Managed care COVID-19 outcomes in a population health program.

OBJECTIVES: To determine (1) factors linked to hospitalizations among managed care patients (MCPs), (2) outcome improvement with use of outpatient off-label treatment, and (3) outcome comparison between MCPs and a mirror group. STUDY DESIGN: Retrospective cohort study comparing MCPs with an age- and gender-matched mirror group in Florida from April 1, 2020, to May 31, 2020. METHODS: A total of 38,193 MCPs in a Florida primary care group were monitored for COVID-19 incidence, hospitalization, and mortality. The highest-risk patients were managed by the medical group's COVID-19 Task Force. As part of a population health program, the COVID-19 Task Force contacted patients, conducted medical encounters, and tracked data including comorbidities and medical outcomes. The MCPs enrolled in the medical group were compared with a mirror group from the state of Florida. RESULTS: The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60% were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73% lower likelihood of hospitalization (P < .05). Compared with the mirror group, MCPs had 60% lower COVID-19 mortality (P < .05). CONCLUSIONS: MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.

Assessment of Burnout: A Pilot Study of International Women Physicians.

INTRODUCTION: Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions. METHODS: Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions. RESULTS: Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evaluated using a 1-way ANOVA, with no statistically significant differences between other regions. DISCUSSION: The data suggests that there may be regional differences in the prevalence of burnout in women physicians. Various factors could play a role in explaining the higher burnout scores in female physicians in Africa, including younger average age, establishing practice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.

Pockets of Inequality in the Distribution of U.S. Pharmacists' Wages and Salaries: A Gender Comparison.

BACKGROUND: The literature contains conflicting arguments regarding inequalities in the distribution of U.S. pharmacists' wages and salaries and the existence of a gender earnings gap. Some authors argue that the dispersion is small compared to other professions and there is no gap; others report that after controlling for number of hours worked, human-capital stock, and job-related preferences, male pharmacists earn higher wages and salaries than female pharmacists. OBJECTIVES: Estimate the central tendency and spread of wages and salaries of pharmacists practicing in the U.S., compare earning levels of male and female pharmacists, and examine the pockets of inequality within each gender. METHODS: The study used self-reported survey data collected from a random sample of licensed pharmacists practicing throughout the United States. The sample consisted of 375 men and 279 women. Means and standard deviations of wage-and-salary earnings for male and female pharmacists were estimated by age, number of hours worked, years of professional experience, marital status, type of pharmacy degree, main role as pharmacist, and type of practice site. The spread of wages and salaries within gender was analyzed using the Gini coefficient. RESULTS: A total of 654 pharmacists provided answers to all relevant questions in the questionnaire (28.9% response rate). Wages and salaries of male pharmacists exceeded those of female pharmacists, but the gap was restricted to practitioners with selected characteristics-older, married, with more experience, whose primary role was dispensing medications, and practicing in a hospital setting. The greatest wage-and-salary inequalities were observed among older pharmacists, with more years of professional experience, and whose primary role was dispensing medications. Different gender-specific pockets of inequality were identified in all variables studied and all categories within these variables. CONCLUSION: The seemingly smooth gender-specific distribution of earnings in the pharmacy profession might be the result of opposing trends by different groups of practitioners that cancel each other when analyzed aggregately. By estimating the wages and salaries for selected categories of pharmacists and examining the pockets of inequality within each gender, this study shed light into recent labor market developments and will hopefully stimulate further research into the dynamics of the pharmacist workforce.

Prevalence and ethnic/racial disparities in the distribution of pediatric injuries in South Florida: implications for the development of community prevention programs.

BACKGROUND: The state of Florida continues to report significant gender, ethnic and racial disparities in trauma incidence, access to care and outcomes in the adult population. Our objective was to assess pediatric injury profiles and ethnic/racial disparities of specific injuries in a Regional Trauma Center (TC) in South Florida. METHODS: Retrospective data from November 2011 to December 2015 were obtained from the Level 2 TC registry for children ≤21 years old. Demographic, injury pattern, geographic area, injury scores and treatment data were analyzed. RESULTS: One thousand six hundred ten patients, ages 0-21 years were cared for at the TC from 2011 to 2015.73% were males. Mean age = 15.7 years. Mortality was 2.3%. Using zip code data and using geographic mapping, we identified two main clusters where injuries were occurring. A multinomial regression analysis demonstrated that Hispanics had higher risks of falls (RR 10.4, 95% CI 2.7-29), motorcycle accidents (RR 3.7, 95% CI 1.7-8.2) and motor vehicle accidents (RR 6.4, 95% CI 3.6-11.4). Black/African American children had higher risks of gunshot wounds and resultant mortality (p < 0.01). CONCLUSION: There were racial, ethnic and gender disparities in the patterns of injury and outcomes among the youth attended at our TC. Geographic mapping allowed us the identification of the zones in South Florida where injuries were occurring. Understanding the differences and using geographic mapping to identify regions of higher prevalence will complement planning for prevention programs.

Response rate, response time, and economic costs of survey research: A randomized trial of practicing pharmacists.

BACKGROUND: There is a gap between increasing demands from pharmacy journals, publishers, and reviewers for high survey response rates and the actual responses often obtained in the field by survey researchers. Presumably demands have been set high because response rates, times, and costs affect the validity and reliability of survey results. OBJECTIVE: Explore the extent to which survey response rates, average response times, and economic costs are affected by conditions under which pharmacist workforce surveys are administered. METHODS: A random sample of 7200 U.S. practicing pharmacists was selected. The sample was stratified by delivery method, questionnaire length, item placement, and gender of respondent for a total of 300 observations within each subgroup. A job satisfaction survey was administered during March-April 2012. RESULTS: Delivery method was the only classification showing significant differences in response rates and average response times. The postal mail procedure accounted for the highest response rates of completed surveys, but the email method exhibited the quickest turnaround. A hybrid approach, consisting of a combination of postal and electronic means, showed the least favorable results. Postal mail was 2.9 times more cost effective than the email approach and 4.6 times more cost effective than the hybrid approach. CONCLUSION: Researchers seeking to increase practicing pharmacists' survey participation and reduce response time and related costs can benefit from the analytical procedures tested here.

An analysis of response rate and economic costs between mail and web-based surveys among practicing dentists: a randomized trial.

This study explored the economic costs and response rate of mail and web-based surveys with practicing dentists. A random sample of 6,000 practicing dentists was randomly assigned into three groups of 2,000: choice (mail or web-based), postal mail, or web-based. The Florida Tobacco Control Survey 2009, which is composed of 28 questions (including subject demographic questions), served as the survey instrument. A total of 1,232 surveys were returned by the three different groups (21% overall response rate). Response rates were best for the mail (26%) with the worst response rate coming from the Web group (11%). However, a cost-effectiveness analysis revealed that web surveys were 2.68 times more cost effective.

A latent class analysis of job satisfaction and turnover among practicing pharmacists.

BACKGROUND: Research on job satisfaction and turnover using latent class analysis (LCA) has been conducted in other disciplines. LCA has seldom been applied to social pharmacy research and may be especially useful for examining job situation constructs in pharmacy organizations. OBJECTIVE: The objective of the study was to determine the probability of turnover among practicing pharmacists using LCA. METHODS: Using a cross-sectional descriptive design, 2400 randomly selected pharmacists with active licenses in Florida were surveyed. A model was created using LCA, then fit indices were used to determine whether underlying "job satisfaction clusters" were present. Once identified, these clusters along with the covariate practice site were modeled on a distal outcome turnover. RESULTS: A 5-class model appeared to best fit the data: a "pseudo-satisfied" class that contained 8% of the sample, a "career-goal" class that contained 11% of the sample, a "satisfied class" that contained 44% of the sample, a "job-expectation" class that contained 3% of the sample, and an "unsatisfied class" that contained 17% of the sample. In terms of predicting the distal outcome "turnover," the calculated odds ratios indicate that compared with class 3 or the satisfied group, class 2 was 14 times more likely, class 4 was 17 times more likely, and class 5 was 26 times more likely to state that they do not intend to be employed with their current employer 1 year from now. CONCLUSION: The LCA method was found to be effective for finding relevant subgroups with a heterogeneous at-risk population for turnover. Results from the analysis indicate that job satisfaction may be parsed into smaller, more interpretable and useful subgroups. This result holds great promise for practitioners and researchers, alike.

The future of optometric practice? The results of a survey of optometrists and optometry students.

BACKGROUND: There is an apparent increase in the number of private optometry practices that are closing due to a lack of interested buyers. We examined some of the factors that influence the market for optometry practices in a survey of practicing optometrists and third- and fourth-year optometry students. METHODS: Optometrists in six states, and students at four schools and colleges of optometry, completed a mailed or faxed survey regarding attitudes toward optometric practice, including fair/reasonable compensation for a new optometrist, the value of optometric practices, and preferred mode of practice on graduation. RESULTS: Doctors and students differed significantly in the amount of money they reported as fair/reasonable compensation for a recently graduated optometrist joining a practice. Comparing students to doctors in specific categories of compensation, students chose a higher fair/reasonable compensation compared to doctors. Students were more likely than doctors to choose >$70,000 as fair/reasonable compensation, while doctors were more likely than students to choose $40,000 to $69,000. Doctors tended to overvalue their practices for the purpose of selling the practice when using percentage of gross income as a valuation method. Students' choices for mode of practice changed dramatically from their ideal when taking their current financial situation into consideration. Students were more likely to choose corporate practice as their preferred practice mode when considering their current financial situation than when not restricted. CONCLUSIONS: There are many factors that affect the value and marketability of an optometric practice. In order to sell a practice, the owner must consider the effects of the needs and desires of recently graduated optometrists.