Divergence in perceptions of diabetes control among patients with type 2 diabetes mellitus treated with basal insulin and health care professionals: results from the US Perceptions of Control (POC-US) study.

Background: Approximately 60% of the patients with type 2 diabetes mellitus (T2DM) on basal insulin have an HbA1c ≥7%. This analysis of the US Perceptions of Control (POC-US) study aimed to understand US patient and health care professional (HCP) views of diabetes "control," which may play a role in whether patients reduce their HbA1c or achieve HbA1c <7%. Methods: A cross-sectional, Web-based survey of 500 US HCPs (primary care physicians, endocrinologists, nurse practitioners/physician assistants) and 618 US adults with T2DM using basal insulin was conducted to assess perceptions, attitudes, and behaviors associated with T2DM management. The survey was developed from previous research examples and qualitative exploratory research and was pretested. Patients self-reported their most recent HbA1c level and confirmed this value with their HCP, if necessary. Results: Patients and HCPs differed on some definitions of "in control." HbA1c value was used most often by both populations, but more frequently by HCPs (91% vs 69%). Patients also often used behavioral criteria (eg, adherence to lifestyle changes and/or treatment regimens), and HCPs often used clinical criteria (eg, hypoglycemia). Most HCPs focused on the last 3 months to define control (67% vs 34% patients; P<0.05), whereas patients more frequently reported focusing on "the current moment" or "the past week." Patients were more likely to agree that controlling their condition is "completely the patients' responsibility" (patients, 67%; HCPs, 34%; P<0.05); HCPs were more likely to agree that they have "a responsibility to actively contribute to the control of their patients' T2DM" (90% vs 60%; P<0.05). Conclusion: US patients with T2DM have differing views from HCPs on key aspects of diabetes control and management and are less likely to consider HbA1c value as a criterion for determining control. Recognizing and addressing these differences may improve patient-HCP communication and may potentially improve patient outcomes.

Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study.

OBJECTIVE: ACTION (Awareness, Care, and Treatment in Obesity maNagement) examined obesity-related perceptions, attitudes, and behaviors among people with obesity (PwO), health care providers (HCPs), and employer representatives (ERs). METHODS: A total of 3,008 adult PwO (BMI ≥ 30 by self-reported height and weight), 606 HCPs, and 153 ERs completed surveys in a cross-sectional design. RESULTS: Despite several weight loss (WL) attempts, only 23% of PwO reported 10% WL during the previous 3 years. Many PwO (65%) recognized obesity as a disease, but only 54% worried their weight may affect future health. Most PwO (82%) felt "completely" responsible for WL; 72% of HCPs felt responsible for contributing to WL efforts; few ERs (18%) felt even partially responsible. Only 50% of PwO saw themselves as "obese," and 55% reported receiving a formal diagnosis of obesity. Despite HCPs' reported comfort with weight-related conversations, time constraints deprioritized these efforts. Only 24% of PwO had a scheduled follow-up to initial weight-related conversations. Few PwO (17%) perceived employer-sponsored wellness offerings as helpful in supporting WL. CONCLUSIONS: Although generally perceived as a disease, obesity is not commonly treated as such. Divergence in perceptions and attitudes potentially hinders better management. This study highlights inconsistent understanding of the impact of obesity and need for both self-directed and medical management.

Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system.

BACKGROUND: The Sherlock 3CG™ Tip Confirmation System (TCS) provides real-time peripherally inserted central catheter (PICC) tip insertion information using passive magnetic navigation and patient cardiac electrical activity. It is an alternative tip confirmation method to fluoroscopy or chest X-ray for PICC tip insertion confirmation in adults. The purpose of this study was to evaluate time and cost of the Sherlock 3CG TCS and blind insertion with chest X-ray tip confirmation (BI/CXR) for PICC insertions. METHODS: A cross-sectional, observational Time and Motion study was conducted. Data were collected at four hospitals in the US. Two hospitals used Sherlock 3CG TCS and two hospitals used BI/CXR to place/confirm successful PICC tip location. Researchers observed PICC insertions, collecting data from the beginning (ie, PICC kit opening) to catheter tip confirmation (ie, released for intravenous [IV] therapy). An economic model was developed to project outcomes for a larger population. RESULTS: A total of 120 subjects were enrolled, with 60 subjects enrolled in each arm and 30 enrolled at each of the four US hospitals. The mean time from initiation of the PICC procedure to the time to release for IV therapy was 33.93 minutes in the Sherlock 3CG arm and 176.32 minutes in the BI/CXR arm (p < 0.001). No malpositions were observed for PICC insertions using the Sherlock 3CG TCS, while 20% of subjects in the BI/CXR arm had a malposition. BI/CXR subjects had significantly more total malpositions (mean 0.23 vs. 0, p < 0.001). For a hypothetical population of 1,000 annual patients, adoption of Sherlock 3CG TCS was predicted to be cost saving compared with BI/CXR in all three analysis years. CONCLUSION: The results from this study demonstrate that Sherlock 3CG TCS, when compared with BI/CXR, is a superior alternative with regard to time to release subject to therapy, malposition rates, and minimization of X-ray exposure.

Comparison of current US risk strategy to screen for hepatitis C virus with a hypothetical targeted birth cohort strategy.

OBJECTIVES: We compared the theoretical performance of a 1-time, birth cohort strategy with the currently recommended risk strategy for screening for hepatitis C virus (HCV) infection, which is undetected in an estimated 75% of 4 million affected people in the United States. METHODS: We applied current American Association for the Study of Liver Disease risk screening guidelines and a targeted birth cohort strategy to National Health and Nutrition Examination Survey data from 2003 to 2006 to estimate their performance in identifying HCV cases. RESULTS: Risk guidelines would recommend testing 25% of the US population aged 20 years or older and, if fully implemented, identify 82% of the projected HCV-exposed population. A targeted birth cohort (1946-1964) strategy would test 45% of the same population and identify 76% of the projected HCV population. CONCLUSIONS: In this ideal-world simulation, birth year and risk screening had similar theoretical performances for predicting HCV infection. However, actual implementation of risk screening has not achieved its theoretical performance, and birth cohort screening might increase HCV testing rates.

Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life.

BACKGROUND: Relationships of asthma control to other asthma outcomes have been incompletely documented. OBJECTIVE: This study examined the relationship between asthma control and health-related quality of life (HRQL) and subsequent healthcare resource utilization. METHODS: A 1-year online prospective longitudinal survey was conducted in 497 adults and 170 children with asthma treated in the past year. Control was measured by Asthma Control Test™ (ACT) and Childhood ACT™ (C-ACT)™ scores dichotomized into "well-controlled" (scores >19) or "not well-controlled" (scores ≤19), and HRQL was measured using the PedsQL™ 3.0 Asthma Module (children) and the SF-12 Health Survey (adults). Multivariate models were used for analysis. RESULTS: HRQL scores were significantly lower for adults (mean decrease 3.4) and children (mean decrease 12.8) whose asthma was not well-controlled compared to patients with well-controlled asthma. Adults with asthma that was not well-controlled at baseline had a threefold greater risk of an asthma-related doctor visit and a 10-fold greater risk of an emergency department (ED) visit for asthma in the subsequent 9 months (odds ratio (OR) = 3.3 and OR = 11.3, respectively). Children with asthma that was not well-controlled had a nearly fivefold increased risk for subsequent asthma-related doctors' and ED visits (OR = 4.8 and OR = 4.9, respectively). CONCLUSION: Both adults and children with not well-controlled asthma had significantly lower quality of life and were more likely to require an office or ED visit for asthma compared to patients with higher ACT scores. Therefore, it is important to continually assess asthma control and adjust controller therapy accordingly.

Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey.

BACKGROUND: Although management techniques have been proposed to accelerate gastrointestinal recovery after elective bowel resection (BR), most data are derived from single-institution experience. This study assessed the current state of perioperative care for elective BRs and the effect of pathway components on length of stay. METHODS: A web-based survey was conducted among surgeons regarding their last elective BR. RESULTS: Among 207 general and 200 colorectal surgeons, 30% practice in hospitals with a perioperative surgical care pathway intended to accelerate gastrointestinal recovery. Pathway components included early ambulation, early diet progression, early nasogastric tube removal/avoidance, and opioid-sparing pain control. Care practices associated with decreased length of stay included laparoscopic technique, early mobilization, early liquids, and antiemetic use to prevent symptoms associated with prolonged postoperative ileus. CONCLUSIONS: Few hospitals have pathways but most surgeons likely would implement nationally endorsed guidelines. These data, along with other studies, may lead to well-accepted BR care pathways.

Generic substitution in the treatment of epilepsy: patient and physician perceptions.

Generic substitution of branded antiepileptic drugs (AEDs) has sparked recent debates. We sought to understand perceptions about generic AED substitution and how these guide prescribing. Surveys were conducted among 550 adult patients with self-reported epilepsy and 606 physicians who treat patients with epilepsy. Physicians (88%) were concerned about an increase in breakthrough seizures in patients switched from a brand AED to a generic or among generics. Two-thirds of physicians and 34% of patients have linked breakthrough seizures to generic AED substitution. Physicians (75%) and patients (65%) were also concerned about efficacy. About half of physicians were extremely/very likely to request that brand AEDs not be substituted with a generic. In conclusion, perceptions among physicians and patients do not align with the FDA position that generic AEDs have the same clinical effect and safety profile as branded AEDs. Additional investigation on bioequivalence may help address ongoing concerns and inform policy-making decisions.

Patient and physician reactions to generic antiepileptic substitution in the treatment of epilepsy.

BACKGROUND: The clinical and economic consequences of generic antiepileptic drug (AED) substitution are not yet fully understood. This article provides a broad perspective of generic AED substitution in five countries. METHODS: Two cross-sectional telephone-based surveys (patient and physician) were undertaken in Canada, the United Kingdom, France, Germany, and Spain. A total of 1409 interviews, 974 patients and 435 physicians, were completed. RESULTS: Across all countries studied, patients and physicians alike have elevated concerns about the safety and efficacy of generic AEDs as compared with drugs for acute care. CONCLUSION: There is an opposition to generic substitution by both patients and physicians, especially with concern over increased breakthrough seizure risk. Further evidence is required to understand how costs and effects of generic AED substitution affect patient welfare.

Injury hospitalization and risks for subsequent self-injury and suicide: a national study from New Zealand.

OBJECTIVES: Risks for suicide and nonfatal self-injury hospitalizations associated with previous injury hospitalizations were investigated in a nationwide retrospective cohort study conducted in New Zealand. METHODS: Linked data from all New Zealand public hospitals were used to identify individuals with injury hospitalizations. Participants were followed for 12 months. RESULTS: Significantly increased age- and sex-adjusted relative risks for suicide were associated with previous hospitalization for self-injury, injuries of undetermined causes, and assault. Also, elevated risks were associated with these causes of hospitalization in the case of subsequent self-injury hospitalizations. CONCLUSIONS: Results indicate that identifiable subgroups of individuals hospitalized for injuries are at marked risk for serious suicidal behavior and suggest the potential of targeted suicide prevention for these individuals.