Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.978
Filtrar
1.
J Contin Educ Nurs ; 54(1): 25-31, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36595726

RESUMO

Ensuring that evidence-based practice is adopted across hospital systems is difficult. A system-wide Nursing Research Council in a large academic health care system in Maryland implemented a unique strategy to support the evidence-based practice process by collaborating with other system-wide councils. As a result, new system-wide evidence-based practices were adopted and improved organizational outcomes were seen. [J Contin Educ Nurs. 2023;54(1):25-31.].


Assuntos
Educação Continuada em Enfermagem , Pesquisa em Enfermagem , Humanos , Enfermagem Baseada em Evidências , Hospitais , Maryland
2.
JAMA Netw Open ; 6(1): e2249791, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36607637

RESUMO

Importance: Advanced primary care is a team-based approach to providing higher-quality primary care. The association of advanced primary care and COVID-19 outcomes is unknown. Objective: To evaluate the association of advanced primary care with COVID-19 outcomes, including vaccination, case, hospitalization, and death rates during the first 2 years of the COVID-19 pandemic. Design, Setting, and Participants: This retrospective cohort study used Medicare claims data from January 1, 2020, through January 31, 2022, and Maryland state vaccination data. All Part A and B Medicare claims for Maryland Medicare beneficiaries were included. The study population was divided into beneficiaries attributed to Maryland Primary Care Program (MDPCP) practices and a matched cohort of beneficiaries not attributed to MDPCP practices but who met the eligibility criteria for study participation from January 1, 2020, through December 31, 2021. Eligibility criteria for both groups included fee-for-service Medicare beneficiaries who were eligible for attribution to the MDPCP. A forced-match design was used to match both groups in the study population by age category, sex, race and ethnicity, Medicare-Medicaid dual eligibility status, COVID-19 Vulnerability Index score, Maryland county of residence, and primary care practice participation. Exposures: Primary care practice participation in the MDPCP. Main Outcomes and Measures: Primary outcome variables included rate of vaccination, monoclonal antibody infusion uptake, and telehealth claims. Secondary outcomes included rates of COVID-19 diagnosis, COVID-19 inpatient claims, COVID-19 emergency department claims, COVID-19 deaths, and median COVID-19 inpatient admission length of stay. Claims measures were assessed from January 1, 2020, through October 31, 2021. Vaccination measures were assessed from January 1, 2020, through March 31, 2022. Results: After matching, a total of 208 146 beneficiaries in the MDPCP group and 37 203 beneficiaries in the non-MDPCP group were included in this study, comprising 60.10% women and 39.90% men with a median age of 76 (IQR, 71-82) years. Most participants (78.40% and 78.38%, respectively) were White. There were no significant demographic nor risk measure baseline differences between the 2 groups. The MDPCP beneficiaries had more favorable primary COVID-related outcomes than non-MDPCP beneficiaries: 84.47% of MDPCP beneficiaries were fully vaccinated, compared with 77.93% of nonparticipating beneficiaries (P < .001). COVID-19-positive beneficiaries in MDPCP also received monoclonal antibody treatment more often (8.45% vs 6.11%; P < .001) and received more care via telehealth (62.95% vs 54.53%; P < .001) compared with nonparticipating counterparts. In terms of secondary outcomes, beneficiaries in the MDPCP had lower rates of COVID-19 cases (6.55% vs 7.09%; P < .001), lower rates of COVID-19 inpatient admissions (1.81% vs 2.06%; P = .001), and lower rates of death due to COVID-19 (0.56% vs 0.77%; P < .001) compared with nonparticipating beneficiaries. Conclusions and Relevance: These findings suggest that participation in the MDPCP was associated with lower COVID-19 case, hospitalization, and death rates, and advanced primary care and COVID-19 response strategies within the MDPCP were associated with improved COVID-19 outcomes for attributed beneficiaries.


Assuntos
Teste para COVID-19 , COVID-19 , Idoso , Masculino , Humanos , Estados Unidos/epidemiologia , Feminino , Idoso de 80 Anos ou mais , Maryland/epidemiologia , Estudos Retrospectivos , Pandemias , COVID-19/epidemiologia , Medicare , Atenção Primária à Saúde
3.
Pediatr Clin North Am ; 70(1): 53-65, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36402471

RESUMO

This case study illustrates state legislative advocacy in action in Maryland. Success in strengthening maternal and child health is described using the Academic Pediatric Association's 4-step approach to advocacy: (1) Identify the Issue and Target Audience; (2) Craft the Message; (3) Develop Relationships and Coalitions, and (4) Communicate the Message. Starting with state legislation and formation of a Maryland Maternal Child Health Task Force led to maternal child health named as 1 of 3 state population health priorities. This guided subsequent programmatic investment and attention. Further dissemination of task force recommendations has led to additional supportive legislation.


Assuntos
Prioridades em Saúde , Saúde da População , Criança , Humanos , Maryland , Saúde da Criança
4.
Clin Infect Dis ; 74(11): 2053-2056, 2022 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34473242

RESUMO

Among 9048 people infected with SARS-CoV-2 between January and May 2021 in Maryland, in regression-adjusted analysis, SARS-CoV-2 viruses carrying the spike protein mutation E484K were disproportionately prevalent among persons infected after full vaccination against COVID-19 compared with infected persons who were not fully vaccinated (aOR, 1.96; 95% CI: 1.36-2.83).


Assuntos
COVID-19 , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Humanos , Maryland/epidemiologia , Mutação , SARS-CoV-2/genética , Glicoproteína da Espícula de Coronavírus/genética
5.
Methodist Debakey Cardiovasc J ; 18(5): 81-84, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36561090

RESUMO

This issue's Poet's Pen is an experiential work submitted by Captain Justin C. Cordova, MD, from the Department of Anesthesiology at Walter Reed National Military Medical Center in Bethesda, Maryland. The submission was a response to an invitation for our readers to submit poems for consideration of publication. Captain Cordova's work, "Against Medical Advice," is an engaging and provocative poem that focuses on a disturbing healthcare provider challenge-attempting to deliver "best care" to patients who, for countless reasons, choose a pathway we label as noncompliance or against medical advice.


Assuntos
Militares , Humanos , Maryland
6.
J Opioid Manag ; 18(6): 547-556, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36523206

RESUMO

BACKGROUND AND AIMS: Prescription drug monitoring programs (PDMPs) were implemented to decrease dangerous opioid prescribing but have had variable results. This report details how automatic PDMP review changed opioid prescribing across a statewide medical system. DESIGN: An observational study. SETTING: Fourteen hospital networks in the United States. CASES: Healthcare encountered from July 1, 2016 to June 30, 2019. INTERVENTION: Starting from July 1, 2018, the patient's PDMP data would be displayed automatically to providers in the unified electronic medical record (EMR) whenever the provider began to write for an opioid prescription. MEASUREMENTS: Outcomes were prescriptions per encounter (PPE) and the morphine milligram equivalents (MME) per prescription. Outcomes were stratified by practice location, medication prescribed, and diagnosis. All data, including whether the prompt was triggered for a given encounter and whether a prescription was given, were extracted from the EMR. An interrupted timeseries analysis was used to determine how PPE and MME changed in response to the implementation of automatic PDMP review. FINDINGS: Of the 624,488 encounters examined, 18.37 percent (n = 114,710) were in emergency departments, 56.79 percent were admissions (n = 354,634), and 24.84 percent (n = 155,144) were outpatient visits. Opioid prescriptions were started and then canceled 24 percent of the time after the PDMP was shown. There was a decline in MME (ßOverall + Policy Trends = -3.17, p = <0.0001), which was driven by inpatient (ßOverall + Policy Trends = -2.10, p < 0.0001) and outpatient providers (ßOverall + Policy Trends = -3.24, p < 0.01). A decline in MME was seen in all medication categories (-1.72 < ßOverall + Policy Trends < -5.87, p < 0.01). There were no changes in these trends after excluding encounters for severe and acute pain. CONCLUSIONS: Automated PDMP review is associated with fewer prescriptions and smaller doses without decreasing appropriate use.


Assuntos
Médicos , Programas de Monitoramento de Prescrição de Medicamentos , Humanos , Estados Unidos , Analgésicos Opioides/efeitos adversos , Maryland , Padrões de Prática Médica , Hospitais
7.
JAMA Netw Open ; 5(11): e2244077, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36445707

RESUMO

Importance: In the US, more than 50 000 women experience severe maternal morbidity (SMM) each year, and the SMM rate more than doubled during the past 25 years. In response, professional organizations called for birthing facilities to routinely identify and review SMM events and identify prevention opportunities. Objective: To examine SMM levels, primary causes, and factors associated with the preventability of SMM using Maryland's SMM surveillance and review program. Design, Setting, and Participants: This cross-sectional study included pregnant and postpartum patients at 42 days or less after delivery who were hospitalized at 1 of 6 birthing hospitals in Maryland between August 1, 2020, and November 30, 2021. Hospital-based SMM surveillance was conducted through a detailed review of medical records. Exposures: Hospitalization during pregnancy or within 42 days post partum. Main Outcomes and Measures: The main outcomes were admission to an intensive care unit, having at least 4 U of red blood cells transfused, and/or having COVID-19 infection requiring inpatient hospital care. Results: A total of 192 SMM events were identified and reviewed. Patients with SMM had a mean [SD] age of 31 [6.49] years; 9 [4.7%] were Asian, 27 [14.1%] were Hispanic, 83 [43.2%] were non-Hispanic Black, and 68 [35.4%] were non-Hispanic White. Obstetric hemorrhage was the leading primary cause of SMM (83 [43.2%]), followed by COVID-19 infection (57 [29.7%]) and hypertensive disorders of pregnancy (17 [8.9%]). The SMM rate was highest among Hispanic patients (154.9 per 10 000 deliveries), primarily driven by COVID-19 infection. The rate of SMM among non-Hispanic Black patients was nearly 50% higher than for non-Hispanic White patients (119.9 vs 65.7 per 10 000 deliveries). The SMM outcome assessed could have been prevented in 61 events (31.8%). Clinician-level factors and interventions in the antepartum period were most frequently cited as potentially altering the SMM outcome. Practices that were performed well most often pertained to hospitals' readiness and adequate response to managing pregnancy complications. Recommendations for care improvement focused mainly on timely recognition and rapid response to such. Conclusions and Relevance: The findings of this cross-sectional study, which used hospital-based SMM surveillance and review beyond the mere exploration of administrative data, offers opportunities for identifying valuable quality improvement strategies to reduce SMM. Immediate strategies to reduce SMM in Maryland should target its most common causes and address factors associated with preventability identified at individual hospitals.


Assuntos
COVID-19 , Gravidez , Humanos , Feminino , Criança , Maryland/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Etnicidade
8.
AANA J ; 90(6): 455-461, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36413191

RESUMO

This article presents data on anesthesia cases filed with the Maryland Health Claims Alternative Dispute Office between 1994 and 2017, a publicly available resource that includes all anesthesia-related claims filed in Maryland, regardless of whether they were reported to any national claims repository. Analysis of anesthesia malpractice claims offers critical information that can both decrease legal liability and improve patient outcomes for those receiving anesthesia. A total of 276 claims were filed. Variables under investigation included venue, types of surgery, legal cause of action, trends, and outcomes. Types of anesthesia-related claims included the administration of general anesthesia (59.8%), monitored anesthesia care (14.9%), pain management (10.9%), epidural/spinal anesthesia (9%), nerve blocks (2.9%), and local anesthesia infiltration (2.6%). Most cases (39.5%) involved failure to adequately monitor the patient. Inadequate perioperative care was alleged as the cause of action in 68.8% of cases. Major adverse patient outcomes were death (38.8%), brain damage (21%), and permanent nerve damage (14.9%). Understanding the events that lead to legal action can assist anesthesia providers to focus on ways to improve their practice.


Assuntos
Anestesia Epidural , Anestesiologia , Imperícia , Humanos , Maryland , Responsabilidade Legal
9.
BMJ Open ; 12(10): e060592, 2022 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-36253048

RESUMO

INTRODUCTION: Achieving glycaemic targets for people living with diabetes (PLWD) is challenging, especially in settings with limited resources. Programmes need to address gaps in knowledge, skills and self-management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower PLWD to improve self-management activities. This protocol describes a pilot study assessing the feasibility, acceptability and effect on clinical outcomes of implementing DSME in clinics caring for people living with insulin-dependent diabetes in Liberia. METHODS AND ANALYSIS: Our protocol is a three-phased, mixed-methods, quasi-experimental prospective cohort study. Phase 1 focuses on (a) establishing a Patient Advisory Board and (b) training providers in DSME who provide care for PLWD. In phase 2, clinicians will implement DSME. In phase 3, we will train additional providers who interact with PLWD.We will assess whether this DSME programme can lead to increased provider knowledge of DSME, improvements in diabetes self-management behaviours, glycaemic control, diabetes knowledge and psychosocial well-being, and a reduction in severe adverse events. Primary outcomes of interest are implementation outcomes and change in frequency of self-management behaviours by patients. Secondary outcomes include change in haemoglobin A1c, psychosocial well-being, severe adverse events and change in provider knowledge of DSME. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Liberia Institutional Review Board (IRB) and the Brigham and Women's Hospital IRB. Findings from the study will be shared with local and national clinical and programmatic stakeholders and published in an open-access, peer-reviewed journal.


Assuntos
Diabetes Mellitus Tipo 2 , Insulinas , Autogestão , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Libéria , Maryland , Projetos Piloto , Estudos Prospectivos , Autocuidado/métodos , Autogestão/educação
10.
PLoS One ; 17(10): e0276014, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36288354

RESUMO

Despite advances in techniques, methods, and theory, northeastern North American archaeologists continue to use early to mid-twentieth century culture historical taxa as units of analysis and narrative. There is a distinct need to move away from this archaeological practice to enable fuller understandings of past human lives. One tool that enables such a move is Bayesian analysis of radiocarbon dates, which provides a means of constructing continuous chronologies. A large dataset of radiocarbon dates for late prehistoric (ca AD 900/1000-1650) sites in the lower upper Ohio River basin in southwestern Pennsylvania and adjacent portions of Maryland, Ohio, and West Virginia is used here as an example. The results allow a preliminary assessment of how the settlement plans of contemporaneous villages varied considerably, reflecting decisions of the village occupants how to structure built environments to meet their needs.


Assuntos
Arqueologia , Datação Radiométrica , Humanos , Datação Radiométrica/métodos , Teorema de Bayes , Rios , Maryland
11.
Medicine (Baltimore) ; 101(36): e30297, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36086768

RESUMO

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has emerged as a global health concern. This study aimed to review the epidemiology and pathophysiology of COVID-19 and provide evidence for the implementation of control measures. We utilized several online databases, including MEDLINE (National Library of Medicine, Bethesda, Maryland, USA), PubMed, EMBASE, Web of Science, and Google Scholar, to collect relevant published papers using a combination of the following keywords: "COVID-19," "SARS-CoV-2," "novel coronavirus," "epidemiology," and "pathophysiology." The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this study. Globally, approximately 3-46% of patients with SARS-CoV-2 infection experience gastrointestinal symptoms. The clinical spectrum of COVID-19 is wide, ranging from mild to severe, and even fatal. COVID-19 was initially reported as a respiratory tract disease; however, gastrointestinal symptoms have only recently been reported. COVID-19 Patients with gastrointestinal symptoms may have more severe clinical manifestations and poor prognosis. This study highlights the need to better understand the mechanisms involved in the development of gastrointestinal symptoms in patients with COVID-19 to prevent the further spread of this pathogen.


Assuntos
COVID-19 , Gastroenteropatias , COVID-19/epidemiologia , Gastroenteropatias/epidemiologia , Saúde Global , Humanos , Maryland , SARS-CoV-2
12.
Theriogenology ; 192: 52-61, 2022 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-36049382

RESUMO

Nocardioform placentitis (NP) has been associated with mid to late pregnancy loss in mares. To date, disease outbreaks have been described only in central Kentucky, although sporadic, isolated cases have been reported globally. This study describes a series of cases of NP that occurred in a sample population of 299 mares foaling in southeastern Pennsylvania and northeastern Maryland in 2020. These cases coincided with an outbreak of NP that occurred in Kentucky that same year. On farms that reported information on both normal and abnormal foalings, nocardioform organisms/DNA were isolated from 6.3% of placental samples based on aerobic culture and/or PCR. In cases with characteristic gross lesions of the chorion, 41% of cases were positive on aerobic culture and/or PCR. NP was confirmed in 16 mares that had not resided in Kentucky for breeding or any part of gestation. Characteristics of mares confirmed positive for NP, including age, gestation length, and problems during gestation are described. Standardbred mares bred by artificial insemination were less likely to be affected than Thoroughbred mares bred by natural cover. Affected mares had prolonged Stage III labor compared with normal mares. These findings suggest that regional increases in NP may occur outside of Kentucky, potentially in parallel with Kentucky outbreaks.


Assuntos
Doenças dos Cavalos , Doenças Placentárias , Aborto Animal/epidemiologia , Animais , Feminino , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/patologia , Cavalos , Maryland/epidemiologia , Pennsylvania/epidemiologia , Placenta/patologia , Doenças Placentárias/veterinária , Gravidez
13.
Am J Disaster Med ; 17(1): 41-48, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913182

RESUMO

INTRODUCTION AND OBJECTIVES: Emergency medical services (EMS) is an invaluable healthcare resource, providing life-saving care in the prehospital setting. During the COVID-19 pandemic, there have been concerns that healthcare resources, including EMS, would be overwhelmed by the potential surge in critically ill patients. This study seeks to determine the impact of the COVID-19 pandemic on EMS utilization in the state of Maryland. METHODS: A retrospective review of data from the Maryland Emergency Medical Services Data System was performed. EMS call volumes were compared from March 1 to August 31 in the years 2018, 2019, and 2020. In addition, adult cases from the three time periods that contained an EMS impression of stroke, cardiac arrest, asthma, traumatic injury, ST elevation myocardial infarction (STEMI), sepsis, and overdose were also analyzed. RESULTS: There was a significant decrease in overall EMS call volumes in the state of Maryland in the first 6 months of 2020 compared to the prior 2 years. While the total number of calls decreased, a higher proportion of patients in 2020 had EMS impressions of cardiac arrest, STEMI, stroke, and traumatic injury compared to the previous 2 years. Additionally, there was an increase in termination of resuscitation for out of hospital cardiac arrest. CONCLUSION: In the state of Maryland, overall call volumes decreased, but the proportion of EMS patients with time-sensitive illnesses increased during the COVID-19 pandemic.


Assuntos
COVID-19 , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Infarto do Miocárdio com Supradesnível do Segmento ST , Acidente Vascular Cerebral , Adulto , COVID-19/epidemiologia , Humanos , Maryland/epidemiologia , Pandemias , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
14.
J Nutr Educ Behav ; 54(10): 957-963, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35987904

RESUMO

OBJECTIVE: Examine characteristics of pandemic meal site (n = 602) location and meals served per site in Maryland, Spring 2020, following federal/state waivers for local meal site placement decision-making. METHODS: Using geographic information systems, we connected meal sites to census tract-level data and generated service areas from sites and distances from population-weighted census tract centroids to the closest pandemic meal site. Regression analysis determined associations of census tract pandemic meal site count and meals served per site with socioeconomic and demographic variables. RESULTS: Census tracts with more meal sites were urban (P < 0.001), food deserts (P < 0.001), and had higher percentages of children in poverty (P < 0.001). Sites serving fewer meals were in food deserts (P < 0.001) and areas with more children in poverty (P < 0.001). CONCLUSIONS AND IMPLICATIONS: Waivers allowing local meal site placement decision-making supported meal sites in high-need areas. Geospatial approaches could optimize site locations to ensure maximum reach to populations in need. Additional supports may be needed to ensure children in poverty areas receive meals distributed at these sites.


Assuntos
COVID-19 , Criança , Humanos , Maryland/epidemiologia , Refeições , Pandemias , Instituições Acadêmicas
15.
JAMA Health Forum ; 3(2): e214920, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35977273

RESUMO

Importance: Since 2014, all hospitals in Maryland have operated under an all-payer global budget system. Hospital global budgets have gained renewed attention as a strategy for constraining cost growth, improving patient outcomes, and preserving health care access in rural and underserved communities. Lessons from the implementation of the Maryland All-Payer Model (MDAPM) may have implications for policy makers, payers, and hospitals in other settings seeking to adopt global budgets or other value-based payment models. Objective: To examine perspectives on the implementation of the MDAPM among health care leaders who participated in its design and execution. Design Setting and Participants: This qualitative study with semistructured telephone interviews was conducted from November 1, 2019, to February 11, 2020. The purposive sample of Maryland health care leaders represents diverse stakeholder groups, including hospitals, state government and regulatory agencies, the federal government, and payers. Main Outcomes and Measures: Key high-level themes were extracted from interviews using qualitative content analysis, with barriers and facilitators to implementation specified within each theme. Results: A total of 20 interviews were conducted with hospital leaders (n = 6), state regulators (n = 4), federal regulators (n = 4), payer representatives (n = 3), and state leaders (n = 3). Key themes were labeled as (1) expectations (setting bold yet achievable goals), (2) autonomy (allowing hospitals to follow individual strategies within MDAPM parameters), (3) communication (encouraging early and ongoing communication between stakeholders), (4) actionable data (sharing useful hospital and patient-level data between stakeholders), (5) global budget calibration (anticipating technical challenges when negotiating budgets for individual hospitals), and (6) shared commitment to change (harnessing collective motivation for system change). Together, these themes suggest that implementing the payment model followed an evolving and collaborative process that requires stakeholder communication, data to guide decisions, and commitment to operating within the new payment system. Conclusions and Relevance: The implementation of hospital global budgets in the state of Maryland offers generalizable lessons that can inform the evolution and expansion of this approach to value-based payment in other states and settings.


Assuntos
Orçamentos , Hospitais , Acesso aos Serviços de Saúde , Humanos , Maryland , Governo Estadual
16.
PLoS One ; 17(8): e0272217, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944051

RESUMO

BACKGROUND: Prescription Drug Monitoring Programs (PDMPs) are electronic databases that track controlled substance prescriptions in a state. They are underused tools in preventing opioid abuse. Most PDMP education research measures changes in knowledge or confidence rather than behavior. OBJECTIVE: To evaluate the impact of online case-based training on healthcare provider use of the Maryland (USA) PDMP. METHODS: We used e-mail distribution lists to recruit providers to complete a brief educational module. Using a pre-training and post-training survey in the module, we measured self-reported PDMP use patterns and perceived PDMP value in specific clinical situations and compared pre- and post-training responses. Within the module, we presented three fictional pain cases and asked participants how they would manage each, both before, and then after presenting prescription drug history simulating a PDMP report. We measured changes in the fictional case treatment plans before and after seeing prescription history. Finally, we measured and compared how often each participant accessed the Maryland PDMP database before and after completing the educational module. We used multivariate logistic regression to measure the effect of the intervention on actual PDMP use frequency. RESULTS: One hundred and fifty participants enrolled and completed the training module, and we successfully retrieved real-world PDMP use data of 137 of them. Participants' decisions to prescribe opioids changed significantly after reviewing PDMP data in each of the fictional cases provided in the module. In the months following the training, the rate of PDMP use increased by a median of four use-cases per month among providers in practice for less than 20 years (p = 0.039) and two use-cases per month among infrequent opioid prescribers (p = 0.014). CONCLUSION: A brief online case-based educational intervention was associated with a significant increase in the rate of PDMP use among infrequent opioid prescribers and those in practice less than 20 years.


Assuntos
Médicos , Uso Indevido de Medicamentos sob Prescrição , Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/uso terapêutico , Humanos , Maryland , Padrões de Prática Médica , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle
17.
Prev Med ; 163: 107216, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36029926

RESUMO

This study sought to characterize frequency and demographic characteristics of firearm injury and penetrating trauma in Maryland over the first year of the pandemic, by comparing these characteristics to those of the three years prior to stay-at-home order issuance. Patients were identified in the Maryland Health Services Cost Review Commission database using ICD-10 codes for firearm injury by all intents and assaults by penetrating trauma. Cases from July 1, 2017 to March 31, 2020 ("pre-stay-at-home") were compared to those from April 1, 2020 to March 31, 2021 ("post-stay-at-home") using descriptive statistics. There was no significant change overall in frequency or demographics of firearm injury or penetrating trauma in the year after stay-at-home orders were issued. Youth between ages 15 and 24, overwhelmingly male, comprise a disproportionately high percentage of firearm injuries and assaults, and most penetrating trauma occurs in urban environments where Black non-Hispanic youth and children of low socioeconomic status are at high risk. Our study also found unintentional firearm injury among adults was significantly increased during the pandemic. While increased unintentional firearm injury among adults was the major significant change found in our study, the persistence of firearm injury, particularly in youth, racial and ethnic minority groups, and those in urban environments, should be deeply concerning. Stay-at-home policies did not keep youth safer from firearm injury. With continued high rates of firearm injury and the national debate over how to prevent these incidents, increased education and comprehensive strategies for prevention are needed.


Assuntos
COVID-19 , Armas de Fogo , Ferimentos por Arma de Fogo , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Etnicidade , Humanos , Masculino , Maryland/epidemiologia , Grupos Minoritários , Vigilância da População , Estados Unidos , Violência , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controle , Adulto Jovem
18.
Perspect Sex Reprod Health ; 54(3): 68-79, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35790127

RESUMO

CONTEXT: Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY: We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS: Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION: COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.


Assuntos
Aborto Induzido , COVID-19 , Adulto , COVID-19/epidemiologia , District of Columbia/epidemiologia , Feminino , Humanos , Maryland/epidemiologia , Pandemias , Gravidez , Estados Unidos/epidemiologia , Virginia/epidemiologia
19.
Int J Drug Policy ; 108: 103806, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35907372

RESUMO

BACKGROUND: Over the past decade, states have passed several laws on prenatal drug use, including "maltreatment laws" deeming prenatal drug use child maltreatment, "reporting laws" requiring providers to report prenatal drug use to Child Protective Services (CPS) and "criminalization laws" that criminalize prenatal drug use. METHOD: We examined the association between a 2012 Utah maltreatment law, a 2013 Alabama maltreatment and criminalization law, and a 2014 Maryland reporting law on the rate of infant CPS reports using 2010-2017 National Child Abuse and Neglect Data System data. We conducted an event study comparing CPS reporting pre/post law in each treatment state with reporting in a pool of control states over the same period. Regression models included state and year fixed effects and state-level demographics. We triangulated quantitative results with qualitative interviews of 11 state leaders whose professional responsibilities included implementation of the state law. RESULTS: We found no association between Alabama's simultaneous maltreatment and criminalization laws and infant reporting. Maryland's reporting law (28.2 fewer reports per 1000 infants, 95%CI: [-42.9, -13.6], 4-years post-law) and Utah's maltreatment laws (31.0 fewer CPS reports per 1000 infants, 95%CI: [-61.2, -0.8], 6-years post-law) were associated with declines in infant CPS reports. Qualitative results suggest that the reduced reporting associated with Maryland's reporting and Utah's maltreatment laws may be due to increased perceived stigma resulting from the law, and health providers' distrust of CPS and/or confusion about reporting to CPS. CONCLUSION: Future research should characterize differential policy implementation across states and counties and identify policy impacts on treatment seeking behavior.


Assuntos
Serviços de Proteção Infantil , Transtornos Relacionados ao Uso de Substâncias , Alabama , Criança , Proteção da Criança , Feminino , Humanos , Lactente , Maryland/epidemiologia , Gravidez , Utah/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...