Association between nintedanib adherence trajectory and healthcare use among idiopathic pulmonary fibrosis patients.

BACKGROUND: Although inverse associations have been found between medication adherence and healthcare use and spending outcomes in many clinical settings, no studies to date have examined these relationships for patients with idiopathic pulmonary fibrosis (IPF) initiating nintedanib. We build on our prior study that used group-based trajectory modeling (GBTM) to compare inpatient hospitalization and medical care spending outcomes between groups of patients with different nintedanib adherence trajectories. METHODS: This analysis used 100% Medicare data and included beneficiaries with IPF who initiated nintedanib during 10/01/2014-12/31/2018. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A (inpatient care), B (outpatient care) and D (prescription drugs) for one year before (baseline) and after (follow-up) initiating nintedanib. Patients were assigned to the GBTM-derived adherence trajectory group closest to their own nintedanib adherence experience. All-cause and IPF-related hospitalization events and total medical spending were measured during the follow-up period. Unadjusted and adjusted regression models were estimated to compare outcomes between patients in different nintedanib adherence trajectories. RESULTS: Among the 1,798 patients initiating nintedanib, the mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectories: high adherence, moderate adherence, high-then-poor adherence, delayed-poor adherence, and early-poor adherence. All-cause hospitalizations and total all-cause medical spending were higher among patients in the high-then-poor, delayed-poor and early-poor adherence trajectories than those in the high adherence trajectory. For example, adjusted total all-cause medical spending was $4,876 (95% CI: $1,470 to $8,282) higher in the high-then-poor adherence trajectory, $3,639 (95% CI: $1,322 to $5,955) higher in the delayed-poor adherence trajectory and $3,907 (95% CI: $1,658 to $6,156) higher in the early-poor adherence trajectory compared with the high adherence trajectory. IPF-related hospitalizations and medical care spending were higher among those in the high-then-poor adherence trajectory compared with those in the high adherence trajectory. CONCLUSIONS: Poor adherence to nintedanib was associated with all-cause hospitalizations and medical costs. Therefore, improved adherence programs, such as support programs, can be implemented to reduce economic burden.

Health care costs and utilization of progressive fibrosing lung disease by underlying interstitial lung disease type.

BACKGROUND: Fibrosing interstitial lung disease (ILD) encompasses more than 200 diverse pulmonary disorders, of which up to 40% become progressive. The 4 underlying ILD types most likely to result in progression are unclassified ILD/idiopathic interstitial pneumonia (IIP), autoimmune ILDs, exposure-related ILD/hypersensitivity pneumonitis, and sarcoidosis. OBJECTIVE: To compare health care resource utilization (HCRU) and costs among patients with fibrosing ILD that has progressed ("progressive" fibrosing cohort) vs patients whose fibrosis did not meet criteria set for progression ("not yet progressed" cohort). METHODS: This was a noninterventional study of commercial enrollees and Medicare Advantage with Part D beneficiaries, which used administrative claims data for the period from October 1, 2015, through May 31, 2021. Adult patients (aged ≥18 years) with fibrosing ILD and 12 months of continuous health plan enrollment were included. Patients with idiopathic pulmonary fibrosis, baseline ILD diagnoses, or missing demographic data were excluded. Patients were first classified according to the underlying type of fibrosing ILD. For statistical analyses of outcomes, 2 cohorts were compared within each subtype: progressive fibrosing ILD vs not yet progressed ILD. The final study population included propensity score-matched (PSM) patients (1:1) based on pre-ILD baseline demographic and clinical characteristics. HCRU categories included inpatient hospitalization counts and the number of inpatient days and total costs (in 2021 US dollars), analyzed descriptively and weighted by the per-patient-per-month cost. Lin's regression was used to predict 12-month total cost estimates for comparison by cohort. RESULTS: The distribution by underlying conditions was as follows: autoimmune ILD (n = 4,156), HP (n = 8,181), sarcoidosis (n = 775), and unclassified ILD/IIP (n = 18,635). After PSM, pre-ILD baseline variables were generally well balanced between the progressive and not yet progressed fibrosing ILD cohorts. For all underlying subtypes of ILD, patients in the progressive cohort had significantly more utilization and higher costs compared with patients in the not yet progressed cohort. Progressive cohorts had significantly higher adjusted rates of inpatient days among patients with at least 1 inpatient stay compared with the not yet progressed cohorts (all P < 0.01). In addition, the progressive cohorts had significantly higher adjusted 12-month total costs, with the differences ranging from $24,493 to $55,072 (all comparisons P < 0.001). CONCLUSIONS: Irrespective of underlying ILD type, patients with progressive fibrosing ILD had significantly increased HCRU and cost relative to those whose fibrosing ILD had not yet progressed.

Using group based trajectory modeling for assessing medication adherence to nintedanib among idiopathic pulmonary fibrosis patients.

BACKGROUND AND OBJECTIVE: Adherence to antifibrotic medications has been evaluated in a few studies using annual proportion of days covered (PDC), a common adherence metric. However, PDC alone cannot identify and distinguish between different patterns of adherence over time, which can be accomplished using group-based trajectory models (GBTM) of monthly PDC. The objective is to assess nintedanib adherence trajectories using GBTM and identify characteristics of patients within each trajectory group. METHODS: Individuals with idiopathic pulmonary fibrosis (IPF) who initiated nintedanib during 10/1/2014-12/31/2018 were identified in 100% Medicare claims and enrollment data. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A, B and D for one year before (baseline) and after (follow-up) initiating nintedanib. A series of GBTMs of adherence was estimated to identify the best-fitting specification. Patients were then grouped based on their estimated adherence trajectories. Associations between baseline patient characteristics, including demographics, comorbidities, and health care use, and group membership probabilities were quantified as odds ratios using fractional multinomial logit modeling. RESULTS: Among the 1,798 patients initiating nintedanib, mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectory groups: high adherence (43.1%), moderate adherence (11.9%), high-then-poor adherence (10.4%), delayed-poor adherence (13.2%), and early-poor adherence (21.5%). The principal factors associated with higher odds of being in at least one of the poor-adherence groups were older age, female sex, race and ethnicity other than non-Hispanic white, and number of medications during baseline. CONCLUSIONS: GBTM identified distinct patterns of nintedanib adherence for the IPF patient cohort. Identifying adherence trajectory groups and understanding the characteristics of their members provide more actionable information to personalize interventions than conventional metrics of medication adherence.

Measuring Empathy in Iranian Pharmacy Students Using the Jefferson Scale of Empathy-Health Profession Student Version.

Objective. To assess validity of the Farsi-translated version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) and measure empathy scores of Iranian pharmacy students.Methods. The JSE-HPS questionnaire was administered to 504 Iranian pharmacy students in 2019. Confirmatory factor analysis and exploratory factor analysis were used to explore the underlying components and construct validity. Group comparisons of the empathy scores and the underlying components were conducted using statistical tests.Results. Based on 496 useable survey questionnaires, three domains of empathy among Iranian pharmacy students were confirmed by confirmatory factor analysis: compassionate care, perspective taking, and standing in a patient's shoes. Two items in the JSE-HPS were removed, as their factor loadings were under the permissible limits in exploratory factor analysis. Empathy scores were significantly higher among female pharmacy students.Conclusion. These findings support the validity and reliability of the Farsi version of the JSE-HPS among Iranian pharmacy students.

Psychosocial Correlates of Insomnia Among College Students.

INTRODUCTION: Among college students, insomnia remains a topic of research focus, especially as it pertains to its correlates and the extent of its association with mental conditions. This study aimed to shed light on the chief predictors of insomnia among college students. METHODS: A cross-sectional survey on a convenience sample of college students (aged ≥18 years) at 2 large midwestern universities was conducted from March 18 through August 23, 2019. All participants were administered validated screening instruments used to screen for insomnia, depression, and attention deficit hyperactivity disorder (ADHD). Insomnia correlates were identified by using multivariate logistic regression. RESULTS: Overall, 26.4% of students experienced insomnia; 41.2% and 15.8% had depression and had ADHD symptoms, respectively. Students with depression (adjusted odds ratio, 9.54; 95% CI, 4.50-20.26) and students with ADHD (adjusted odds ratio, 3.48; 95% CI, 1.48-8.19) had significantly higher odds of insomnia. The odds of insomnia were also significantly higher among employed students (odds ratio, 2.10; 95% CI, 1.05-4.18). CONCLUSION: This study showed an association between insomnia and mental health conditions among college students. Policy efforts should be directed toward primary and secondary prevention programs that enforce sleep education interventions, particularly among employed college students and those with mental illnesses.

A systematic review with meta-analysis of parental interventions for human papillomavirus vaccine uptake.

OBJECTIVES: With the growing ability of pharmacists to vaccinate against HPV, this systematic review with meta-analysis examined the efficacy of interventions targeting parents of children and adolescents in the US to increase HPV vaccine uptake. DATA SOURCES: A systematic search of PubMed, Web of Science, SCOPUS, CINAHL, and Medline was conducted from January 2006 to January 2022. STUDY SELECTION: We included parent-based randomized controlled trials (RCTs) in the US that measured actual HPV vaccine initiation and completion from patients' medical records. DATA EXTRACTION: The revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess studies for risk of bias, and the Michie and Prestwich Theory Coding Scheme will be used to assess the extent of theory use. Results were pooled using the inverse-variance heterogeneity model (IVhet). RESULTS: Of 770 studies, 13 were included for data extraction, and 12 were included in the meta-analysis. Parent-based interventions, when compared to controls, did not demonstrate a statistically significant increase in HPV vaccine initiation (OR = 1.24, 95% CI [0.86, 1.77]) or completion (OR = 1.23, 95% CI [0.78, 1.96]). However, sensitivity analysis suggested parent-based RCTs could improve HPV vaccine initiation (OR = 1.19, 95% CI [0.16, 1.22]) but not completion (OR = 1.25, 95% CI [0.86, 1.81]), after removing cluster RCTs. Reminders/recall interventions showed a significant increase in HPV vaccine initiation (OR = 1.19, 95% CI [0.16, 1.22]) and completion (OR = 1.52, 95% CI [1.04, 2.21]). Eight studies reported theory use in intervention development. No statistically significant differences were observed between atheoretical versus non-theory-based trials. CONCLUSION: Overall, parent-based interventions do not increase HPV vaccine uptake. Reminder and recall systems have the potential to improve HPV vaccine initiation and completion, and pharmacies can leverage these tools to improve vaccination. Behavioral theories and pharmacy-based HPV vaccination appear to be under-utilized.

Care patterns of patients with chronic fibrosing interstitial lung disease (ILD) with a progressive phenotype.

BACKGROUND: Interstitial lung diseases (ILDs) include a variety of parenchymal lung diseases. The most common types of ILDs are idiopathic pulmonary fibrosis (IPF), autoimmune ILDs and hypersensitivity pneumonitis (HP). There is limited real world data on care patterns of patients with chronic fibrosing ILDs with a progressive phenotype other than IPF. Therefore, the aim of this study is to describe care patterns in these patients. METHODS: This retrospective cohort study used claims data from 2015 to 2019 from the Optum Research Database. The study population included adults (≥ 18 years old) with at least two diagnosis codes for fibrosing ILD during the identification period (1OCT2016 to 31DEC2018). A claim-based algorithm for disease progression was used to identify patients likely to have a progressive fibrotic phenotype using progression proxies during the identification period. Index date was the first day of progression proxy identification after fibrosing ILD diagnosis. Patients were required to have continuous enrollment for 12 months before (baseline) and after (follow-up) index date. Patients with an IPF diagnosis were excluded. Descriptive statistics were used to describe the patient population and care patterns. RESULTS: 11,204 patients were included in the study. Mean age of the patient population was 72.7 years, and 54.5% were female. Unclassified ILDs (48.0%), HP (25.2%) and autoimmune ILDs (16.0%) were the most common ILD types. Other respiratory conditions were prevalent among patients including chronic obstructive pulmonary disease (COPD) (58.9%), obstructive sleep apnea (OSA) (25.0%) and pulmonary hypertension (9.8%). During baseline, 65.3% of all patients had at least one pulmonology visit, this proportion was higher during follow-up, at 70.6%. Baseline and follow-up use for HRCT were 39.9% and 48.8%, and for pulmonary function tests were 43.7% and 48.5% respectively. Use of adrenal corticosteroids was higher during follow-up than during baseline (62.5% vs. 58.0%). Anti-inflammatory and immunosuppressive medication classes were filled by a higher percentage of patients during follow-up than during baseline. CONCLUSIONS: Comprehensive testing is essential for diagnosis of a progressive phenotype condition, but diagnostic tests were underutilized. Patients with this condition frequently were prescribed anti-inflammatory and immunosuppressive medications.

Initial maintenance therapy adherence among older adults with asthma-COPD overlap.

OBJECTIVES: To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting ß agonist [ICS/LABA]) on trajectories of adherence among older adults (≥ 65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO). STUDY DESIGN: We used a longitudinal, retrospective cohort design. METHODS: This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum's Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting. RESULTS: Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when "persistent high adherence" was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59). CONCLUSIONS: Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.

Determining the Entrepreneurial and Intrapreneurial Intentions of Student Pharmacists in Iran.

Objective. To identify factors and entrepreneurial characteristics associated with entrepreneurial and intrapreneurial intentions among Doctor of Pharmacy (PharmD) students in Iran.Methods. First, the Entrepreneurial-Intrapreneurial Pharmacist Questionnaire (EIPQ), which was developed in the United States, was translated from English to Persian. The paper-based Persian-EIPQ questionnaire was then tested in a convenience sample of student pharmacists enrolled in pharmacy schools in Iran. The entrepreneurial characteristics questionnaire was evaluated using exploratory factor analysis with varimax rotation. Internal consistency was examined using Cronbach alpha. The association of demographics and educational variables and entrepreneurial characteristics with entrepreneurial and intrapreneurial intentions was determined using a multiple linear regression model.Results. A total of 504 surveys, 98.6% of the completed questionnaires received, were analyzed. A majority of the participants were female (75.8%) and from 18 to 25 years old (92.2%). Entrepreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, autonomy, achievement motivation, and having an entrepreneur in the family. Intrapreneurial intention had a positive and significant association with risk-taking propensity, leadership self-efficacy, achievement motivation, people liking, attending a private school, and having an entrepreneur in the family.Conclusion. Based on the findings, student pharmacists with higher levels of risk-taking propensity, achievement motivation, leadership self-efficacy, autonomy, and people liking may be more likely to have greater levels of entrepreneurial and/or intrapreneurial intention.

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States.

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Association of Entrepreneurial Traits With Interest in Becoming a Pharmacist Provider Among Student Pharmacists.

BACKGROUND: With the emerging opportunities for pharmacists to gain provider status, the need for understanding interest to become a pharmacist provider has never been greater. OBJECTIVE: To determine which entrepreneurial traits (locus of control, innovativeness, autonomy, risk-taking propensity, proactiveness, achievement motivation, people liking, problem-solving, and leadership) are associated with interest in becoming a pharmacist provider. METHODS: A cross-sectional survey was conducted among second- and third-year student pharmacists. Exploratory factor analysis (principal components with varimax rotation) was used to determine any underlying dimensions. Significant differences in interest in becoming a pharmacist provider by demographic and other characteristics were determined using t tests and analysis of variance (ANOVA; P ≤ .05). Multiple linear regression was used to determine the factors associated with interest in becoming a pharmacist provider. RESULTS: A total of 137 completed questionnaires were received. Gender (P = .003) and preference of workplace (P < .001) were significantly associated with interest in becoming a pharmacist provider. All factor loadings were more than 0.50 and Cronbach alpha values were more than .68. In the multiple linear regression analysis model, proactiveness (P = .036) and achievement motivation (P = .018) were positive predictors of interest in becoming a pharmacist provider. Females (P = .006) and individuals who preferred to work in a hospital (P < .001) or in specialty care (P = .007) had a significantly greater interest in becoming a pharmacist provider. CONCLUSIONS: Proactiveness and achievement motivation can be predictors of interest in becoming a pharmacist provider.

A systematic review of interventions using health behavioral theories to improve medication adherence among patients with hypertension.

Medication adherence is a major problem in the treatment of hypertension. Approximately half of the patients who use antihypertensive medications are not adherent. Several interventions have endeavored to improve medication adherence among patients with hypertension, and some have used health behavioral models/theories. However, the quality and effectiveness of using health behavioral models/theories in improving medication adherence among patients with hypertension remain unknown. The main aim of this systematic review was to describe study characteristics and types of health behavioral models/theories used in interventions for improving medication adherence among adults with hypertension. PubMed, Scopus, Ovid MEDLINE, CINAHL, and PsycINFO databases were searched for randomized clinical trial interventions using any health behavioral models/theories published in English from 1979 to 2019. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers searched, screened abstracts and articles, extracted data, and assessed the risk of bias and the use of the model/theory using the Theory Coding Scheme. A total of 11 articles were included in this systematic review. Two studies reported significant improvement in medication adherence. The Self-Regulation Model and Social Cognitive Theory were the most common types of models/theories. Nine studies used a single model/theory, and four studies measured the constructs of a model/theory. Risk of bias was good (n = 4) and fair (n = 5) in interventions. Using health behavioral models/theories may be an efficient way for health care professionals to improve adherence to medications among patients with hypertension. More interventions with rigorous designs are needed that appropriately utilize health behavioral models/theories for improving medication adherence among adults with hypertension.

Initial Validation of an Instrument for Measuring Entrepreneurial and Intrapreneurial Intentions in Student Pharmacists.

Objective. To develop a questionnaire for measuring entrepreneurial and intrapreneurial intentions among student pharmacists and to identify characteristics and personality traits that are associated with these intentions. Methods. A 105-item survey instrument was developed and administered to all Doctor of Pharmacy (PharmD) students (incoming to third year) at a large public university. It consisted of nine scales pertaining to entrepreneurism including previously validated and some newly developed scales adapted for use among student pharmacists. Data analysis consisted of factor analysis to determine scale constructs, reliability assessment, and systematic item-reduction analysis. Multiple linear regression and structural equation modeling was used to determine and confirm the association of personality traits and demographic characteristics with entrepreneurial and intrapreneurial intentions. Results. Of 289 students surveyed, 286 useable survey instruments were included in the analysis. Factor analysis was conducted for each scale, and items that did not load on their theorized factor or had cross-loadings above the permissible limits were removed, reducing the survey to 69 items. Findings demonstrated that gender, joint degree program, and autonomy were significant predictors of entrepreneurial intentions, and achievement motivation, leadership self-efficacy, and problem-solving were significant predictors of intrapreneurial intentions. Conclusion. A multi-dimensional questionnaire to measure entrepreneurial and intrapreneurial intentions of student pharmacists was developed and a few key predictors of such intentions were identified. When fully validated, the questionnaire may be used in pharmacy schools for several purposes, including in the PharmD admission process to gain additional insights into a student's potential to become a future innovative entrepreneurial or intrapreneurial practitioner.

Low-value care: antipsychotic medication use among community-dwelling medicare beneficiaries with Alzheimer's disease and related dementias and without severe mental illness.

Background: Antipsychotic medication use among elderly with Alzheimer's disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness.Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care.Results: Overall 8.5% had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95% CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95% CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95% CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95% CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95% CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95% CI = [1.19,1.38]) had significantly higher odds of low-value care.Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.

Disparities in hepatitis C virus infection screening among Baby Boomers in the United States.

BACKGROUND: The study objective was to identify potential sociodemographic disparities in hepatitis C virus (HCV) infection screening among Baby Boomers in the United States. METHODS: We analyzed cross-sectional data from the 2013-2016 National Health Interview Survey. The outcome was whether a person had an HCV infection screening (yes/no). Key independent variables were race/ethnicity, geographic region, poverty level, education level, and health insurance status. Multivariate logistic regression was performed to examine the factors associated with the receipt of HCV screening. RESULTS: The study sample included a total of 41,914 United States Baby Boomers, who represented a population size of 69,554,339. In 2016, the HCV screening rate among Baby Boomers was 13.9%. In the multivariate logistic regression, we found that Asians had 27% lower odds of receiving an HCV screening compared to Blacks (odds ratio [OR] = 0.74, P = .02). People who lived in the Northeast, South, and West had a higher likelihood of having an HCV screening than those who lived in the Midwest (OR = 1.33, 1.39, and 1.69, respectively; all P values <.001). Additionally, people with less education, lower income, and private health insurance were significantly less likely to have an HCV screening. CONCLUSION: Future studies or interventions are needed to target these disadvantaged populations to improve HCV screening in Baby Boomers.