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1. Lack of Knowledge of Antibiotic Risks Contributes to Primary Care Patients' Expectations of Antibiotics for Common Symptoms

Author

Laytner, Lindsey A., Trautner, Barbara W., Nash, Susan, Zoorob, Roger, Okoh, Jennifer O., Amenta, Eva, Olmeda, Kiara, Salinas, Juanita, Paasche-Orlow, Michael K., and Grigoryan, Larissa

Subjects
Medical research, Medicine, Experimental, Diarrhea -- Complications and side effects -- Dosage and administration -- Physiological aspects, Patients -- Surveys, Health literacy -- Surveys, Primary health care -- Surveys, Symptomatology -- Drug therapy -- Surveys, Patient education -- Surveys, Health, Science and technology
Abstract

Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use. We conducted a survey (n = 564) between January 2020 to June 2021 in public and private primary care clinics in Texas to study the prevalence and predictors of patients' antibiotic expectations for common symptoms/illnesses. We surveyed Black patients (33%) and Hispanic/Latine patients (47%), and over 93% expected to receive an antibiotic for at least 1 of the 5 pre-defined symptoms/illnesses. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu than private clinic patients. Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (odds ratio [OR] = 1.6; 95% CI, 1.1-2.4) and cold/flu symptoms (OR = 2.9; 95% CI, 2.0-4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. Future antibiotic stewardship interventions should tailor patient education materials to include information on antibiotic risks and guidance on appropriate antibiotic indications. Key words: antibiotic use; antimicrobial stewardship; primary care; antibiotic risks; patient expectations, https://doi.org/10.1370/afm.3161 INTRODUCTION Patients often receive antibiotic prescriptions to treat common viral symptoms/ illnesses, such as respiratory tract infection, (1-6) cold/flu, (7,8) and diarrhea, (9,10) despite guidelines recommending against these practices. [...]

Published
2024
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4. Changes in primary care inbox message volume during COVID-19 pandemic

Author

Hirth, Jacqueline, Langabeer, James, Zoorob, Roger, and Hansen, Michael

Subjects
Health care industry -- Technology application, Primary health care -- Methods -- Technology application, Electronic messaging systems -- Forecasts and trends, Health care industry, Wireless messaging service, Market trend/market analysis, Technology application, Health, Science and technology
Abstract

Background: The SARS CoV-2 virus (COVID-19) and associated lockdown have impacted healthcare practice in the United States. Technology has played an emerging role in providing access to care while also reducing iatrogenic infection amongst patients and providers. This rapid adoption of technology has resulted in unintended consequences. Since COVID-19 lockdown, providers have noticed an increase in the volume of patient messages to request various clinical services from their primary care providers, which has placed further stress on an already overwhelmed healthcare system. However, quantitative information about the volume of electronic messages as a result of the COVID-19 lockdown is lacking. Methods: In one large academic healthcare system, all incoming inbox items (telephone calls, refill requests, and electronic messages) received by providers from patients were retrospectively analyzed between March 1, 2019 and March 31, 2021. Inbox item rates were evaluated as a ratio of items per patient encounters (in person or telemedicine) each week. Trends in inbox rates were assessed during the 12 months before lockdown in March 2020 and 12 months post-lockdown. Logistic regression was utilized to examine effects of post-COVID-19 lockdown on inbox message volume as compared to the pre-lockdown period. Results: There was an increase in total new inbox volume, from 2.07 before COVID lockdown and 2.87 items post-lockdown, although this was not statistically significant. However, the rate of patient-initiated messaging increased dramatically after lockdown and stabilized at a rate higher than pre-COVID-19 pandemic rates (RR 1.27, p-value < 0.001). Prescription refill requests and telephone calls spiked quickly and then returned to pre-pandemic levels. Conclusion: On average, if a provider saw 20 patients per day before COVID-19, they would expect to receive 40 new inbox items per day. Post-COVID they would expect to receive 57 new inbox items per day, with the majority being electronic messages. These messages require additional time that adds to the workload of administrators, staff and clinical providers typically devoted to healthcare responsibilities. Interventions are needed to reduce the amount of time that healthcare providers and staff spend on increasing rates of electronic patient requests., Presenters Jacqueline Hirth, James Langabeer, PhD, EdD, Roger Zoorob, MD, MPH, Michael Hansen, MD, MPH, MS, MPH, [...]

Published
2023

13. sj-docx-1-whe-10.1177_17455057221112188 – Supplemental material for Racial/ethnic variations in alcohol and cigarette use by pregnancy status among 20- to 44-year-old women, NHANES 2001–2018

Author

Hirth, Jacqueline M, Valadez, Catherine, Gonzalez, Sandra, Kowalchuk, Alicia, Gutierrez, Judith A, and Zoorob, Roger

Subjects
FOS: Clinical medicine, 111402 Obstetrics and Gynaecology
Abstract

Supplemental material, sj-docx-1-whe-10.1177_17455057221112188 for Racial/ethnic variations in alcohol and cigarette use by pregnancy status among 20- to 44-year-old women, NHANES 2001–2018 by Jacqueline M Hirth, Catherine Valadez, Sandra Gonzalez, Alicia Kowalchuk, Judith A Gutierrez and Roger Zoorob in Women’s Health

Published
2022
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18. Anxiety Disorders in Children and Adolescents.

Author

Kowalchuk, Alicia, Gonzalez, Sandra J., and Zoorob, Roger J.

Subjects
ANXIETY disorders, GENERALIZED anxiety disorder, COGNITIVE therapy, SEROTONIN uptake inhibitors, SOCIAL anxiety, SEROTONIN syndrome
Abstract

Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety disorders, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety disorders in children eight years and older; there is insufficient evidence to support screening in children younger than eight years. Symptoms of anxiety disorders in children and adolescents are similar to those in adults and can include physical and behavioral symptoms such as diaphoresis, palpitations, and tantrums. Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration. (Am Fam Physician. 2022;106(6):657–664. Copyright © 2022 American Academy of Family Physicians.) Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety disorders, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety disorders in children eight years and older; there is insufficient evidence to support screening in children younger than eight years. Symptoms of anxiety disorders in children and adolescents are similar to those in adults and can include physical and behavioral symptoms such as diaphoresis, palpitations, and tantrums. Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration. [ABSTRACT FROM AUTHOR]

Published
2022

23. Which CAM modalities are worth considering? This review - with a handy at-a-glance guide - examines 8 modalities, the level of evidence behind them, and the adverse effects you'll need to keep in mind

Author

Zoorob, Roger, Chakrabarty, Sangita, O'Hara, Heather, and Kihlberg, Courtney

Subjects
Alternative medicine -- Complications and side effects -- Usage, Fish oils -- Usage, Glucosamine -- Usage, Health
Abstract

CASE > Bob F, age 54, seeks care for chronic low back pain. The conservative treatments you have prescribed, including physical therapy, regular exercise, and an over-the-counter nonsteroidal anti-inflammatory drug, [...]

Published
2014

24. Increased Black--White disparities in mortality after the introduction of lifesaving innovations: a possible consequence of US federal laws

Author

Levine, Robert S., Rust, George S., Pisu, Maria, Agboto, Vincent, Baltrus, Peter A., Briggs, Nathaniel C., Zoorob, Roger, Juarez, Paul, Hull, Pamela C., Goldzweig, Irwin, and Hennekens, Charles H.

Subjects
Mortality -- United States, Mortality -- Demographic aspects, Mortality -- Research, Highly active antiretroviral therapy -- Usage, HIV patients -- Care and treatment, HIV patients -- Patient outcomes, Government, Health care industry
Abstract

Objectives. We explored whether the introduction of 3 lifesaving innovations introduced between 1989 and 1996 increased, decreased, or had no effect on disparities in Black-White mortality in the United States through 2006. Methods. Centers for Disease Control and Prevention data were used to assess disease-, age-, gender-, and race-specific changes in mortality after the introduction of highly active anti-retroviral therapy (HAART) for treatment of HIV, surfactants for neonatal respiratory distress syndrome, and Medicare reimbursement of mammography screening for breast cancer. Results. Disparities in Black-White mortality from HIV significantly increased after the introduction of HAART, surfactant therapy, and reimbursement for screening mammography. Between 1989 and 2006, these circumstances may have accounted for an estimated 22441 potentially avoidable deaths among Blacks. Conclusions. These descriptive data contribute to the formulation of the hypothesis that federal laws promote increased disparities in Black-White mortality by inadvertently favoring Whites with respect to access to lifesaving innovations. Failure of legislation to address known social factors is a plausible explanation, at least in part, for the observed findings. Further research is necessary to test this hypothesis, including analytic epidemiological studies designed a priori to do so. (Am J Public Health. 2010;100:2176-2184. doi: 10.2105/ AJPH.2009.170795)

Published
2010

29. 2019 Health Equity Summer Research Summit Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 18th, 2019

Author

Uribe-Gomez, A, primary, Salinas-Miranda, Abraham A., additional, Turner, Acara E., additional, Strutt, Adriana M., additional, Joseph, Adrienne, additional, Wright, Alex, additional, Martin, Alexander C., additional, Milton, Alexis N., additional, Khoei, Amelia, additional, Kanakamedala, Amritha, additional, Iyinbor, Angie, additional, O, Anna, additional, Morrow, Asha, additional, Butler, Ashley M., additional, Young, Ashley, additional, Shah, Asim, additional, Matin, Asna, additional, Christiansen, Audrey E., additional, Ibrahimou, Boubakari, additional, Alonzo, Breanna, additional, Ossenkop, Chase, additional, O, Carli, additional, Hsu, Chih-Wei, additional, Ikeanyionwu, Charles, additional, Anyanwu, Chinwe, additional, Rivas, Charlotte, additional, Ikedionwu, Chioma A., additional, Anugwom, Chioma, additional, Broda, Christopher R., additional, Bocchini, Claire, additional, Cummins, Claire, additional, Rooney, Cliona M., additional, Keo-Meier, Colton L., additional, Johnson, Connor, additional, Miller-Chism, Courtney, additional, Titus, Courtney, additional, Parker, Crystal L., additional, Bird, Cylaina, additional, Mauck, Daniel, additional, Persse, David, additional, Austin, Deborah A., additional, Dongarwar, Deepa, additional, Cherla, Deepa V., additional, Wolf, Dwayne, additional, Schwartz, Eleanor Bimla, additional, Petrova, Elena, additional, Perli, Elias, additional, Shell, Elisabeth, additional, Tran, Elizabeth U., additional, Baena, Elsa, additional, Lopez, Elyse, additional, Berry, Estrellita, additional, Rodriguez, Evadne, additional, Faustinella, Fabrizia, additional, Ihekweazu, Faith D., additional, Jiwani, Faiz, additional, Chmaitelli, Gabriella P., additional, Chan, Galant, additional, Wang, Haijun, additional, Salihu, Hamisu M., additional, Combs, Hannah L., additional, Rogers, Hayley, additional, Haq, Heather, additional, Sosa, Iberia Romina, additional, Jose, Irene E., additional, Griffin, Isabel, additional, Cao, J., additional, Montealegre, Jane, additional, Salemi, Jason L., additional, Chang, Jennifer, additional, Stinson, Jennifer M., additional, Mills, JL, additional, Schulte, Joann, additional, Thomas, Joel, additional, Prochaska, John, additional, Saunders, John, additional, Go, Jonathan, additional, Lim, Jonathan, additional, Salley, Jordan, additional, Pineda, Josue Estiven, additional, Tabilona, Jules, additional, Holihan, Julie L., additional, Bowen-Jallow, Kanika, additional, Bernardi, Karla, additional, Fredricks, Karla, additional, Salciccioli, Katherine B., additional, Lopez, Keila N., additional, Barning, Kenneth, additional, Vuong, Kevin Dat, additional, Yusuf, Korede K., additional, Myers, Kristopher, additional, Wilson, Kyle, additional, Laufman, Larry E., additional, Love, Latanya J., additional, Nolan, Lauren, additional, Schoen, Lauren, additional, Huang, Lillian, additional, King, Lindsey M., additional, Nunez, Lisa F., additional, Brown, Louis, additional, Hernandez, Luna, additional, Hydod, Lynn, additional, Rossetti, M. Agustina, additional, Allman, Madeleine, additional, Khan, Mahmood, additional, Marty, Makenna, additional, Lee, MaKenzie D., additional, Jaramillo, Maria A., additional, Vigil, Maria, additional, Boyle, Mariaelena, additional, Masciale, Marina, additional, Hilliard, Marisa, additional, Munoz, Marisela, additional, Dickinson, Mary E., additional, Bell, Meishon, additional, York, Michele K., additional, Loor, Michelle, additional, Lopez, Michelle, additional, Liang, Mike K., additional, Aziz, Moez Karim, additional, Karla, Moriel, additional, Osazuma, Nancy, additional, Ramirez, Natalya, additional, Navejar, Natasha, additional, Cort, Nicol, additional, Lyons, Nicole B., additional, Perez, Norma, additional, Barshes, NR, additional, Barron, Olivia A., additional, Olavarria, Oscar A., additional, Constable, Petra, additional, Nwokolo, Phyllis, additional, Omokaro, Precious, additional, Patel, Premal, additional, Vallabh, Prithvi, additional, Shah, Puja, additional, Yusuf, Rafeek A., additional, Rosero, Rebecca A., additional, Lunstroth, Rebecca, additional, Obure, Renice, additional, Beach, Robert, additional, Goin-Kochel, Robin, additional, Parihar, Robin, additional, Zoorob, Roger, additional, Wilson, Ronee E., additional, Schmidt, Rosa Michelle, additional, Pettit, Rowland, additional, Udoetuk, Sade C., additional, Tasnim, Sadia, additional, Khan, Sara, additional, Adnan, Sareema, additional, Rodriguez, Sean, additional, Anandasabapathy, Sharmila, additional, Nesbitt, Shawna, additional, Bhushan, Sheena, additional, Sharath, Sherene, additional, Rogers, SO, additional, Dinh, Son, additional, Banu, Sophia, additional, Rose, Stacey, additional, Drake, Stacy, additional, Morain, Stephanie, additional, McCauley, Stephen R., additional, Abdelaziz, Sue, additional, Malik, Tahir, additional, Rasmussen, Tara L., additional, Shum, Thomas, additional, Raphel, Tiana, additional, Ko, Tien C., additional, Harris, Toi, additional, Hadley, Trevor, additional, Akoma, Uchechukwu, additional, Eduok, Uwem Bridgette, additional, Armendariz, Victoria, additional, Cole-Lewis, Yasmin C., additional, Al-Mohtaseb, Zaina, additional, and Yusuf, Zenab, additional

Published
2020
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39. Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization

Author

Mainous, Arch G., III, Zoorob, Roger J., Oler, Michael J., and Haynes, Delicia M.

Subjects
Antibiotics -- Usage, Respiratory tract infections -- Drug therapy, Patients -- Beliefs, opinions and attitudes
Abstract

BACKGROUND. Upper respiratory infections (URIs) account for many of the visits in primary care and are commonly treated with ineffective antibiotic therapy. The purpose of this study was to examine [...]

Published
1997

49. Preparations for Treating Opioid Use Disorder in the Office: Use this guide to plan for offering medication-assisted treatment with buprenorphine.

Author

KOWALCHUK, ALICIA, MEJIA DE GRUBB, MARIA, and ZOOROB, ROGER

Subjects
METHADONE treatment programs, BUPRENORPHINE, NALOXONE, SUBSTANCE abuse diagnosis, COMBINATION drug therapy, DRUG overdose, FAMILY medicine, MEDICAL protocols, MEDICAL prescriptions, CLASSIFICATION of mental disorders, GENERAL practitioners, PUBLIC health, QUALITY of life, SUBSTANCE abuse, HEALTH insurance reimbursement, DRUG approval, TREATMENT effectiveness, CONTINUING education units, MEDICAL coding, THERAPEUTICS
Abstract

The article presents a guide for offering medication-assisted treatment (MAT) for opioid use disorder in the office with buprenorphine. Topics discussed include buprenorphine's effectiveness as an alternative to methadone, and the first step of training and obtaining a waiver for its prescription. Also noted are the required practice champion identification, setting up of office protocols with readiness and security of pharmacy, laboratory, and counselling services, and creation of a workflow.

Published
2018

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