Prescribing Patterns for Long-Acting Inhaled Bronchodilators Among Rural Adults With Chronic Obstructive Pulmonary Disease.

Background: Chronic obstructive pulmonary disease (COPD) is prevalent in rural areas of the USA. Long-acting inhaled bronchodilators (LABDs) are a key tool in COPD management and are underutilized. The purpose of this study was to determine whether rates of prescriptions for LABD differed by payer among patients with COPD in a rural healthcare network. Methods: In analysis 1, a random sample of patients with spirometry- and symptom-confirmed COPD over April 1, 2017 to December 31, 2019 was identified. Patient characteristics, including payer status, extracted from medical records were compared for those who did and did not have any prescriptions for LABD during the study window. In analysis 2, patients with one or more COPD-related hospitalizations during the same time period were identified and similar comparisons were made by LABD prescription status. Results: Among a random sample of patients with spirometry-confirmed COPD, 93.0% had been prescribed LABD during the study window with no difference in proportion by payer. Among the 461 patients with a COPD-related hospitalization, 388 (84.2%) had been prescribed LABD, again with no difference in prescriptions by payer. Those with a COPD-related hospitalization who had been prescribed LABD were younger, had lower body mass index, were more likely to be current smokers and had higher rates of hospitalizations for COPD during the study period than those not prescribed LABD. Conclusion: While disparities in LABD utilization may occur due to cost or other barriers to filling prescriptions, in our study, prescriptions for LABD were common and did not differ by payer status.

Loneliness Among Rural Self-Management Education Program Enrollees During the COVID-19 Pandemic.

PURPOSE: Pandemic-related isolation may exacerbate loneliness among rural adults; we sought to characterize loneliness and associated factors among rural adults during the COVID-19 pandemic. DESIGN: Cross-sectional observational study. SETTING: Remotely delivered self-management education (SME) workshops, rural upstate New York, May-December 2020. SUBJECTS: Rural SME workshop enrollees, aged 18+, n = 229. MEASURES: De Jong Gierveld 6-Item Loneliness Scale, sociodemographics, workshop type (chronic disease, chronic pain, diabetes), delivery mode (videoconference, phone, self-study); data collected via workshop process measures and enrollment surveys. ANALYSIS: Multivariable linear regression. RESULTS: Mean overall, emotional and social loneliness scores were 2.78 (SD = 1.91), 1.27 (SD = 1.02), and 1.52 (SD = 1.26). Being not married/partnered (ß = .61) and self-reported depression/anxiety (ß = .64) were associated with higher overall scores, and selection of videoconference (ß = -.77) and self-study (ß =-.85) modes with lower scores. Self-reported depression/anxiety (ß = .51) was associated with increased emotional loneliness. Being not married/not partnered (ß = .37) and selection of chronic pain workshops (ß = .64) was were associated with increased social loneliness. Selection of videoconference (ß = -.44) and self-study (ß = -.51) delivery modes were protective of social loneliness. CONCLUSION: In addition to marital status and depression/anxiety, experiencing chronic pain and selecting phone-based workshops were associated with higher degrees of loneliness among rural adults during the pandemic. The latter may be partly explained by insufficient internet access. Health educators should be prepared to address loneliness in rural areas during the pandemic.

Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity.

BACKGROUND: Prescription Drug Monitoring programs (PDMPs) are intended to reduce opioid prescribing and aberrant drug-related behavior thereby reducing morbidity and mortality due to prescription opioid overdose. Expansion of the New York (NY) State's PDMP in 2013 included the institution of the I-STOP law that mandated clinicians to consult the statewide PDMP database to review the patient's prescription history prior to prescribing opioids. METHODS: Trends in prescription opioid distribution, prescribing, and prescription opioid and heroin overdose morbidity in NY were analyzed using time series. A Chow test was used to test the difference in trends before and after the implementation of I-STOP. RESULTS: The results indicated that: 1) the number of opioid prescriptions appears to be declining following the implementation of the I-STOP, 2) however, supply chain data shows that the total quantity of opioids in the supply chain increased, 3) statewide trends in inpatient and emergency department visits for prescription opioid overdose increased from 2010 to the third quarter of 2013 where the slope leveled off following I-STOP, but this change in slope was not significant, 4) visits for heroin overdose started escalating in 2010 and continued to increase through the second quarter of 2016. The overall significance of these findings show a small impact of PDMPs on prescription opioid overdose morbidity in NY in the context of the increasing national trend during this time period. CONCLUSIONS: Prescription opioid morbidity leveled off following the implementation of a mandated PDMP although morbidity attributable to heroin overdose continued to rise.

Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use.

BACKGROUND: Previous studies of urban school-based health centers (SBHCs) have shown that SBHCs decrease emergency department (ED) utilization. This study seeks to evaluate the effect of SBHCs on ED utilization in a rural setting. METHODS: This retrospective, controlled, quasi-experimental study used an ED patient data set from the Bassett Healthcare Network in rural New York to compare ED visits between school-aged children from 12 SBHC schools before and after the SBHC opening. Time series analysis was used to determine trends in SBHC schools and 2 control schools without SBHCs over the 18-year study period. RESULTS: ED visit incidence densities for all 12 school districts combined showed a significant increase in ED visits post-SBHC (Rate ratio (RR) = 1.15; p < .0001). This increase may, in part, be explained by the upward trend of ED visits in the region, as seen in the small, but significant, positive slope (RR = 0.0033, p < .0001) for control schools. There was variation in the change in incidence density post-SBHC among school districts, with increases in 78% of schools. CONCLUSIONS: The opening of SBHCs in rural settings results in a slight, but significant, increase in ED use, which is contrary to previous cross-sectional studies in urban settings.

Developing Surveillance Methodology for Agricultural and Logging Injury in New Hampshire Using Electronic Administrative Data Sets.

OBJECTIVE: Agriculture and logging rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Sources of data such as patient care reports (PCRs) and hospitalization data have recently transitioned to electronic databases. METHODS: Using narrative and location codes from PCRs, along with International Classification of Diseases, 9th Revision, external cause of injury codes (E-codes) in hospital data, researchers are designing a surveillance system to track farm and logging injury. RESULTS: A total of 357 true agricultural or logging cases were identified. CONCLUSIONS: These data indicate that it is possible to identify agricultural and logging injury events in PCR and hospital data. Multiple data sources increase catchment; nevertheless, limitations in methods of identification of agricultural and logging injury contribute to the likely undercount of injury events.

Estimation of agricultural and logging injury incidence in Maine using electronic administrative data sets.

Agriculture and forestry rank among industries with the highest rates of occupational fatality and injury. Establishing a nonfatal injury surveillance system is a top priority in the National Occupational Research Agenda. Recently, new sources of data such as Pre-Hospital Care Reports (PCRs) and hospitalization data have transitioned to electronic databases. Using narrative free text and location codes from Maine PCRs, along with International Classification of Diseases (ICD)-9 External Cause of Injury Codes (E-codes) in Maine hospital data, researchers are designing a surveillance system to track farm and forestry injury that utilizes electronic match-merging of the two data sources. For 2008, PCR records produced a total of 104 true agricultural cases. Of these, 66 (63%) were identified from the keyword/visual inspection process alone, 25 (24%) were identified by the farm checkbox only, and the remaining 13 (13%) by both methods. For the 150 unique injury events found in hospitalization data, 146 had the initial episode of care documented in only one of the three hospital files. The emergency department (ED) file had the largest number of these (123/146 = 84.2%), followed by the outpatient file (12/146 = 8.2%) and the inpatient file (11/146 = 7.5%). Of the 250 unique agricultural injuries identified (100 PCR only + 146 hospital only + 4 from both), 66 (26%) would not have been identified without free text review of PCR narrative. The false-positive rate (97.14%) keyword searches underscores that without visual inspection, it is not an effective strategy. Both sources of data (PCR and hospital data) need to be used in a continued surveillance system.

Electronic merger of large health care data sets: cautionary notes from a study of agricultural morbidity in New York State.

Agriculture ranks among industries with the highest rates of occupational injury and fatality. Administrative medical data sets have long been thought to have potential for occupational injury surveillance. This research explores the feasibility of establishing an agricultural injury surveillance system in New York State that combines data from existing electronic sources. Prehospital Care Report (PCR) data containing the nature of the accident, type of injury, time and date, and patient disposition were received. Researchers also obtained both hospital inpatient and emergency department (ED) records for 2007 through 2009 from the Statewide Planning and Research Cooperative System (SPARCS). For SPARCS data, a computer algorithm identified all potential cases of agricultural injury using International Classification of Diseases (ICD)-9 codes. An attempt was then made to match PCR and SPARCS data using accident date, gender, age, and admitting hospital. Of the PCR records that were matched to SPARCS, 46.8% were found on subsequent inspection to not actually relate to the same incident. Total PCR counts for 2007 and 2008 showed considerable fluctuation, at 2,512,828 and 2,948,841, respectively. A total of 1275, 1336, and 1393 farm injuries were identified in the SPARCS records for 2007, 2008, and 2009, respectively. This study demonstrates that accurate matching of PCR and SPARCS records requires the use of unique personal identifiers. Further, annual fluctuations in PCR counts preclude their current use in a surveillance system. An electronic data set consisting of SPARCS data could be used for surveillance, but would benefit from the addition of PCR data as these become more consistent.