. Five trajectory groups were identified for CP + NDDs: 37.9% as negligible probability of polypharmacy exposure, 32.8% as constantly high probability, and 29.2% as changing probability (eg, increasing/decreasing). CONCLUSIONS: Children with CP are chronically exposed to differing levels of polypharmacy. Findings can help establish polypharmacy surveillance practices. Studies need to determine if polypharmaceutical strategies are balanced to optimize health and development for children with CP. DISCLOSURES: Dr Whitney is supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund. The funding source had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Background/aims: Persons with intellectual or developmental disabilities and who exhibit challenging behaviors are often prescribed medication to control behavior. Little is known about the environmental factors that may be associated with taking these medications., Methods and Outcomes: This study examined the association between individual and intermediate or environmental factors and the documented use of medication for clients with intellectual or developmental disabilities (IDD) who exhibit challenging behavior, using the 2014-15 National Core Indicators Adult Consumer Survey dataset., Results and Conclusions: Individual-level variables associated with a higher likelihood of taking medication for persons with IDD exhibiting challenging behaviors included being of younger age, male gender, having moderate or severe intellectual disability, being ambulatory, communicating verbally, having a behavioral plan, requiring support for behavioral challenges, and having a history of mental illness. Environment-level variables included infrequently eating out and having less everyday choice. This study found that restrictions in opportunities to make choices in their life was associated with a greater likelihood of being on a medication for persons with IDD who exhibit challenging behavior. Living in group home settings also increased the likelihood of medication use. A limitation of the study is a lack of information on why medications were prescribed and whether they were intended to treat the challenging behavior., Implications: This work has important implications for health providers, as addressing malleable social factors may provide an avenue for reducing challenging behaviors without the need for medication., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective. To determine whether student confidence in their knowledge of ambulatory care pharmacy and ability to contribute to patient care in this setting increased after participating in an ambulatory care introductory pharmacy practice experience (IPPE), and whether it changed student interest in pursuing a career in ambulatory care pharmacy. Methods. Second-year pharmacy students (n=86) completed a required ambulatory care experience which included four hours of didactic work and 13.5 hours of clinic experience with an ambulatory care pharmacist. Before and after the experience, students completed an eight-question survey in which they rated their confidence in their knowledge of ambulatory care practice and in providing patient care in this setting, as well as their interest in a career in ambulatory care. A five-point Likert scale was used to assess student confidence (1=not at all confident, 5=very confident) and interest in ambulatory care (1=not at all interested, 5=extremely interested). The Wilcoxon signed rank test was used to compare pre-post survey responses. Results. Eighty-five pharmacy students completed both the pre- and post-survey. Median scores on the post-intervention test increased from 3 to 4 in seven of the domains assessed. Student interest in a career in ambulatory care remained unchanged. Conclusion. An ambulatory care IPPE increased student confidence in their understanding of ambulatory care pharmacy practice and caring for patients in this setting., (© 2021 American Association of Colleges of Pharmacy.)

Background: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear., Objective: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States., Methods: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior., Results: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status., Conclusions: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions., (©Lin-Ya Yang, Jennifer G Lyons, Steven R Erickson, Chung-Hsuen Wu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.03.2021.)

Background: Individual patient characteristics, social determinants, and geographic access may be associated with patients engaging in appropriate health behaviors., Objective: To assess the relationship between statin adherence, geographic accessibility to pharmacies, and neighborhood sociodemographic characteristics in Michigan., Methods: The proportion of days covered (PDC) was calculated from pharmacy claims of a large insurer of adults who had prescriptions for statins between July 2009 and June 2010. A PDC ≥0.80 was defined as adherent. The predictor of interest was a ZIP code tabulation area (ZCTA)-level measure of geographic accessibility to pharmacies, measured using a method that integrates availability and access into a single index. We fit unadjusted models as well as adjusted models controlling for age, sex, and ZCTA-level measures of socioeconomic status (SES), racial isolation (RI) of non-Hispanic blacks, and urbanicity., Results: More than 174 000 patients' claims data were analyzed. In adjusted models, pharmacy access was not associated with adherence (0.99; 95% CI: 0.96, 1.03). Greater RI (0.87; 95% CI: 0.85, 0.88) and urban status (0.93; 95% CI: 0.89, 0.96) were associated with lower odds of adherence. Individuals in ZCTAs with higher SES had higher odds of adherence, as were men and older age groups., Conclusion and Relevance: Adherence to statin prescriptions was lower for patients living in areas characterized as being racially segregated or lower income. Initiating interventions to enhance adherence, informed by understanding the social and systematic barriers patients face when refilling medication, is an important public health initiative that pharmacists practicing in these areas may undertake.

Objectives: To assess the feasibility of conducting in-home comprehensive medication reviews (CMRs) and to identify and intervene when appropriate for medication-related problems (MRPs) found in medication regimens taken by people with an intellectual or developmental disability., Setting: Community-based group homes in southeast Michigan., Practice Description: Implementation and evaluation of a pilot program conducting CMRs within community-based group homes., Practice Innovation: An in-home CMR conducted by a clinical pharmacist., Evaluation: Identified MRPs, pharmacist recommendations, recommendation acceptance, time spent directly on intervention, and barriers to implementation., Results: CMRs were conducted for 15 patients identified as receiving 5 or more medications by their community support agency. Thirty-six MRPs were identified (mean ± SD of 2.4 ± 1.5 per person). The most common MRPs were a medication that was being taken with no indication for its use (7 occurrences) and identification of an untreated medical problem (7). Other MRPs included wrong dose (5); patient or caregiver indicated that the medication was not working (4); wrong dosage form was being used or given (3); duplication of therapy (2); pharmacy error (2); extended release medications were being crushed before administration (2); and wrong administration time, drug ordered but not given, drug-disease potential interaction, and poor drug administration technique (1 for each). The interventions included sending information letters to the group home manager containing information to be discussed with the patient's physician or telephone calls made directly to the prescriber or pharmacy. The interventions made by telephone calls to prescribers included 3 calls to physicians to discuss 5 MRPs, and 3 telephone calls for pharmacy-related MRPs, all of which were accepted., Conclusion: The results of this prospective pilot project provide justification to further explore the role of conducting independent CMRs for patients with an intellectual or developmental disability living in the community to ensure safe and effective use of their medications., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Patients who have intellectual/developmental disabilities (IDDs) develop atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) at rates similar to or higher than the general population. They also face disparities accessing and using health care services., Objective: To determine if disparities exist in the use of guideline-based pharmacotherapy (GBP) for ASCVD or HF for adults with IDD., Methods: Using the 2014 Clinformatics Data Mart Database, adults with ASCVD or HF were divided into IDD or non-IDD groups. Patients with contraindications for GBP medications were excluded. Use of GBP between IDD and non-IDD groups was examined. Subgroup analysis included comparisons between IDD groups., Results: For HF, 1011 patients with IDD and 236,638 non-IDD patients were identified. For ASCVD, 2190 IDD and 790,343 non-IDD patients were identified. We found that 47.9%, 35.8%, and 13.1% of IDD and 58.7%, 48.4%, and 18.9% of non-IDD patients had pharmacy claims for statins ( P < 0.001), β-blockers ( P < 0.001), or antiplatelet therapy ( P < 0.001), respectively. For HF, 46.8% and 50.3% of IDD and 59.8% and 55.4% of non-IDD patients had pharmacy claims for β-blockers (P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs; P = 0.003), respectively. In all but one multivariate regression models patients with IDD were less likely to use GBP than patients in the non-IDD group. Subgroup analysis revealed that patients who had Down syndrome had lower GBP use in 4 of the 5 measures., Conclusion and Relevance: Disparities exist in the use of GBP for patients with IDD with ASCVD or HF. Patients who have an IDD should be examined by clinicians to ensure appropriate access to and use of GBP.

Background: Few studies have examined how adherence to antihypertensive medications varies across different regions or how neighborhood-level factors were related to individuals' medication-taking behaviors in patients., Objective: To explore local variation in medication adherence and examine environmental and individual influences on adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) among elderly hypertensive patients with chronic kidney disease (CKD) in the United States., Methods: The Medicare 5% sample claim data (2006-2013), American Community Survey 5-Year Data (2005-2009) and the Health Resources and Services Administration Primary Care Service Area data (2007). The primary outcome was medication adherence, measured by Proportion of Days Covered (PDC). Geographically weighted regression (GWR) and linear mixed-effects models were used to investigate the relationship between environmental factors, individual risk factors and medication adherence., Results: A total of 70,201 hypertensive CKD patients residing in 2,981 counties of the US were selected. Significant spatial autocorrelation was observed in ACEIs/ARBs PDC. The West North Central and New England regions demonstrated higher adherence compared to the East South Central and West South Central regions. Residing in Medically Underserved Areas, counties with high deprivation scores, and not receiving Part D Low-income Subsidy were associated with poor medication adherence., Conclusions: Medication adherence is geographically differentiated across the US. Environmental and individual factors identified may be helpful in the design of local interventions focused on improving patient outcomes from a population perspective., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study examined the proportion of hospitalizations associated with adverse medication events (AMEs) for adults with intellectual and developmental disabilities (IDD) and adults from the general population in the United States using the 2013 National Inpatient Sample (NIS) dataset of the Healthcare Cost and Utilization Project (HCUP). Adults with IDD had greater odds of having a hospitalization associated with an AME than the general adult population. Unadjusted odds ratios (95% CI) for hospitalization due to any medication for IDD was 2.47 (2.31-2.65). In the multivariate logistic regression model, IDD was significantly associated, with an odds ratio of 1.28 (1.19-1.38). Adults who have IDD are at greater risk of having a hospital admission due to an AME.

The purpose of this study was to evaluate the association between tocolysis for preterm uterine contraction and the risk of nonreassuring fetal status.This was a retrospective cohort study using data from the Taiwan National Health Insurance Research Database. Pregnant women were enrolled if they delivered a baby during January 1, 2003 to December 31, 2011. The occurrence of the nonreassuring fetal status was compared between pregnant women with and without tocolytic treatment for preterm uterine contraction. Multivariable logistic regression models with adjusted cofounders were used to evaluate the association between tocolysis and the risk of nonreassuring fetal status.Of 24,133 pregnant women, 1115 (4.6%) received tocolytic treatment during pregnancy. After adjusting for covariates, pregnant women receiving tocolysis more than one time during pregnancy were found to have significantly higher risk of the nonreassuring fetal status when compared with pregnant women who did not receive tocolysis for uterine contraction (Odds Ratio = 2.70, 95% Confidence Interval: 1.13-6.49).Pregnant women with more frequent tocolysis for preterm uterine contraction during pregnancy had an increased risk of nonreassuring fetal status. Close evaluation of dose and duration of tocolytic treatment is necessary for pregnant women with preterm uterine contraction.

Background: The rapid growth of the specialty pharmacy industry will require many pharmacists with experience and/or training in specialty pharmacy practice (SPP). Unfortunately, there is no standard requirement set forth by the Accreditation Council for Pharmacy Education (ACPE) for specialty pharmacy education among pharmacy schools, which has resulted in graduates with doctor of pharmacy degrees (PharmD) having little to no didactic or experiential training in SPP., Objectives: To (a) assess PharmD student perspectives on coverage of specialty pharmacy in their respective curricula and (b) identify whether attitudes and perspectives towards SPP vary based on student work experience., Methods: Study investigators created a 16-item web-based survey that assessed student work experience in pharmacy practice, presence of learning experiences that cover SPP in PharmD curricula, and familiarity with, exposure to, and interest in SPP, SPP learning experiences, and SPP careers. The survey was made available to students at ACPE-accredited colleges of pharmacy from January to April 2018., Results: 643 students from 20 different colleges of pharmacy completed the survey. Over half of the surveys (63.3%) originated from schools in the Midwest region of the United States. Just over one third (37.7%) of students reported that their curricula offered a learning experience specifically dedicated to SPP, whereas 17.6% reported that SPP was integrated into other pharmacy coursework. 28% reported that SPP was covered using a mixture of dedicated courses and class integration. Students with current or previous work experience in SPP or managed care were more likely to report willingness to take an experiential rotation in SPP and pursue a career in SPP than students with no or other pharmacy-related work experience. These students were also more likely to report that their curriculum performed poorly in preparing students to pursue a career in SPP., Conclusions: In a convenience sample survey of pharmacy students at ACPE-accredited colleges of pharmacy, perspectives on SPP, curricular coverage of SPP, and SPP careers varied significantly based on student work experience., Disclosures: This study received funding support from the Wayne State University Department of Pharmacy Practice Research & Development Fund. The authors do not have any conflicts of interest or financial disclosures to declare.

Study Objectives: To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease., Design: Retrospective cohort study with an active comparator design., Data Source: National Health Insurance Research Database in Taiwan (2001-2011)., Patients: A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group)., Measurements and Main Results: Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72-1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (≤ 90 cMDs) (HR 3.06, 95% CI 1.35-6.97)., Conclusion: Among patients with Parkinson's disease in Taiwan, those with a high cumulative dose of anticholinergics had an increased risk of being diagnosed with dementia. Physicians should consider prescribing the lowest therapeutic dose of anticholinergic medication when making treatment decisions for patients with Parkinson's disease., (© 2019 Pharmacotherapy Publications, Inc.)

Background: The issue of suboptimal influenza vaccination coverage among pregnant women remains relevant. Our study aimed to explore the determinants and coverage of influenza vaccination among pregnant women in the United States using a nationally representative sample. Materials and Methods: This study was conducted with the 2012-2016 U.S. National Health Interview Survey. The Andersen's Health Behavior Model was applied as the conceptual framework to explore potential factors that may influence the influenza vaccination rate. A series of individual determinants, categorized into predisposing, enabling, and need factors, were compared using logistic regressions between women who received an influenza vaccination before or during pregnancy and those who did not. Results: An average of 36% women received an influenza vaccination before or during pregnancy among an estimated five million pregnant women. Even though the percentage increased from 31% in 2012 to 40% in 2016, it remained lower than the Healthy People 2020 target of 80%. The odds of receiving an influenza vaccination before or during pregnancy were lower among women who had public or no insurance coverage (odds ratio [OR]; 95% confidence interval, 0.510 [0.323-0.806] and 0.351 [0.175-0.705], respectively), lived in South (0.546 [0.336-0.887]), ever smoked 100 cigarettes (0.622 [0.419-0.923]), and had infrequent to light alcohol consumption in the past year (0.670 [0.457-0.983], reference: no alcohol consumption in the past year). Having a bachelor's degree increased the odds of getting an influenza vaccine compared to a high school diploma or less (2.086 [1.353-3.215]). Conclusions: Our study found that the influenza vaccination coverage among pregnant women remains suboptimal, and disparities may still exist across women with different sociodemographic and socioeconomic status. Clinicians should actively recommend influenza vaccination for pregnant women, and policy makers may consider developing interventions to improve the vaccination rate.

Background Medication management is undertaken by caregivers of people who have intellectual or developmental disabilities. Objective The objectives were to measure the medication management hassles reported by caregivers of adults who have intellectual or developmental disabilities and to describe associations between characteristics of caregivers, medication regimens, and the person with intellectual or developmental disability and the scale score. Setting Web-based survey conducted in the United States. Method A newsletter announcement with a link to the survey was sent to members of a disability advocacy organization. Caregivers were age 18 years and older who manage medications for adults with intellectual or developmental disabilities. The survey questions were used to obtain characteristics of the caregiver, the medication regimen they managed, and the care-recipient. The study was approved by the Institutional Review Board of Michigan Medicine (HUM00091002). Main outcome measure The Family Caregiver Medication Administration Hassles Scale (caregiver scale). Results Forty-two caregivers responded, with 41 being female with a mean age of 56.7 years. The mean caregiver scale score was 28.9 (possible range 0-120). Highest scores (greatest hassles) were significantly associated with a greater level of support required by the care-recipient, stronger caregiver beliefs of the necessity of medication and concern about using medications, lack of previous caregiver health-care training, and being an employed caregiver rather than family member. Conclusion Medication management can contribute to caregiver stress. Pharmacists should ensure that caregivers are counseled about medication that they manage, be accessible for questions, and examine medication regimens to reduce polypharmacy and complexity of regimens.

Background: Medication nonadherence is a major barrier to both patients and health care professionals when trying to manage medical conditions. An appropriate self-report adherence tool would be helpful in determining a patient's medication adherence. Objectives: To observe variations in scale scores based on modifications to an Original Adherence Scale, with the hypothesis that making modifications to the Original Adherence Scale will create variations in the percentage of adherent patients. Methods: This cross-sectional study utilized mailed surveys to people identified in a prescription claims administrative dataset who had a pharmacy claim for at least 2 antihypertensive medications. One thousand people were equally divided and randomly placed in 1 of 4 groups: Original Adherence Scale Group, Time Reference Scale Group, 4-Point Likert-Type Scale Group, Multiple Medication Scales Group. Each scale underwent assessment of internal reliability using Cronbach's α. Changes made to the Original 4-item scale included altering the time reference period from 3 months to 7 days, changing response options from Yes/No to a Likert-type scale, and incorporating multiple scales so that the respondent may report on up to 4 different options. Results: There were 437 surveys completed appropriately, yielding a 46.4% response rate. The overall scale scores indicating perfect adherence was 51.8% for the 4-Point Likert-Type Scale Group, 66.5% for the Multiple Medication Scales Group, 68.8% for the Original Adherence Scale Group, and 78.9% for the Time Reference Scale Group. Conclusion: When there are more selection options, a change in time reference, or more medications reported, the amount of adherent patients varied., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2018.)

Objectives: To evaluate the association between zolpidem use and the risk of Alzheimer's disease among older people., Design: A retrospective cohort study using data from 2001 to 2011 from the National Health Insurance Research Database., Setting: Taiwan., Participants: A total of 6,922 patients aged 65 years or older enrolled from January 2002 to December 2004 (the enrollment period)., Intervention (exposure): Zolpidem users were identified as patients who used zolpidem during the enrollment period. The index date was the date of the first zolpidem prescription. Dosage of zolpidem use was defined using cumulative defined daily dose (cDDD) based on the cumulative dosage that patients took within one year after the index date (grouped as: less than 28, 28-90, 91-180, and more than 180 cDDD)., Measurements: The occurrence of Alzheimer's disease was defined as the time period from the end of one year after the index date to the date of the Alzheimer's disease diagnosis. The propensity score was used to adjust the measured confounders of Alzheimer's disease. Cox proportional hazards models were used to evaluate the association between zolpidem use and the incidence of Alzheimer's disease., Results: Zolpidem users with a high cumulative dose (>180 cDDD) in the first year after initiation had a significantly greater risk of Alzheimer's disease than non-zolpidem users (HR = 2.97, 95% CI = 1.61-5.49) and low cumulative dose (<28 cDDD) users (HR = 4.18, 95% CI = 1.77-9.86)., Conclusion: We found the use of a high cumulative dose of zolpidem was associated with an increased risk of Alzheimer's disease among older people living in Taiwan. It is advised to use caution when considering long-term use of zolpidem in older patients., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Purpose: Results of a study to determine if disparities in drug pricing, pharmacy services, and community pharmacy access exist in a Tennessee county with a predominantly minority population are reported., Methods: A cross-sectional survey of community pharmacies in Shelby County, a jurisdiction with a total population more than 60% composed of racial and ethnic minority groups, was conducted. Data collection included "out-of-pocket" (i.e., cash purchase) prices for generic levothyroxine, methylphenidate, and hydrocodone-acetaminophen; pharmacy hours of operation; availability of selected pharmacy services; and ZIP code-level data on demographics and crime risk. Analysis of variance, chi-square testing, correlational analysis, and data mapping were performed., Results: Survey data were obtained from 90 pharmacies in 25 of the county's 33 residential ZIP code areas. Areas with fewer pharmacies per 10,000 residents tended to have a higher percentage of minority residents ( p = 0.031). Methylphenidate pricing was typically lower in areas with lower employment rates ( p = 0.027). Availability of home medication delivery service correlated with income level ( p = 0.015), employment rate ( p = 0.022), and crime risk ( p = 0.014)., Conclusion: A survey of community pharmacies in Shelby County, Tennessee, found that areas with a high percentage of minority residents had lower pharmacy density than areas with a high percentage of white residents. Pharmacies located in communities with low average income levels, low employment rates, and high scores for personal crime risk were less likely to offer home medication delivery services., (Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)

Introduction: The goal of the study was to identify perceived barriers to implementation of vaccination services encountered by independent and small-chain community pharmacies in an urban setting., Methods: Pharmacists in independent and small-chain pharmacies located in 29 Michigan ZIP codes were visited and asked to complete a 5- to 10-min semi-structured interview., Results: A total of 93 independent and 12 small-chain pharmacies participated (n = 105; 61%). The pharmacies filled an average of 700 prescriptions each week with 1.1 pharmacist full-time equivalents and 57 h of technician time. The most common services that participating pharmacies provided were dispensing outpatient medication (99%), medication therapy management (MTM, 65.7%), disease management or coaching (54.3%), point-of-care testing (34.3%), and dispensing medications to inpatient facilities (16.2%). Only seven pharmacies (6.7%) administered vaccinations. When pharmacists were asked to identify what it would take to start to administer vaccines, the most common responses were increased demand from patients (37.1%), adequate time (19%), appropriate space (17.1%), appropriate amount of staff (14.3%), change in attitudes or beliefs of the owner or pharmacists at that pharmacy (13.3%), increased profit related to vaccines (11.4%), and increased awareness among patients about the importance of vaccines (11.4%). The majority of pharmacies (65.3%) reported that only one factor would need to change to start to administer vaccines., Conclusion: Independent and small-chain community pharmacies in an urban, primarily low-income area identified several barriers that have prevented implementation of vaccination services. However, the majority of pharmacies reported that only one factor would need to change in order to begin to administer vaccines. Interventional efforts necessary to address commonly cited barriers may include providing education to pharmacists about the need for community pharmacy-based immunization programs in addition to services provided by physician offices, as well as the importance of proactively providing immunization-related recommendations to patients.

People who have intellectual and developmental disabilities (IDD) often rely on caregivers to assist in the medication management process. The aim of this study was to learn from caregivers, who are either family or support staff, what major issues arise throughout the process of managing medication and how these might be addressed. Problems identified by caregivers include (a) prescribers understanding of insurance and agency policies regarding medication utilization; (b) lack of continuity of care and accuracy of the medication record as well as clinical records;, ((c) poor communication among patients, caregivers, and clinicians; (d) patient willingness to take medication; (e) caregiver understanding and training of medication-related topics; and (f) the health system being unprepared to work with people who have IDD.)

Background: People with intellectual/developmental disabilities (IDDs) face the development of cardiovascular disease (CVD) similar to the general population. The purpose of this study was to describe and compare the presence of CVD risk factors, the atherosclerotic cardiovascular (ASCVD) risk score, and medication prescribing patterns for medications to treat related risk factors for patients with IDD and those without., Methods: This was a retrospective study of patients age 18years and older of a health system's primary care medicine practices. The IDD group had documentation of a diagnosis related to IDD. The comparison group was a random sample of patients from the same practices who had no indication of IDD. Patient characteristics included demographics, smoking status, cholesterol, and blood pressure. The presence of a diagnosis of hypertension, hyperlipidemia, diabetes, coronary artery disease, history of stroke or myocardial infarction, and related medication therapy were documented. The dependent variable was the estimated 10-year primary risk of ASCVD., Results: The IDD group included 78 patients while the GenMed group included 187. There were no significant differences in the prevalence of risk-related diagnoses or in blood pressure and cholesterol between the two groups. The estimated 10-year ASCVD risk was significantly higher in the GenMed group compared to the IDD group (p=0.02). Prescribing was similar between the groups. The regression analysis found that group assignment was not significantly associated with ASCVD risk, while age, gender, and race were., Conclusions: CV risk and related treatment among patients with IDD was similar to that of the general population., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure., Methods: The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R(2) values were compared between HRQoL-CI and Charlson CI (CCI)., Results: Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R(2) in the prediction models (R(2) values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively)., Conclusion: The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.

Background and Objective: Metformin is a first-line treatment for patients with diabetes. Recent animal studies indicated that metformin can reduce airway inflammation. However, it remains unclear whether the use of metformin can help patients maintain asthma control. The purpose of this study was to evaluate the association between the use of metformin and asthma-related outcomes, which include asthma-related hospitalization, asthma-related emergency room visits and asthma exacerbation, among patients with concurrent asthma and diabetes., Methods: We conducted an 11-year (2001-2011) retrospective cohort study using the Taiwan National Health Insurance Research Database. Patients with concurrent asthma and diabetes were included. The date of the first observed prescription of metformin was defined as the index date. For each metformin user, two matched metformin non-users of the same age and gender were randomly selected. Patients were followed for 3 years to measure the occurrence of asthma-related outcomes. Multivariable logistic regression models were used to assess the association between metformin use and asthma-related outcomes., Results: Of 1332 patients with concurrent asthma and diabetes, 444 (33.3%) were metformin users. Compared with non-users, metformin users had a lower risk of asthma-related hospitalization (OR = 0.21, 95% CI: 0.07-0.63) and asthma exacerbation (OR = 0.39, 95% CI: 0.19-0.79)., Conclusion: The risk of asthma-related outcomes was lower for metformin users than non-users. Health-care providers should consider metformin as a treatment strategy for patients with concurrent asthma and diabetes., (© 2016 Asian Pacific Society of Respirology.)

Background: Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes., Methods: This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001-2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke., Results: Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02-1.72)., Limitations: The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist., Conclusion: A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: The prevalence of diabetes mellitus is high among patients with developmental disabilities (cerebral palsy, autism, Down's syndrome and cognitive disabilities)., Objectives: The purpose of this study was to examine the racial health disparities in medication adherence and medication persistence in developmentally disabled adults with type 2 diabetes enrolled in Medicaid., Methods: This was a retrospective cohort study using the MarketScan(®) Multi-State Medicaid Database. Adults aged 18-64 years with a prior diagnosis of a developmental disability (cerebral palsy/autism/down's/cognitive disabilities) and a new diagnosis of type 2 diabetes enrolled in Medicaid from January 1, 2004 and December 31, 2006, were included. Adults were included if they had a continuous enrollment for at least 12 months and were excluded if they were dual eligible. Anti-diabetes medication adherence and diabetes medication persistence were measured using multivariate logistic regression and the Cox-proportional hazard regression, respectively., Results: The study population comprised of 1529 patients. Although overall diabetes medication adherence in this population was optimal, African Americans had significantly lower odds (25%) of adhering to anti-diabetes medications compared to Caucasians (OR = 0.75, 95% CI = 0.58-0.97, P < 0.05). Also, after controlling for other covariates, the rate of discontinuation was higher in African Americans compared to Caucasians (hazard ratio = 1.03, 95% CI = 0.91-1.18, P < 0.629)., Conclusion: In this study, racial disparities were found in anti-diabetes medication adherence among Medicaid enrollees with developmental disabilities (DD). Studies conducted in the future should examine predictors that impact access to care, availability of primary and specialized care, social support as well as beliefs of racial minority populations with developmental disabilities and chronic conditions like diabetes to optimize medication use outcomes in this especially vulnerable population., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Prostate cancer is prevalent with significant morbidity in the United States. Aspirin previously has been found to be associated with reduced carcinogenesis of prostate cells. However, it remains unclear whether regularly taking aspirin could lower the risk of prostate cancer. Therefore, our aim was to examine the association between self-reported regular use of aspirin and the prevalence of prostate cancer in a national sample of the US adult population.The National Health Interview Survey is an annual survey conducted by the National Center for Health Statistics to investigate health and healthcare use of the US population. The current study is a population-based cross-sectional study using the 2010 National Health Interview Survey data. Adult male respondents who self-reported regularly taking aspirin at least 3 times per week were grouped as regular users. The prostate cancer prevalence was measured by respondents' self-report of prostate cancer. Multivariable logistic regression models were used to evaluate the association between these 2 factors by adjusting for covariates selected based on Andersen Behavioral Model of Health Services Use.An estimated 23 million (23.7%) males in the United States reported that they took aspirin regularly. Of them, 5.0% had prostate cancer. Regular aspirin use was significantly associated with a lower self-reported prevalence of prostate cancer after adjusting for predisposing, enabling, and need factors (odds ratio 0.60, 95% confidence interval 0.38-0.94).Regular aspirin use was found to be significantly associated with a lower self-reported prevalence of prostate cancer in the United States in 2010. Further clinical trials and longitudinal studies are needed to confirm the causality between regular aspirin use and prostate cancer., Competing Interests: W-TH, SRE, and C-HW declared that they have no conflict of interest. RAH has received consulting funds from Daiichi Sankyo and has provided expert testimony for Allergan and Boehringer Ingelheim. This study was part of WTH's Master's thesis. The authors have no conflicts of interest to disclose.

The use of dietary supplements was compared between a cohort of committed exercisers, U.S. Masters Swimming (USMS) members (n = 1,042), and the general U.S. population, exemplified by respondents to the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2010 (n = 6,209). USMS swimmers were significantly more likely to take dietary supplements (62%) than the general U.S. adult population, as represented by the NHANES population (37%). Those taking dietary supplements were older, more likely to be female and Caucasian, and more highly educated and affluent than those not taking supplements (p < .001 for all). When adjusted for age, race, gender, annual income, and education, masters swimmers were still more likely (p < .001) to use dietary supplements than the NHANES cohort. In addition, masters swimmers were significantly more likely (p < .001) to use either creatine or dehydroepiandrosterone or testosterone than those in the NHANES cohort.

Background: Inadequate medication adherence reduces optimal health outcomes and can lead to increased costs, particularly in patients with diabetes. Efforts to improve adherence have resulted in limited effects; approaches leveraging mobile technology have emerged, but their focus has mainly been limited to simple reminder messages., Objective: The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes., Methods: Adults aged 21-64, with uncontrolled diabetes, and taking at least one anti-diabetic medication were recruited and randomized into 2 study arms: daily tailored text messaging for 90 days or standard care. Comparing baseline and endpoint survey responses, changes in theory-driven health beliefs and attitudes were assessed. The impact on medication adherence was evaluated using pharmacy claims by calculating the percent of days covered (PDC)., Results: A total of 75 subjects were consented, and 48 were randomized. Mean PDC at baseline were comparable between cohorts (84.4% and 87.1%, respectively). Declines in adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period. Unadjusted tests suggested that perceived benefits and competence might have improved in the intervention arm., Conclusions: Tailoring mobile phone text messages is a novel way to address medication nonadherence and health beliefs; further investigation to this combined technique is needed to better understand its impact on behavior change in adults with diabetes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Currently no research exists assessing lifestyle modifications and emotional state of acute aortic dissection (AAD) survivors. We sought to assess activity, mental health, and sexual function in AAD survivors., Hypothesis: Physical and sexual activity will decrease in AAD survivors compared to pre-dissection. Incidence of anxiety and depression will be significant after AAD., Methods: A cross sectional survey was mailed to 197 subjects from a single academic medical center (part of larger IRAD database). Subjects were ≥18 years of age surviving a type A or B AAD between 1996 and 2011. 82 surveys were returned (overall response rate 42%)., Results: Mean age ± SD was 59.5 ± 13.7 years, with 54.9% type A and 43.9% type B patients. Walking remained the most prevalent form of physical activity (49 (60%) pre-dissection and 47 (57%) post-dissection). Physical inactivity increased from 14 (17%) before AAD to 20 (24%) after AAD; sexual activity decreased from 31 (38%) to 9 (11%) mostly due to fear. Most patients (66.7%) were not exerting themselves physically or emotionally at AAD onset. Systolic blood pressure (SBP) at 36 months post-discharge for patients engaging in ≥2 sessions of aerobic activity/week was 126.67 ± 10.30 vs. 141.10 ± 11.87 (p-value 0.012) in those who did not. Self-reported new-onset depression after AAD was 32% and also 32% for new-onset anxiety., Conclusions: Alterations in lifestyle and emotional state are frequent in AAD survivors. Clinicians should screen for unfounded fears or beliefs after dissection that may reduce function and/or quality of life for AAD survivors., (© 2015 Wiley Periodicals, Inc.)

Objectives: To measure health literacy (HL) of caregivers of adults with intellectual/developmental disabilities (IDDs); to determine the association between HL and a medication administration task (MAT) assessment; and to identify caregiver characteristics associated with higher HL and MAT scores., Design: Cross-sectional study., Setting: Southeastern Michigan., Participants: Caregivers, aged 18 years or older, who provided supportive care of adults with IDDs., Interventions: Survey and demonstration., Main Outcome Measures: Short Test of Functional Health Literacy in Adults (STOFHLA); a MAT assessment consisting of interpretation of five sets of medication instructions followed by demonstration of understanding using a pill box; and a survey of caregivers' demographics, medication-related experiences, education, characteristics of persons for whom they provide care, and care-related activities performed., Results: A total of 47 caregivers provided data. Caregivers had a mean age of 45.7 ± 14.6 years; 41 (87.2%) were women and 38 (80.9%) had education beyond high school. Caregivers were involved in obtaining medication from pharmacies, reminded the person with IDD to take medications and/or administered them to the person, documented medication and health information, and accompanied persons with IDD to physician offices. Most did not conduct monitoring procedures. The STOFHLA mean score was 34.5 ± 2.5 (median, 35; range, 22-36), while the MAT mean score was 12.0 ± 2.2 (median, 12; range, 6-15). Compared with family caregivers, direct support staff more frequently had undergone some medication training and had other people with whom they could discuss medication questions, but they had worked with the person with IDD a significantly shorter amount of time. No significant differences in STOFHLA and MAT scores between the family caregivers and direct support staff were observed. Caregiver education was significantly correlated with the STOFHLA score. MAT scores were not significantly correlated with caregiver characteristics., Conclusion: Caregivers are involved in the medication use process for people who have IDD. Ensuring caregiver understanding of medication regimens and/or improving medication-related HL may be an important step to ensure safe and effective use of medications by people with IDD.

Background: Research has demonstrated that variation in availability and utilization of health care resources exist on a range of scales, from regions of the United States, hospital referral regions, ZIP codes, and census tracts. Limited research using spatial analyses has found that variation in medication adherence exists across census tracts. Using spatial analysis, researchers may be able to effectively analyze geographically dispersed data to determine whether factors such as sociodemographics, local shared beliefs and attitudes, barriers to access such as availability of prescribers or pharmacies, or others are associated with variations in medication adherence in a defined geographic area. , Objectives: To (a) demonstrate that medication adherence may be mapped across an entire state using medication possession ratios and (b) determine whether a geographic pattern of adherence to statins could be identified at the ZIP code level for members of a statewide insurer., Methods: This study utilized pharmacy claims data from a statewide insurer. Insured statin users were aged greater than 30 years, had at least 1 statin prescription, and were continuously enrolled for the observation year. Patient medication possession ratios (MPR) were derived, which were then aggregated as a mean MPR for each ZIP code. ZIP codes were categorized as higher (MPR  greater than 0.80) or lower (MPR  less than  0.80) adherence and mapped using Arc GIS, a platform for designing and managing solutions through the application of geographic knowledge. Analysis included a determination of whether the MPRs of higher and lower adherence ZIP codes were significantly different. Hot spot analysis was conducted to identify clustering of higher, midrange, and lower adherent ZIP codes using the GetisORD Gi* Statistic. This test provides z-scores and P values to indicate where features with either high or low values cluster spatially. MPRs for these 3 categories were compared using one-way analysis of variance (ANOVA). , Results: Of 1,154 Michigan ZIP codes, 907 were represented by 212,783 insured statin users. The mean statin MPR by ZIP code was 0.79 ± 0.4. The mean MPR for higher adherent ZIP codes was 0.83 ± 0.03 and 0.76 ± 0.03 for lower adherent ZIP codes (P  less than  0.001). Significant clustering of ZIP codes by adherence levels was evident from the hot spot analysis. The mean MPR was 0.84 ± 0.04 for high adherence areas, 0.79 ± 0.03 for midrange areas, and 0.74 ± 0.04 for lower adherent areas (overall P  less than  0.001). , Conclusions: Significant variations in adherence exist across ZIP codes at a state level. Future research is needed to determine locally relevant factors associated with this finding, which may be used to derive locally meaningful interventions.