RESUMEN
BACKGROUND: Varenicline, a selective α4ß2 nicotinic acetylcholine receptor partial agonist, is a pharmacotherapy indicated for smoking cessation treatment. To our knowledge, no studies have described varenicline treatment adherence and efficacy from real-world treatment patterns in a U.S. primary care setting. OBJECTIVE: To estimate adherence to varenicline prescription orders and subsequent quit rates among smokers in a primary care setting. METHODS: In this retrospective cohort study, eligible patients were enrolled with Geisinger Health Plan, had an initial varenicline prescription written by a Geisinger provider between January 1, 2006, and December 31, 2009, and had a follow-up clinic visit within the subsequent 12 months. Adherence was derived from linking electronic prescriptions with adjudicated pharmacy claims. Smoking status was collected at each health care encounter. RESULTS: Of the 1,477 eligible patients, 823 (55.7%) were primary nonadherent, having failed to initiate on the prescribed varenicline therapy. Of the remaining 654 patients, 359 (54.9%) were adherent, having completed a full 12-week course of therapy, and 295 (45.1%) were partially adherent, having initiated but not completed the full course of therapy. A total of 521 patients (35.3%) ceased smoking during the 12-month follow-up period: 182 (50.7%) of the adherent cohort, 82 (27.8%) of the partially adherent population, and 257 (31.2%) of the nonadherent cohort. No significant difference was found in quit rates between the partially adherent and nonadherent patient cohorts (adjusted HR 0.88 [95% CI=0.69-1.13]). However, patients adherent to the varenicline regimen were almost twice as likely to succeed in quitting smoking compared with completely nonadherent patients (HR 1.93 [95% CI=1.59-2.33]). CONCLUSION: Smoking cessation occurred more often among individuals adherent to varenicline therapy; however, medication nonadherence was common. After prescribing varenicline, clinicians and payers could consider active patient follow-up to maximize adherence and optimize treatment outcomes.
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Benzazepinas/uso terapéutico , Centros Comunitarios de Salud , Agonistas Nicotínicos/uso terapéutico , Cooperación del Paciente , Atención Primaria de Salud , Quinoxalinas/uso terapéutico , Cese del Hábito de Fumar , Tabaquismo/tratamiento farmacológico , Adulto , Estudios de Cohortes , Registros Electrónicos de Salud , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pennsylvania , Organizaciones Proveedor-Patrocinador , Estudios Retrospectivos , Autoinforme , Negativa del Paciente al Tratamiento , VareniclinaRESUMEN
INTRODUCTION AND HYPOTHESIS: The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care. METHODS: The General Longitudinal Overactive Bladder Evaluation-UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the Bladder Health Survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg. RESULTS: A total sample of 7,059 women received the BHS. Of those, 3,316 (47 %) responded. Prevalence of UI was 1,366 (41 %). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91 vs 87 %), significantly more overweight or obese (74 vs 61 %), and more likely to have a college education or higher (54 vs 46 %), P < 0.01. Nine hundred fifty-eight (73 %) women with UI reported duration of more than 2 years and 72 % reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25 %) sought care, 313 (23 %) received some care, and 164 (12 %) received subspecialty care. CONCLUSIONS: UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.
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Encuestas Epidemiológicas , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/terapia , Servicios de Salud para Mujeres/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Educación del Paciente como Asunto , Pennsylvania/epidemiología , Médicos de Atención Primaria , Prevalencia , Encuestas y CuestionariosRESUMEN
AIMS: To determine predictors of health care utilization in women with urinary incontinence (UI) from the population to specialty care. METHODS: The General Longitudinal Overactive Bladder Evaluation-UI is a population-based study on the natural history of UI in women ≥40 years of age. Prevalence of UI was estimated using the Bladder Health Survey (BHS). Survey data were linked with electronic health records (EHRs) to examine factors associated with a clinical UI diagnosis using logistic regression. Risk factors analyzed included: UI symptoms, subtypes, bother, severity, duration, and effect on quality of life, and demographic and other health characteristics. All statistical tests were two-sided with a P-value < 0.05 being significant. RESULTS: The overall prevalence of any UI based on responses to the BHS was 1,618/4,064 (40%). Of the 1,618 women with UI, there were only 398 (25%) women with EHR (clinical) diagnosis of UI. Women with UI versus those without UI were more likely to be have a BMI >25 kg/m(2) (70% vs. 58%), more likely to be parous (91% vs. 87%) and college educated (54% vs. 46%), P < 0.001. After adjusting for confounders in the model, variables significantly associated with clinical UI diagnosis included: older age (OR = 1.96), higher parity (> 1 birth) (OR = 1.76), higher urgency UI (OR = 1.08), adaptive behavior (OR = 1.2), and UI bother scores (OR = 1.01), as well as more frequent outpatient visits (OR = 1.03), P < 0.05. CONCLUSIONS: UI is a highly prevalent condition with only a minority of women seeking care. Factors associated with health care utilization include older age, parity (1+), number of doctor visits, urgency UI subtype, UI bother, and impact on behavior.
Asunto(s)
Aceptación de la Atención de Salud , Vejiga Urinaria Hiperactiva/epidemiología , Vejiga Urinaria Hiperactiva/terapia , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Prevalencia , Encuestas y CuestionariosRESUMEN
BACKGROUND: Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes. OBJECTIVE: To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes. DESIGN: The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes. SETTING: Primary care practices in 3 U.S. states. PARTICIPANTS: Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington. MEASUREMENTS: Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics. RESULTS: 110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors. LIMITATIONS: Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels. CONCLUSION: Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability. PRIMARY FUNDING SOURCE: The Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and Koplow Charitable Foundation.