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Purpose: Current guidelines recommend triple therapy maintenance inhalers for patients with recurrent exacerbations of chronic obstructive pulmonary disease (COPD); however, these maintenance therapies are underutilized. This study aimed to understand how physicians make COPD treatment decisions, and how combination maintenance therapies are utilized in a real-world setting. Patients and Methods: This exploratory, hypothesis-generating, non-interventional study used a cross-sectional online survey that was administered to a sample of practicing physicians in the United States. The survey included five fictitious vignettes detailing common symptoms experienced by patients with COPD. Survey questions included factors physicians consider in their decisions, and perceived barriers to prescribing treatments. Repeated measures multivariable analyses were conducted to evaluate how likely physicians were to switch to triple therapy versus no change to patient's current maintenance therapy or change to another maintenance therapy. Results: In total, 200 physicians completed the survey. Cost of treatment and patient access to treatment were reported as the most common barriers physicians consider in their prescribing decisions. Physicians were more likely to switch a patient's maintenance inhaler to triple therapy versus no change to maintenance inhaler if they considered the patient's history of new symptoms, insurance status, and clinical guidelines in their decision. Physicians with more experience treating patients with COPD, and those who treat more patients with COPD per week, were more likely to switch to triple therapy versus no change to maintenance inhaler. Conclusion: This study demonstrates the complexity of factors that can influence physicians' decisions when prescribing treatments for patients with COPD, including considerations of treatment cost, patient access and adherence, patient comorbidities, efficacy of current treatment, clinical guidelines, and provider's level of experience treating COPD. Further research may help elucidate the relative importance of the factors influencing physicians' decisions and inform what types of decision-support tools would be most beneficial.
Chronic obstructive pulmonary disease (COPD) symptoms can be effectively managed with maintenance therapies, which are treatments that are taken routinely to help improve symptoms. A combination of three different therapies (triple therapy maintenance) has been shown to be more effective than a combination of two different therapies (dual therapy maintenance) in patients with moderate-to-severe COPD. However, maintenance therapies, including triple therapy, are underutilized. This study aimed to explore how physicians make their treatment decisions for patients with COPD, and how combination maintenance therapies are utilized. To do so, we administered a survey to a sample of practicing physicians in the United States. The survey included five clinically based, fictitious profiles, or vignettes, of patients with COPD, with common symptoms and patient characteristics being described. Physicians were then asked to answer questions about what treatment they would prescribe for each patient, and any factors they considered when deciding on a treatment for a patient. We found that cost of treatment and patient access to treatment were the most common barriers that physicians considered when choosing a treatment. Physicians were also more likely to switch a patient's maintenance inhaler to a triple therapy maintenance inhaler if they considered the patient's history of new symptoms, patient's insurance status, and clinical guidelines when making their decisions. Our study shows that there are many complex factors that influence physicians' decisions when deciding on a treatment for patients with COPD.
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Broncodilatadores , Toma de Decisiones Clínicas , Encuestas de Atención de la Salud , Pautas de la Práctica en Medicina , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Estados Unidos , Broncodilatadores/administración & dosificación , Administración por Inhalación , Nebulizadores y Vaporizadores , Quimioterapia Combinada , Actitud del Personal de Salud , Resultado del Tratamiento , Conocimientos, Actitudes y Práctica en Salud , Costos de los Medicamentos , Pulmón/fisiopatología , Pulmón/efectos de los fármacos , Anciano , Guías de Práctica Clínica como Asunto , Adulto , Accesibilidad a los Servicios de SaludRESUMEN
INTRODUCTION: Psoriasis (PsO) is associated with the development of psoriatic arthritis (PsA). Patients with PsO often experience pre-PsA musculoskeletal (MSK) symptoms, leading to potential structural damage and substantial disease burden with impact on function. The objective of this study is to describe prevalence rates and evidence of MSK symptoms, including incidence of comorbid PsA diagnosis, in patients newly diagnosed with PsO and identify factors associated with PsA diagnosis. METHODS: This retrospective analysis included administrative claims from the Optum Research Database for adult patients with a new PsO diagnosis between January 2008 and February 2019. Eligible patients had ≥ 2 claims for PsO on unique dates, were aged ≥ 18 years at the date of the first claim with a diagnosis of PsO (index date), and had continuous enrollment with medical and pharmacy coverage for 12 months before (baseline period) and ≥ 12 months following the index date. Primary outcomes were incidence of comorbid PsA diagnosis, prevalence of MSK symptoms other than PsA, and evidence of MSK symptoms collected at baseline and assessed in 12-month intervals through 60 months. RESULTS: Of the 116,203 patients with newly diagnosed PsO, 110,118 were without baseline comorbid PsA. High prevalence rates of MSK symptoms among patients with only PsO were seen at baseline (47.1%), 12 months (48.2%), and 60 months (82.1%). Patient age, baseline MSK symptoms, and baseline MSK symptom-related healthcare utilization were associated with increased hazard of a PsA diagnosis. CONCLUSION: Increased prevalence rates of MSK symptoms and burden are experienced by patients newly diagnosed with PsO through 60 months of follow-up. Several baseline factors were associated with increased risk of PsA diagnosis.
A Study to Look at Symptoms of Muscles, Joints, and Bones in Patients with Psoriasis and Whether They Can Predict a Diagnosis of Psoriatic ArthritisPsoriasis is an inflammatory skin disease that results in areas of significant itchiness, pain, and scaling, and ultimately decreases patient quality of life. Psoriasis affects approximately 24% of the general US population and 1.32.2% of the UK population. Some patients with psoriasis may experience musculoskeletal symptoms and may go on to develop psoriatic arthritis. The goal of this study was to determine the frequency of patients with psoriasis who experienced complaints of musculoskeletal pain prior to and/or following their psoriasis diagnosis, and whether these were associated with further probability of developing psoriatic arthritis.Using a large US-based database with data from approximately 115,000 patients with newly diagnosed psoriasis, we determined the percentage of newly diagnosed psoriasis patients with existing musculoskeletal pain complaints within 12 months of their initial diagnosis. We found that 47% of newly diagnosed patients had previous musculoskeletal pain complaints, with joint pain, back pain, and overall fatigue representing the most common forms. Notably, psoriasis patients with previous joint pain were approximately 50% more likely to develop psoriatic arthritis compared with patients with no previous joint pain. Furthermore, patients with previous other forms of arthritis were nearly twice as likely to develop psoriatic arthritis.This study provides additional support that existing musculoskeletal pain in patients with newly diagnosed psoriasis may predict the potential future onset of psoriatic arthritis. These findings will help guide primary care physicians, dermatologists, and rheumatologists in understanding the importance of earlier detection of psoriatic arthritis to provide more appropriate care.
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OBJECTIVE: Although research suggests racial/ethnic disparities in influenza vaccination and mortality rates, few studies have examined racial/ethnic trends among US adolescents. We used national cross-sectional data to determine (1) trends in influenza vaccination rates among non-Hispanic white (hereinafter, white), non-Hispanic black (hereinafter, black), and Hispanic adolescents over time and (2) whether influenza vaccination rates among adolescents varied by race/ethnicity. METHODS: We analyzed provider-reported vaccination histories for 2010-2016 from the National Immunization Survey-Teen. We used binary logistic regression models to determine trends in influenza vaccination rates by race/ethnicity for 117 273 adolescents, adjusted for sex, age, health insurance, physician visit in the previous 12 months, vaccination facility type, poverty status, maternal education level, children in the household, maternal marital status, maternal age, and census region of residence. We calculated adjusted probabilities for influenza vaccination for each racial/ethnic group, adjusted for the same demographic characteristics. RESULTS: Compared with white adolescents, Hispanic adolescents had higher odds (adjusted odds ratio [aOR] = 1.11; 95% confidence interval [CI], 1.06-1.16) and black adolescents had lower odds (aOR = 0.95; 95% CI, 0.90-1.00) of vaccination. Compared with white adolescents, Hispanic adolescents had significantly higher adjusted probabilities of vaccination for 2011-2013 (2011: 0.22, P < .001; 2012: 0.23, P < .001; 2013: 0.26, P < .001). Compared with white adolescents, black adolescents had significantly lower probabilities of vaccination for 2016 (2016: 0.21, P < .001). CONCLUSIONS: Targeted interventions are needed to improve adolescent influenza vaccination rates and reduce racial/ethnic disparities in adolescent vaccination coverage.
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Disparidades en Atención de Salud/estadística & datos numéricos , Vacunas contra la Influenza/uso terapéutico , Grupos Raciales/estadística & datos numéricos , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Estudios Transversales , Etnicidad/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Disparidades en Atención de Salud/etnología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
In this article, we use data from the 2016 National Survey on Drug Use and Health (NSDUH) to examine the association between religious involvement and marijuana use for medical and recreational purposes in U.S. adults (N = 41,517). We also consider whether the association between religious involvement and marijuana use varies according to personal health status. Our results show that adults who attend religious services more frequently and hold more salient religious beliefs tend to exhibit lower rates of medical and recreational marijuana use. We also find that these "protective effects" are less pronounced for adults in poor health. Although our findings confirm previous studies of recreational marijuana use, we are the first to examine the association between religious involvement and medical marijuana use. Our moderation analyses suggest that the morality and social control functions of religious involvement may be offset under the conditions of poor health.
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OBJECTIVES: Although racial and ethnic differences in HPV vaccination initiation are well established, it is unclear whether these disparities have changed over time. The role of health provider recommendations in reducing any racial and ethnic inequalities is also uncertain. This study addresses these gaps in the literature. STUDY DESIGN: Repeated cross-sectional design. METHODS: Using data from the National Immunization Survey-Teen (2008-2013), we estimated a series of binary logistic regressions to model race-specific trends in (1) provider recommendations to vaccinate against HPV and (2) HPV vaccine initiation for males (n = 56,632) and females (n = 77,389). RESULTS: Provider recommendations to vaccinate and HPV vaccination uptake have increased over time for adolescent males and females and across all racial and ethnic groups. Among girls, minority youths have seen a sharper increase in provider recommendations and HPV vaccination uptake than their White counterparts. Among boys, minority teens maintain higher overall rates of HPV vaccine uptake, however, Hispanics have lagged behind non-Hispanic Whites in the rate of increase in provider recommendations and HPV vaccinations. CONCLUSIONS: Our results suggest that racial and ethnic disparities in provider recommendations and HPV vaccinations have waned over time among males and females. While these trends are welcomed, additional interventions are warranted to increase overall rates of vaccination across race, ethnicity, and gender.