Patient attitudes, experiences, and satisfaction with healthcare and office visit utilization among Medicare beneficiaries with type 2 diabetes.

OBJECTIVES: To examine patient attitudes, experiences, and satisfaction with healthcare associated with office visit utilization among Medicare beneficiaries with type 2 diabetes. METHODS: We analyzed the 2019 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with type 2 diabetes (n = 1092). The ordinal dependent variable was defined as 0, 1 to 5, and ≥6 office visits. An ordinal partial proportional odds model was conducted to examine associations of beneficiaries' attitudes, experiences, and satisfaction with healthcare and office visit utilization. RESULTS: Among the beneficiaries, approximately 17.7%, 22.8%, and 59.5% reported having 0, 1 to 5, and ≥6 office visits, respectively. Being male (OR = 0.67, p = 0.004), Hispanic (OR = 0.53, p = 0.006), divorced/separated (OR = 0.62, p = 0.038) and living in a non-metro area (OR = 0.53, p < 0.001) were associated with a lower likelihood of attending more office visits. Trying to keep sickness to themselves (OR = 0.66, p = 0.002) and dissatisfaction with the ease and convenience of getting to providers from home (OR = 0.45, p = 0.010) were associated with a lower likelihood of having more office visits. DISCUSSION: The proportion of beneficiaries foregoing office visits is concerning. Attitudes concerning healthcare and transportation challenges can be barriers to office visits. Efforts to ensure timely and appropriate access to care should be prioritized for Medicare beneficiaries with diabetes.

Trends in Drug Spending of Oral Anticoagulants for Atrial Fibrillation, 2014-2021.

INTRODUCTION: This study documents cost trends in oral anticoagulants (OAC) in patients with newly diagnosed atrial fibrillation. METHODS: Using MarketScan databases, the mean annual patients' out-of-pocket costs, insurance payments, and the proportion of patients initiating OAC within 90 days from atrial fibrillation diagnosis were calculated from July 2014 to June 2021. Costs of OACs (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) and the payments by three insurance types (commercial payers, Medicare, and Medicaid) were calculated. Patients' out-of-pocket costs and insurance payments were adjusted to 2021 prices. Joinpoint regression models were used to test trends of outcomes and average annual percent changes (AAPC) were reported. Data analyses were performed in 2022-2023. RESULTS: From July 2014 to June 2021, the mean annual out-of-pocket costs of any OAC increased for commercial insurance (AAPC 3.0%) and Medicare (AAPC 5.1%) but decreased for Medicaid (AAPC -3.3%). The mean annual insurance payments for any OAC significantly increased for all insurance groups (AAPC 13.1% [95% CI 11.3-15.0] for Medicare; AAPC 11.8% [95% CI 8.0-15.6] for commercial insurance; and AAPC 16.3% [95% CI 11.3-21.4] for Medicaid). The initiation of any OAC increased (AAPC 7.3% for commercial insurance; AAPC 10.2% for Medicare; AAPC 5.3% for Medicaid). CONCLUSIONS: There was a substantial increase in the overall cost burden of OACs and OAC initiation rates in patients with newly diagnosed atrial fibrillation in 2014-2021; these findings provide insights into the current and anticipated impact of rising drug prices on patients' and payers' financial burden.

Association of cardiovascular disease with health-related quality of life among older women with early-stage breast cancer undergoing adjuvant endocrine therapy.

INTRODUCTION: Due to the improved overall survival and life expectancy of older women with breast cancer, cardiovascular disease (CVD) arose as the primary cause of non-cancer-related deaths in this population. Therefore, assessing the health-related quality of life (HRQoL) of breast cancer patients with comorbid CVD is becoming increasingly vital. Our study aimed to evaluate the association between comorbid CVD and HRQoL among older women with early-stage breast cancer who are receiving adjuvant endocrine therapy (AET) in the United States. MATERIALS AND METHODS: We conducted a retrospective cohort study using the 2006-2017 Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data. We identified female patients over the age of 65 who were diagnosed with stage I-III hormone receptor-positive breast cancer and treated with AET. HRQoL was assessed by the physical and mental component summary (PCS & MCS) in the health survey. CVD was defined as a history of acute myocardial infarction (AMI), congestive heart failure (CHF), angina, stroke, or other heart-related conditions. We performed multivariate linear regression models while controlling for covariates. RESULTS: Among 3,904 older women, a history of CHF [ß = -1.97, p = 0.025], stroke [ß = -3.00, p < 0.010], or other heart-related condition [ß = -1.10, p = 0.046] was significantly associated with lower PCS. However, no significant differences in PCS scores were found between women with a history of AMI or angina and those without these conditions. Having a history of CHF [ß = -1.72, p = 0.033] or stroke [ß = -1.48, p = 0.038] was significantly associated with lower MCS, whereas a history of angina, AMI, or other heart conditions was not associated with significant differences in MCS. Our study did not observe any significant differences in PCS and MCS between the two types AETs. DISCUSSION: The study found that older women with early-stage breast cancer who were being treated with AETs had a lower HRQoL if they had a history of CHF or stroke. These comorbidities were identified as strong predictors for decreased HRQoL. The findings highlight the significance of managing cardiovascular diseases in such patients for better HRQoL while they receive AET treatment.

Systematic Review of the Economic Evaluation of Sodium-Glucose Cotransporter-2 Inhibitors Used as Treatment in Patients with Heart Failure.

BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been recently used as therapeutic agents for type 2 diabetes mellitus. Recent clinical trials have shown that they are beneficial for reducing the risk of cardiovascular mortality and hospitalization in patients with heart failure (HF). A comprehensive review regarding the cost-effectiveness of different SGLT2 inhibitors for HF treatment may be necessary to help clinicians and decision-makers select the most cost-effective HF treatment option. OBJECTIVE: This study conducted a systematic review of economic evaluation studies of SGLT2 inhibitors for the treatment of patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). METHOD: We searched PubMed, Cochrane, Embase, and EBSCOhost to identify published economic evaluation studies on SGLT2 inhibitors for HF treatment until May 2023. Studies on the economic evaluation of SGLT2 inhibitors in the treatment of HF were included. We extracted information such as country, population, intervention, type of model, health status, and conclusion of cost-effectiveness. RESULT: Of the 410 studies, 27 were finally selected. All economic evaluation studies used the Markov model, and commonly included health status as stable HF, hospitalization due to HF, and death. All dapagliflozin studies focused on patients with HFrEF (n = 13), and dapagliflozin was cost-effective in 14 countries, but not in the Philippines. All empagliflozin studies focused on the patients with HFrEF also showed the cost-effectiveness of empagliflozin (n = 11). However, empagliflozin use in patients with HFpEF was determined to be cost-effective in studies in Finland, China, and Australia studies but not in studies in Thailand and the USA. CONCLUSIONS: Most of the studies reported the cost-effectiveness of dapagliflozin and empagliflozin in patients with HFrEF. However, the cost-effectiveness of empagliflozin differed from country to country regarding patients with HFpEF. We suggest that further economic evaluation of SGLT2 inhibitors should focus on patients with HFpEF in more countries.

Hospital outcomes and costs for prostate cancer patients with comorbid heart failure by age group: An analysis of the US Nationwide Inpatient Sample.

RATIONALE, AIMS, AND OBJECTIVES: The prevalence of patients hospitalized with comorbid prostate cancer (PC) and heart failure (HF) has been steadily increasing. Both diseases share a set of common risk factors, with the most prominent being age. This study aimed to examine the outcomes and costs for patients with comorbid PC and HF, stratified by age. METHODS: We analyzed 41,340 hospitalization events of patients with PC using the US National Inpatient Sample from 2015 to 2018. Associations of HF with in-hospital mortality, length of stay (LOS), and hospital costs per hospitalization were measured using multivariable logistic regression, negative binomial regression, and generalized linear regression with log-link and gamma distribution, respectively, controlling for covariates. Subgroup analyses were performed for age groups <65 and ≥65. RESULTS: Visits of comorbid HF patients made up 2.3% (n = 952) of the PC study sample. Compared with PC patients without HF, those with HF had higher in-hospital mortality rates (odds ratio = 1.33, 95% confidence interval [CI] = 0.96-1.84, p = 0.085), longer hospital stays (incidence rate ratio = 1.32, 95% CI = 1.21-1.44, p < 0.001), and higher hospital costs (cost ratio = 1.17, 95% CI = 1.07-1.27, p = 0.001), controlling for covariates. On average, this amounted to a higher in-hospital mortality rate of 2.10%, an increased LOS of 1.73 days, and higher hospital costs of $2110 per patient. While in-hospital mortality did not differ significantly in patients aged <65 (p = 0.900), patients aged ≥65 had a 41% increased risk of in-hospital mortality compared with those without HF (p = 0.047). CONCLUSIONS: In comparison to those without HF, PC patients with comorbid HF showed higher rates of in-hospital mortality, LOS, and hospital costs, with mortality showing a significant difference exclusively in the ≥65 population. Effective management of older patients with PC is needed to improve outcomes and decrease costs.

Accessibility and Utilization of Telehealth Services During the COVID-19 Pandemic Among Medicare Beneficiaries by Diabetes Status.

Due to the influence types of telehealth services (i.e., phone and/or video) can have on patient care and outcomes, we sought to examine factors associated with the types of telehealth services offered and used among Medicare beneficiaries. We analyzed the Medicare Current Beneficiary Survey COVID-19 Public Use File (N = 1,403 and N = 2,218 for individuals with and without diabetes, respectively) and performed multinomial logit models to examine factors (e.g., sociodemographics, comorbidities, digital access/knowledge) associated with types of telehealth services offered and used among beneficiaries aged ≥65 years by diabetes status. Medicare beneficiaries seemed to prefer using telehealth via phone than video. Regardless of diabetes status, having not previously participated in video or voice calls or conferencing can be a barrier to telehealth being offered and used via video for beneficiaries. For older adults with diabetes, disparities in accessibility of telehealth via video by income and languages spoken other than English were observed. [Research in Gerontological Nursing, 16(3), 134-146.].

Dissatisfaction of Out-of-Pocket Costs and Problems Paying Medical Bills Among Medicare Beneficiaries With Type 2 Diabetes.

PURPOSE: The purpose of the study was to examine the relationship between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills among Medicare beneficiaries with type 2 diabetes. METHODS: The 2019 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample of Medicare beneficiaries aged ≥65 years with type 2 diabetes, was analyzed (n = 2178). A survey-weighted multivariable logit regression model was conducted to examine the association between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills, adjusted for sociodemographics and comorbidities. RESULTS: Among study beneficiaries, 12.6% reported problems paying medical bills. Among those with and without problems paying medical bills, 59.5% and 12.8%, respectively, were dissatisfied with out-of-pocket costs. In the multivariable analysis, beneficiaries who were dissatisfied with out-of-pocket costs were more likely to report problems paying medical bills than those who were satisfied. Younger beneficiaries, beneficiaries with lower incomes, those with functional limitations, and those with multiple comorbidities were more likely to report problems paying medical bills. CONCLUSIONS: Despite having health care coverage, more than one-tenth of Medicare beneficiaries with type 2 diabetes reported problems paying medical bills, which raises concerns about delaying or forgoing needed medical care due to unaffordability. Screenings and targeted interventions that identify and reduce financial hardships associated with out-of-pocket costs should be prioritized.

Adherence to Adjuvant Endocrine Therapy and Survival Among Older Women with Early-Stage Hormone Receptor-Positive Breast Cancer.

BACKGROUND AND OBJECTIVE: Although improving adherence to adjuvant endocrine therapies (AETs) is critical to ensure better patient outcomes, the evidence is still lacking on differences in 5-year AET adherence trajectories. This study aimed to estimate the time trend of adherence by the type of individual AET and the association of adherence to AETs with overall survival among older women with hormone receptor-positive breast cancer. METHODS: This study used the Surveillance, Epidemiology, and End Results-Medicare database 2006-2016. We included women aged ≥ 65 years with newly diagnosed hormone receptor-positive breast cancer and who had initiated AET (anastrozole, letrozole, exemestane, or tamoxifen). Adherence to AETs was defined as the proportion of days covered that was calculated for the follow-up period (5 years). The overall survival time was defined as the time from the date of AET initiation to death. The linear mixed models with repeated measures were used to estimate the changes in adherence to AETs. The Cox proportional hazard model was used to assess the relationships (hazard ratio [HR] and 95% confidence interval [CI]) between adherence to AETs and death. RESULTS: A total of 11,617 patients were included. Anastrozole was the most commonly used (n = 6,908), followed by letrozole (n = 2,586), tamoxifen (n = 1,750), and exemestane (n = 373). The mean (standard deviation) of proportion of days covered for 5 years was 57.4 (34.6), indicating the highest proportion of days covered in the anastrozole group [61.1 (34.1)] and the lowest proportion of days covered in the exemestane group [44.0 (35.1)]. Overall, adherence to AET decreased over the 5-year follow-up period in all AET groups, but the decrease in the tamoxifen group was steeper (42.3% decreased) compared with other AETs. Anastrozole, letrozole, and exemestane groups were associated with a lower risk of death compared with the tamoxifen group (HR = 0.80, 95% CI 0.71-0.89 for anastrozole; HR = 0.82, 95% CI 0.72-0.93 for letrozole; HR = 0.82, 95% CI 0.63-1.07 for exemestane). CONCLUSIONS: Patients who initiated with tamoxifen had a steeper decrease in adherence over the 5 years compared with anastrozole, letrozole, and exemestane groups. Furthermore, higher adherence was associated with a decreased risk of mortality. Physicians should be cognizant of decreasing adherence over time and choose effective treatment options with minimal side-effect profiles to better support adherence by patients with breast cancer.

Comparing survival outcomes between neoadjuvant and adjuvant chemotherapy within breast cancer subtypes and stages among older women: a SEER-Medicare analysis.

BACKGROUND: This study aimed to compare survival outcomes of neoadjuvant (NAC) and adjuvant chemotherapy (AdC) within each breast cancer subtype and stage among older women. METHODS: Older (≥ 66 years) women newly diagnosed with stage I-III invasive ductal breast cancer during 2010-2017 and treated with both chemotherapy and surgery within one year were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Analyses were performed within each of six groups, jointly defined based on subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2 + , and triple-negative) and stage (I-II and III). Kaplan-Meier curves and multivariable Cox models were used to compare overall and recurrence-free survival between NAC and AdC, with optimal full matching performed for confounding adjustment. RESULTS: Among 8,495 included patients, 8,329 (20.6% received NAC) remained after matching. Before multiple testing adjustment, Cox models showed that NAC was associated with a lower hazard for death among stage III HER2 + patients (hazard ratio = 0.347, 95% confidence interval CI 0.161-0.745) but a higher hazard for death among triple-negative patients (stage I-II: hazard ratio = 1.558, 95% CI 1.024-2.370; stage III: hazard ratio = 2.453; 95% CI 1.254-4.797). A higher hazard for death/recurrence was associated with NAC among stage I-II HR + /HER2- patients (hazard ratio = 1.305, 95% CI 1.007-1.693). No significant difference remained after multiple testing adjustment. CONCLUSIONS: The opposite trends (before multiple testing adjustment) of survival comparisons for advanced HER2 + and triple-negative disease warrant further research. Caution is needed due to study limitations such as cancer stage validity.

Cost-related medication nonadherence among Medicare beneficiaries with cardiovascular disease risk factors: The role of comprehension of the Medicare programme and its prescription drug benefits.

RATIONALE, AIMS, AND OBJECTIVES: This study aims to investigate how reported comprehension of the Medicare programme and its prescription drug benefits is associated with cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. METHODS: This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking and obesity) (n = 2821). A survey-weighted logistic model was used to examine associations between perceived difficulty of understanding the Medicare programme and its prescription drug benefits and CRN, controlling for beneficiaries' demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. RESULTS: Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare programme and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare programme (OR = 1.50; 95% CI = 1.11-2.04; p = 0.009) and its prescription drug benefits (OR = 2.01; 95% CI = 1.52-2.66; p < 0.001). Similar results were obtained for the subgroups with obesity, hypertension or hyperlipidemia. CONCLUSIONS: Perceived difficulty of understanding the Medicare Programme and its prescription drug benefits is associated with CRN among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries' overall understanding of the Medicare programme may reduce CRN.

A systematic review of economic evaluations of tyrosine kinase inhibitors for non-small cell lung cancer (NSCLC).

INTRODUCTION: Although tyrosine kinase inhibitors (TKIs) have improved the efficacy of treatment for non-small cell lung cancer (NSCLC), the accessibility of TKIs is limited due to high costs. Despite the critical role of the cost-effectiveness of TKIs on decision-making, no systematic reviews have compared the cost-effectiveness of comparable TKIs. Therefore, we systemically reviewed the economic evaluation studies on various TKIs for NSCLC. AREAS COVERED: We searched PubMed and the Cochran Library to identify the published economic evaluation studies of TKIs in NSCLC patients that were published by January 2022. All of the included studies (n = 38) evaluated the cost-effectiveness of epidermal growth factor receptor (EGFR)-TKIs (n = 29) or anaplastic lymphocyte kinase (ALK)-TKIs (n = 9). The cost-effectiveness results were reported as the incremental cost-effectiveness ratio per quality-adjusted life-year, except for three studies. EXPERT OPINION: We found that the economic evaluation studies of the first and second generation of EGFR-TKIs and ALK-TKIs varied by the country and study settings, such as comparator and input parameters. In 12 studies, osimertinib (EGFR-TKI) was not cost-effective compared to other first/second EGFR-TKIs, regardless of the study settings. More evidence can be provided about cost-effectiveness of the third-generation TKIs in future research.

Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010-2017.

PURPOSE: This study assessed chemotherapy use trends before (neoadjuvant chemotherapy [NAC]) or after surgery (adjuvant chemotherapy [AdC]) among older women with breast cancer and examined factors related to NAC receipt. METHODS: Women (> 65 years) diagnosed with stage I-III breast cancer during 2010-2017 who received NAC or AdC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. All patients were stratified into six strata based on subtype (hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR + /HER2-], HER2 + , and triple-negative breast cancer [TNBC]) and stage (I-II and III). Cochran-Armitage tests were performed to test temporal trends of NAC use in each stratum. Multivariable logistic regression analyses were performed to identify factors (sociodemographic and clinical) related to NAC use. RESULTS: Among included older (mean ± standard deviation: 72.3 ± 5.2 years) women (N = 8,495) with stage I-III breast cancer, NAC use increased from 11.7% (2010) to 32.6% (2017). Significant increases in NAC were found in all strata (p < .0001) with more substantial increases in HER2 + disease and TNBC compared to HR + /HER2- disease. Multivariable logistic regressions identified the youngest age category (66-69 years) and later stage as significant (p < 0.05) predictors of NAC receipt in most strata, in addition to diagnosis year. CONCLUSION: Similar to the overall breast cancer population, NAC use increased among a population of older women. NAC was received by most patients with stage III HER2 + disease or TNBC in more recent years and was more common among younger elderly women and those in stage III.

Prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer.

BACKGROUND: Medication nonadherence among older patients with cancer can have profound health consequences. This study examines the association between prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. METHODS: We analyzed the 2017 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with reported non-skin cancer (n = 806). Beneficiaries were considered to have medication nonadherence if they reported: skipping doses, taking smaller doses than prescribed, or delaying or not filling a prescription because of cost. A survey-weighted logistic model, adjusted for covariates, was conducted to examine the association between prescription drug coverage satisfaction and medication nonadherence. RESULTS: Of study beneficiaries with cancer, 14.7% reported medication nonadherence. Higher proportions of beneficiaries with medication nonadherence were dissatisfied with the amount paid for medications (33.2% vs. 11.0%, p < 0.001) and the medications included on formulary (29.5% vs 5.2%, p < 0.001). In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.22; p = 0.050) and the medications included on formulary (OR = 5.03; p = 0.005). CONCLUSIONS: Strategic mitigation of these barriers is essential to improving health outcomes in this at-risk population.

Inability to access health care due to COVID-19 among Medicare beneficiaries.

OBJECTIVES: The understanding of which factors are associated with inability to access health care services due to the COVID-19 pandemic is limited. We aimed to examine factors associated with being unable to access health care due to the pandemic among Medicare beneficiaries. STUDY DESIGN: A cross-sectional study. METHODS: We analyzed the summer and fall 2020 Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire data. Our study included community-dwelling Medicare beneficiaries 65 years and older (summer: n = 8751; fall: n = 7421). Logistic regressions were used to examine factors (eg, sociodemographics, comorbidities) associated with being unable to access health care services due to the pandemic. RESULTS: Approximately 20.9% and 7.5% of the beneficiaries reported they were unable to access health care services due to the pandemic in the summer and fall of 2020, respectively. The most frequent types of services that beneficiaries were unable to access were dental care (summer, 45.5%; fall, 35.1%) and regular check-ups (summer, 35.9%; fall, 46.1%). Beneficiaries who reported a higher income (income ≥ $25,000) (summer: odds ratio [OR], 1.55; P < .001; fall: OR, 1.52; P = .002) or speaking English at home (summer: OR, 1.50; P = .016; fall: OR, 1.53; P = .082) were more likely to report being unable to access services than their counterparts (lower income or speaking a language other than English at home). Beneficiaries with at least 4 chronic conditions were unable to access health care significantly more often than those with 1 or no conditions. CONCLUSIONS: Given that sociodemographics and comorbidity burden contributed to the disparities that we observed in accessibility of health care services due to the pandemic, these findings can allow decision makers to target resource allocation and outreach efforts to those populations most at risk.

Health-related quality of life among elderly breast cancer patients treated with adjuvant endocrine therapy: a U.S Medicare population-based study.

OBJECTIVES: The evidence regarding the impact of individual adjuvant endocrine therapies (AET) on health-related quality of life (HRQoL) is limited. We aimed to assess the association between the type of AET and HRQoL and to examine the relationship between HRQoL and one-year mortality among women with breast cancer in the USA. METHODS: This retrospective cross-sectional study used the 2006-2017 Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey database to identify older women with early-stage hormone receptor-positive breast cancer. Multivariate linear regressions were used to assess the association between types of AET (anastrozole, letrozole, exemestane, and tamoxifen) and HRQoL scores (physical component summary (PCS) and mental component summary (MCS)). Multivariate logistic regressions were used to predict the impact of PCS and MCS on one-year mortality. RESULTS: Out of 3537 older women with breast cancer, anastrozole was the most commonly prescribed (n = 1945, 55.0%). Regarding PCS, there was no significant difference between the four AET agents. Higher MCS scores, which indicate better HRQoL, were reported in patients treated with anastrozole (vs. letrozole [ß = 1.26, p = 0.007] and exemestane [ß = 2.62, p = 0.005) and tamoxifen (vs. letrozole [ß = 1.49, p = 0.010] and exemestane [ß = 2.85, p = 0.004]). Lower PCS and MCS scores were associated with higher one-year mortality, regardless of type of AET initiated, except for tamoxifen in MCS. CONCLUSION: Although there was no significant difference in physical HRQoL scores between AET agents, anastrozole and tamoxifen were associated with better mental HRQoL scores.

Accessibility and utilisation of telehealth services among older adults during COVID-19 pandemic in the United States.

The removal of regulatory and reimbursement barriers during the COVID-19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations. Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID-19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID-19 Supplement File of community-dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey-weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio-demographics, co-morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID-19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID-19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non-metro area (versus metro) were 7.1% (marginal effect [ME] = -7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = -8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = -6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non-Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co-morbidities (versus 0-1 condition) (e.g., 2-3 co-morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care.

The Role of Media Sources for COVID-19 Information on Engaging in Recommended Preventive Behaviors Among Medicare Beneficiaries Aged ≥ 65 Years.

OBJECTIVES: The public relies on various media sources and communication platforms for receipt of coronavirus disease 2019 (COVID-19) information. Therefore, identifying the primary sources of COVID-19 information among older adults can be valuable, as it can enable information on life-saving measures to be effectively disseminated to this population. METHODS: We analyzed the Medicare Current Beneficiary Survey COVID-19 Supplement that was administrated from June 2020 through July 2020 (n = 8,050). A survey-weighted logistic model was conducted to examine the association between the sources of COVID-19 information Medicare beneficiaries most relied on (i.e., traditional news sources, social media, comments/guidance from government officials, other webpages/internet, friends/family members, and health care providers) and engaging in all 3 recommended preventive behaviors (i.e., mask wearing, social distancing, and handwashing). RESULTS: Among study participants, 89.8% engaged in all 3 recommended preventive behaviors. Approximately 59.3% of beneficiaries reported that they most relied upon traditional news sources for COVID-19 information; 11.4% reported health care providers; 10.6% reported comments/guidance from government officials; 8.8% reported other webpages/internet; 8.6% reported friends/family members; and 1.3% reported they relied upon social media. Beneficiaries who relied on comments/guidance from government officials for COVID-19 information (vs. traditional news sources) were more likely to engage in preventive behaviors (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.20-2.35). However, those who relied on COVID-19 information from friends/family members (vs. traditional news sources) were less likely to engage in preventive behaviors (OR = 0.56, 95% CI = 0.44-0.73). DISCUSSION: Our findings can inform decision making about the effective communication sources to reach Medicare beneficiaries for public health messaging regarding preventive measures, including COVID-19 vaccination.

In-hospital mortality, length of stay and hospital costs for hospitalized breast cancer patients with comorbid heart failure in the USA.

OBJECTIVES: Breast cancer and heart failure (HF) are frequently interconnected due to shared risk factors and the cardiotoxicity of breast cancer treatment. However, the association between HF and hospital outcomes among breast cancer patients has not been studied. This study examined the association between HF and hospital outcomes among hospitalized patients with breast cancer. METHODS: This cross-sectional study using the 2015-2018 Healthcare Cost and Utilization Project-National Inpatient Sample data included hospitalized women who were aged 18 years or older and had a primary diagnosis code for breast cancer. Logistic regression, negative binomial regression, and generalized linear models with log-link and gamma distribution were used to assess the associations of HF with in-hospital mortality, length of stay (LOS) and hospital costs. RESULTS: Among 17,335 hospitalized patients with breast cancer, 4.2% (n = 1021) had HF. Compared to breast cancer patients without HF, those with HF were more likely to die during hospitalization (odds ratio = 1.65, 95% CI = 1.27-2.16, p < .001), stay in the hospital longer (incidence rate ratio = 1.22, 95% CI = 1.15-1.30, p < .001) and have higher hospital costs (cost ratio = 1.09, 95% CI = 1.03-1.14, p = .003) during hospitalization, controlling for covariates. CONCLUSION: HF has a substantial negative impact on health outcomes among hospitalized breast cancer patients. Breast cancer and HF are often considered separate medical conditions, but promoting effective management of comorbid HF in breast cancer patients may help to improve hospital outcomes in this population.

Accessibility of Telehealth Services During the COVID-19 Pandemic: A Cross-Sectional Survey of Medicare Beneficiaries.

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.