Factors Associated with Early and Periodic Screening, Diagnostic, and Treatment Services in a Medicaid Managed Care Pediatric Population.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services is a Medicaid benefit for children that addresses their health problems before they become advanced, debilitating, and expensive. We conducted a retrospective cross-sectional analysis of pediatric beneficiaries (newborn to younger than 21 years) enrolled in a Medicaid managed care organization to examine the factors associated with EPSDT screening services completion. We obtained 2018 administrative claims data for beneficiaries continuously enrolled for a minimum of 90 days (n=156,108). Completion of EPSDT screening services among our Medicaid managed care beneficiaries was low. Those having more emergency department visits and hospitalizations, having family medicine practitioners as primary care physicians, belonging to the racial/ethnic group Asian/Pacific Islander/Hawaiian/Alaskan Native/Native American, and 18 to younger than 21 years age group were less likely than others to complete EPSDT services. Our results provide information on segments of pediatric beneficiaries that can be targeted to increase EPSDT screening services completion.

Understanding Physicians' Perceptions of Patient-Identified Barriers to Osteoporosis Medication Initiation: A Cognitive Mapping Approach.

Objective: Interventions to initiate medication and increase adherence for postmenopausal women who have had a fragility fracture were not always successful. The purpose of this study was to derive an empirical framework for patient-identified barriers to osteoporosis medication initiation and adherence from physician experts. Methods: A cognitive mapping approach involving nominal group technique (NGT) meetings and a card sorting and rating task were used to obtain formative data. We first conducted four NGT meetings with 18 women patients who were not on osteoporosis treatment to identify barriers to osteoporosis medication, then invited 27 osteoporosis physicians to sort and rate 25 patients identified barriers. Descriptive analysis, multidimensional scaling analysis, and hierarchical cluster analysis were applied for data analysis. Results: A two-dimensional five-cluster cognitive map was derived to provide an organizational framework for understanding patients perceived barriers to medication initiation and adherence. The five clusters were concerns about side effects, experience of side effects, lifestyle changes, medication access and complexity, and patient uncertainty about treatment and trust in the provider. The two dimensions were interpreted as internal to patients (X-axis) and external to patients (Y-axis). Conclusions/Implications: Views of patients solicited in a structured format provided directions to help in designing interventions to improve osteoporosis medication initiation and adherence.

Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis.

OBJECTIVE: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate. METHODS: Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data. RESULTS: Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients' personal barriers, (2) patients' treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic). CONCLUSION: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.

Health care utilization among beneficiaries with diabetes from federally qualified health centers: Analysis from a Medicaid managed care organization.

We examined health care utilization among federally qualified health center (FQHCs) users from a Medicaid managed care organization based on 2016 administrative claims data (n = 8,402). FQHC users had fewer primary care visits (Adjusted Incidence Rate Ratios (aIRR): 0.82; 95% CI: 0.76-0.88) compared with non-FQHC users. Statistically significant differences were not observed in emergency department visits (aIRR: 1.19; 95% CI: 0.98-1.46) and hospitalizations (aIRR: 1.03; 95% CI: 0.80-1.34). FQHCs provide comprehensive primary care to Medicaid managed care beneficiaries with diabetes in fewer PCP visits. Results provide evidence to health policy experts and MCOs to increase provider network contracting with FQHCs.

Preventative diabetes self-care management practices among individuals with diabetes and mental health stress.

BACKGROUND: The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress. METHODS: Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors. RESULTS: Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior. LIMITATIONS: Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional. CONCLUSIONS: Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.

Diabetes Self-Management Among Individuals With Diabetes and Physical Disabilities.

PURPOSE: The purpose of this study was to examine diabetes self-management behavior among individuals who have diabetes living with and without physical limitations. METHODS: Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey was used. Dependent variables were utilization of dilated eye exams, foot checks, at least 1 dental checkup annually, treating diabetes with oral medication, treating diabetes with insulin injections, and engagement in moderate or vigorous physical exercise 5 times per week. The independent variable was diabetes with physical limitations compared with diabetes without physical limitations. The study controlled for predisposing, enabling, and need factors. RESULTS: Findings indicate that individuals with diabetes and physical limitations were less likely to engage in moderate or vigorous physical exercise 5 times per week, have at least 1 annual dental checkup, and treat their diabetes orally with medication. CONCLUSIONS: Self-management behavior was poor among individuals with diabetes and physical limitations. Environmental barriers may partially contribute to reasons why individuals with diabetes and physical limitations do not engage in diabetes self-management behaviors that would assist them in mitigating diabetes complications. Other reasons could be the lack of equipment accessibility or adaptability and cultural competence among providers treating/caring for individuals with physical limitations.

Is type of practice setting associated with physician's cultural competency training? Analysis from the National Ambulatory Medical Care Survey.

This study examined whether type of physician practice settings was associated with cultural competency training for newly hired physicians. We used data from the 2016 National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services for Office-based Physician Survey. The survey contains a sample of 397 office-based physician responses completed during the period from August to December 2016 (weighted n = 293306). The outcome variable was whether cultural competency training was required for newly hired physicians. The primary predictor variable was type of physician practice settings. We used logistic regression to analyze the association between physician practice settings and cultural competency training for newly hired physicians adjusting for covariates. About 71% physicians belonged to solo or group practice settings. Among these, only 10.4% required cultural competency training for newly hired physicians. Among other practice settings, 34.8% required the training. Results from logistic regression showed that newly hired physicians in solo or group practices (adjusted odds ratio: 0.22; 95% confidence interval: 0.11-0.44) were less likely to have cultural competency training compared to those in other settings. Practice settings are associated with cultural competency training. Cultural competency training across all practice settings may contribute toward improving patient-physician communication, reducing health disparities, and increasing patient satisfaction.

Increasing HPV Vaccination Support Through a Pilot Film-Based Community Engagement.

Mass media interventions are considered an effective tool to improve support for preventive health behavior. We conducted a retrospective analysis of data collected during 2016-2017 community screenings of the film Someone You Love: The HPV Epidemic to raise public awareness about human papillomavirus (HPV). The objective was to examine the change in participants' support for HPV vaccination after viewing the film. The film was screened five times at four different communities. Each screening was followed by a discussion session with local health care experts. A 9-item structured survey measured the impact of the film on motivation and overall support for HPV vaccine on a 4-point Likert scale. We used Wilcoxon Signed Rank test to examine the change in vaccination support. We obtained 64 survey responses. Participants were informed about the film through word of mouth and friends (20%), flyers (19%), and their health care providers (9.4%). Fifty-five percent were parents/guardians, and 75% were aged 26-65 years. About 28% and 22% of participants reported their daughters or sons had completed all 2 or 3 HPV shots. Results from Wilcoxon Signed Rank Test indicated statistically significant increase in vaccination support (Z = - 5.44, p < 0.001) after viewing the film. The median response from before to after changed from "supportive" to "very supportive". Community film screening followed by discussion with local health care experts is a promising strategy for increasing HPV vaccine support. Future work should address increasing access to the film, examine the film's impact on increasing HPV vaccine uptake and assessing program cost effectiveness.

Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities.

PURPOSE: The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. METHODS: We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. RESULTS: Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. CONCLUSIONS: Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.

Urgent Care Center and Emergency Department Utilization for Non-Emergent Health Conditions: Analysis of Managed Care Beneficiaries.

The objective was to identify predictors of utilization for urgent care centers (UCCs), emergency departments (EDs), or for both services for non-emergent health conditions among beneficiaries from a managed care organization (MCO) who resided within a 10-mile radius of UCCs. A cross-sectional design was used to analyze 2016 administrative claims data from an MCO that contracted with a UCC with 12 locations (n = 20,107). Outcome variables were number of visits to UCC, ED, or both. The MCO used the New York University ED algorithm to identify non-emergent health conditions. The Behavioral Model of Health Care Utilization was used as a conceptual framework to identify predictors in the model; age, sex, race/ethnicity, distance to UCC from residence, type of insurance, primary care physician visits, inpatient admissions, chronic conditions, morbid obesity, and smoking behavior. Generalized linear models were used to analyze the association between outcomes and predictors. About 22.7% were UCC users, 66.8% were ED users, and 10.5% used both. African Americans (incident rate ratio [IRR] = 0.95; 95% confidence interval [CI]: 0.91-0.98] were less likely to use UCCs and more likely to use the ED (IRR = 1.10; 95% CI: 1.07-1.13). Beneficiaries with multiple chronic conditions were more likely to use the ED than UCCs. Distance was not a predictor of UCC or ED usage. Utilization of UCC was low for non-emergent health conditions. African Americans and individuals with multiple chronic conditions preferred the ED to UCC for non-emergent health conditions. This study implies that MCO beneficiaries, especially the African American population, need to be informed about UCC locations and services provided.

Trends and Racial/Ethnic Disparities in Pneumococcal Polysaccharide Vaccination.

Even though pneumococcal vaccination recommendations have been in existence since 1983, vaccination rates are low in the United States. This study analyzed 5-year trends in pneumococcal polysaccharide vaccination uptake across racial/ethnic groups of individuals aged ≥65 years and high-risk individuals aged 19-64 years. Further, it examined factors that may explain the association between race/ethnicity and vaccination uptake. The 2011-2015 annual Behavioral Risk Factor Surveillance System (BRFSS) data were used to determine trends. The Behavioral Model of Health Care Utilization was used to identify covariates in the model. Multivariate logistic regressions were used to identify the association between race/ethnicity and vaccination uptake from 2015 BRFSS. Overall, from 2011 to 2015, vaccination uptake increased moderately from 69% to 71% among those aged ≥65 years, and from 21% to 24% for high-risk individuals aged 19-64 years. Among those aged ≥65 years (n = 99,403), African Americans (adjusted odds ratio [AOR]: 1.36, 95%CI: 1.21-1.52) and Hispanics (AOR: 2.13, 95%CI: 1.85-2.46) were more likely to be vaccinated than Whites. Among the younger population (n = 177,976), African Americans (AOR: 0.85, 95%CI: 0.79-0.92) and Asians (AOR: 0.73, 95%CI: 0.63-0.84) were less likely to be vaccinated than Whites. Over the 5 years there were no significant increases in vaccination uptake. The rates are far below the Healthy People 2020 goals. Reverse disparities were observed in the older group. In younger group, minorities were less likely to get vaccinated. As gaps still exist, this study implies tailored interventions based on race/ethnicity to promote vaccination uptake among both groups.

Healthcare Providers' Recommendations for Physical Activity among US Arthritis Population: A Cross-Sectional Analysis by Race/Ethnicity.

INTRODUCTION: We examined racial/ethnic disparities in healthcare providers' recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not. METHODS: With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, ≥18 years of age (n = 83,376). Outcome variable was healthcare providers' recommendations for physical activity. Race/ethnicity was categorized as African American, Hispanic, and White. Associations were examined using multivariate logistic regression. RESULTS: African Americans (Adjusted OR: 0.66; 95% CI: 0.55-0.79) and Hispanics (Adjusted OR: 0.68; 95% CI: 0.56-0.83) were less likely to receive providers' recommendations. CONCLUSIONS: Although the importance of physical activity to improve health outcomes for adults with arthritis, as well as providers' influence on individuals' behavior change, is well established, providers are less likely to recommend physical activity to minorities. Further studies are required to identify the causes for this quality-of-care issue.

Individuals With Disabilities Who Have Diabetes: Do We Have Targeted Interventions?

According to 2010 data from the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of death in the United States. It is assumed that various diabetes interventions are available to help individuals manage this chronic disease, but that is not the case. The literature is scant regarding interventions focused on people with disabilities who have diabetes. The purpose of this article is to review interventions specifically focused on people with disabilities who have diabetes and to discuss the effect of these interventions on this population.

Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials.

OBJECTIVES: To describe the quality of life among sepsis survivors. DESIGN: Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESS-SHOCK [validation cohort]). SETTING: ICUs in North and South America, Europe, Africa, Asia, and Australia. PATIENTS: Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year. CONCLUSIONS: Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials.

Acupuncture Use in the United States: Who, Where, Why, and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.

Access to urban acute care services in high- vs. middle-income countries: an analysis of seven cities.

PURPOSE: Cities are expanding rapidly in middle-income countries, but their supply of acute care services is unknown. We measured acute care services supply in seven cities of diverse economic background. METHODS: In a cross-sectional study, we compared cities from two high-income (Boston, USA and Paris, France), three upper-middle-income (Bogota, Colombia; Recife, Brazil; and Liaocheng, China), and two lower-middle-income (Chennai, India and Kumasi, Ghana) countries. We collected standardized data on hospital beds, intensive care unit beds, and ambulances. Where possible, information was collected from local authorities. We expressed results per population (from United Nations) and per acute illness deaths (from Global Burden of Disease project). RESULTS: Supply of hospital beds where intravenous fluids could be delivered varied fourfold from 72.4/100,000 population in Kumasi to 241.5/100,000 in Boston. Intensive care unit (ICU) bed supply varied more than 45-fold from 0.4/100,000 population in Kumasi to 18.8/100,000 in Boston. Ambulance supply varied more than 70-fold. The variation widened when supply was estimated relative to disease burden (e.g., ICU beds varied more than 65-fold from 0.06/100 deaths due to acute illnesses in Kumasi to 4.11/100 in Bogota; ambulance services varied more than 100-fold). Hospital bed per disease burden was associated with gross domestic product (GDP) (R (2) = 0.88, p = 0.01), but ICU supply was not (R (2) = 0.33, p = 0.18). No city provided all requested data, and only two had ICU data. CONCLUSIONS: Urban acute care services vary substantially across economic regions, only partially due to differences in GDP. Cities were poor sources of information, which may hinder their future planning.

Health care providers' recommendations for physical activity and adherence to physical activity guidelines among adults with arthritis.

INTRODUCTION: Physical activity is beneficial for reducing pain and improving health-related quality of life among people with arthritis. However, physical inactivity is prevalent among people with arthritis. Health care providers' recommendations act as a catalyst for changes in health behavior. However, information about the effectiveness of such recommendations is limited in the arthritis literature. We examined the association between providers' recommendations for physical activity and adherence to physical activity guidelines for adults with arthritis and whether adults' age influenced this association. METHODS: We used combined data of adult respondents aged 45 years or older with provider-diagnosed arthritis (N = 10,892) from the 2011 Behavioral Risk Factor Surveillance System to conduct a retrospective, cross-sectional study. We used a multivariable logistic regression model to examine the association between health care providers' recommendations and adherence to physical activity guidelines among adults with arthritis. RESULTS: Adults with arthritis who received health care providers' recommendations for physical activity were more likely (odds ratio, 1.22; 95% confidence interval, 1.12-1.32) to adhere to physical activity guidelines than those who did not, after controlling for relevant covariates. Adults' age did not influence the association between providers' recommendations and adherence to physical activity (odds ratio, 1.00; 95% confidence interval, 0.99-1.00), after controlling for covariates. CONCLUSION: Health care providers' recommendations are associated with adherence to physical activity guidelines among adults with arthritis. Providers should recommend physical activity to adults with arthritis.

Age bias in physicians' recommendations for physical activity: a behavioral model of healthcare utilization for adults with arthritis.

OBJECTIVE: To examine whether age bias exists in physicians' recommendations for physical activity among individuals with arthritis. METHODS: A cross-sectional sample with 33,071 U.S. adults, 45 years or older with physician-diagnosed arthritis was obtained from 2007 Behavioral Risk Factor Surveillance System Survey. We used logistic regression to examine physicians' recommendations for physical activity as a function of age controlling for gender, race, education, marital status, employment, income, health insurance, personal physician, emotional support, body mass index, activity limitations, health status, and comorbidities. RESULTS: Majority of individuals were females (65%), White (85%), had annual household income < $50,000 (67%), and with comorbidities (86%). Respondents were approximately equal across age groups: middle-aged group (53%) and older group (47%). About 36% were obese and 44% had activity limitations, and 44% did not receive any physicians' recommendations for physical activity. Results from logistic regression indicated older adults (≥ 65 years old) were less likely (OR = 0.87; 95% CI, 0.82-0.92) to receive physicians' recommendations for physical activity compared with the middle-aged group (45-64 years old). CONCLUSIONS: This study indicates that although the benefits associated with the physical activity is well recognized, there is age bias in physicians' recommendations for physical activity.

Disparities in use of gynecologic oncologists for women with ovarian cancer in the United States.

OBJECTIVE: To examine disparities in utilization of gynecologic oncologists (GOs) across race and other sociodemographic factors for women with ovarian cancer. DATA SOURCES: Obtained SEER-Medicare linked dataset for 4,233 non-Hispanic White, non-Hispanic African American, Hispanic of any race, and Non-Hispanic Asian women aged ≥ 66 years old diagnosed with ovarian cancer during 2000-2002 from 17 SEER registries. Physician specialty was identified by linking data to the AMA master file using Unique Physician Identification Numbers. STUDY DESIGN: Retrospective claims data analysis for 1999-2006. Logistic regression models were used to analyze the association between GO utilization and race/ethnicity in the initial, continuing, and final phases of care. PRINCIPAL FINDINGS: GO use decreased from the initial to final phase of care (51.4-28.8 percent). No racial/ethnic differences were found overall and by phase of cancer care. Women >70 years old and those with unstaged disease were less likely to receive GO care compared to their counterparts. GO use was lower in some SEER registries compared to the Atlanta registry. CONCLUSIONS: GO use for the initial ovarian cancer treatment or for longer term care was low but not different across racial/ethnic groups. Future research should identify factors that affect GO utilization and understand why use of these specialists remains low.

Association between adherence to physical activity guidelines and health-related quality of life among individuals with physician-diagnosed arthritis.

PURPOSE: To examine the association between adherence to physical activity guidelines and health-related quality of life (HRQOL) among individuals with arthritis. METHODS: A cross-sectional sample with 33,071 US adults, 45 years or older with physician-diagnosed arthritis was obtained from 2007 Behavioral Risk Factor Surveillance System survey. We conducted negative binomial regression analysis to examine HRQOL as a function of adherence to physical activity guidelines controlling for physicians' recommendations for physical activity, age, sex, race, education, marital status, employment, annual income, health insurance, personal physician, emotional support, body mass index, activity limitations, health status, and co-morbidities based on Behavioral Model of Health Services Utilization. RESULTS: Descriptive statistics showed that 60% adults with arthritis did not adhere to physical activity guidelines, mean physically and mentally unhealthy days were 7.7 and 4.4 days, respectively. Results from negative binomial regression indicated that individuals who did not adhere to physical activity guidelines had 1.14 days more physically unhealthy days and 1.12 days more mentally unhealthy days than those who adhered controlling for covariates. CONCLUSIONS: Adherence to physical activity is important to improve HRQOL for individuals with arthritis. However, adherence is low among this population. Interventions are required to engage individuals with arthritis in physical activity.