RESUMO
BACKGROUND: Several states have passed Medicaid Home and Community-based Services (HCBS) waivers that expand eligibility criteria and available services for children with autism spectrum disorder (ASD). Previous research has shown considerable variation in these waivers, but little is known about the extent to which they address the health care needs of children with ASD. OBJECTIVE: To determine the effects of Medicaid HCBS waivers, and their characteristics, on unmet health care needs among children with ASD. METHODS: We used data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health with detailed information on the Medicaid HCBS waiver programs of 35 states. Quasi-difference-in-difference-in-differences models were used to determine the effects of waivers and their characteristics on parent report of unmet health care needs of children with ASD compared with children without ASD. RESULTS: Greater waiver cost limits per child, estimated costs of services, and enrollment limits were associated with significant decreases in the adjusted rate of unmet health care needs, with considerable variation by household income level. CONCLUSIONS: These findings suggest that Medicaid HCBS waivers significantly decrease the unmet need for health care among children with ASD, most substantially among those who would not otherwise qualify for Medicaid. The findings regarding the effects of specific aspects of these waivers can inform the development of insurance policies in other states to address the needs of children with ASD.
Assuntos
Transtorno do Espectro Autista/economia , Serviços de Saúde Comunitária/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/economia , Medicaid/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicaid/legislação & jurisprudência , Estados UnidosRESUMO
The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration-approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.
Assuntos
Conscientização , Anticoncepção/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Adolescente , Adulto , Feminino , Humanos , Cobertura do Seguro , Seguro Saúde , Fatores Socioeconômicos , Estados Unidos , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Little is known about the use of extended-release naltrexone (XR-NTX) during residential rehabilitation, and its effects on early outcomes and rates of follow-up treatment. This study examined patient characteristics and rates of treatment completion and engagement in post-residential care of opioid dependent patients who received XR-NTX during residential rehabilitation, compared with patients who did not receive this medication. METHODS: Electronic records for opioid dependent patients from three Pennsylvania residential detoxification and treatment facilities (N = 7,687) were retrospectively analyzed. We determined the proportion of patients who received XR-NTX (INJ), and compared rates of treatment completion and engagement in follow-up care relative to a naturalistic control group of patients recommended for, but not administered, XR-NTX (Non-INJ). Data on whether the patient initiated follow-up care were available from one site (N = 3,724). RESULTS: Overall, 598 (7.8%) patients were recommended for XR-NTX and of these, 168 (28.1%) received injections. Compared to non-INJ patients, INJ patients were less likely to leave against medical advice (4.8% vs. 30.2%, p < .001) and more likely to initiate follow-up care (37.7% vs. 19.7%, p < .001). These differences remained significant after controlling for demographic covariates using regression analysis. CONCLUSIONS: XR-NTX was associated with higher rates of residential and early post-residential care engagement in patients with opioid dependence. SCIENTIFIC SIGNIFICANCE: XR-NTX may be an effective adjunct in the residential treatment and aftercare of patients with opioid dependence.
Assuntos
Naltrexona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adulto , Estudos de Coortes , Preparações de Ação Retardada/administração & dosagem , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Pennsylvania , Centros de Reabilitação , Suspensão de Tratamento , Adulto JovemRESUMO
BACKGROUND: In the years immediately following the Affordable Care Act (ACA)'s contraceptive coverage requirement, out-of-pocket costs fell for all Food and Drug Administration-approved contraceptive methods and use of long-acting reversible contraception (LARC) increased. This analysis examines whether these trends have continued through 2020 for privately insured women. METHODS: Using 2006-2020 MarketScan data, we examined trends in prescription contraceptive use and out-of-pocket costs among women 13 to 49 years old. Multivariable analyses model the likelihood of contraceptive use and paying $0 post-ACA requirement (vs. pre-ACA requirement) for contraception, controlling for age group, U.S. region, urban versus rural, and cohort year. RESULTS: The likelihood of LARC insertion increased post-ACA requirement (adjusted odds ratio [aOR] 1.127, 95% confidence interval [CI] 1.121-1.133), with insertion rates peaking at 3.73% for intrauterine devices (IUDs) and 1.08% for implants in 2019, before declining with the onset of the COVID-19 pandemic in 2020. Although the likelihood of paying $0 for LARC increased after the ACA requirement (IUD: aOR 5.495, 95% CI 5.278-5.716; implant: aOR 7.199, 95% CI 6.992-7.412), the proportion of individuals paying $0 declined to 69% for IUDs and 73% for implants in 2020, after having peaked at 88% in 2014 and 90% in 2016, respectively. For oral contraceptives, both use (aOR 1.028, 95% CI 1.026-1.030) and paying $0 (aOR 20.399, 95% CI 20.301-20.499) increased significantly after the ACA requirement. CONCLUSION: With the exception of oral contraceptives, the proportion of individuals paying $0 for all contraceptive methods declined after peaking in 2014 for IUDs, 2016 for the implant, and 2019 for non-LARC methods. Future monitoring is needed to understand the continuing impact of the ACA requirement on prescription contraceptive use and costs.
Assuntos
Anticoncepcionais Femininos , Dispositivos Intrauterinos , Estados Unidos/epidemiologia , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Pandemias , Cobertura do Seguro , Anticoncepção/métodos , Anticoncepcionais Orais/uso terapêutico , PrescriçõesRESUMO
BACKGROUND: The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated. METHODS: Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people. RESULTS: Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32). CONCLUSION: Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
Assuntos
Transtornos Relacionados ao Uso de Opioides , Humanos , Feminino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Gravidez , Adulto , Estudos Transversais , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Tratamento de Substituição de Opiáceos , Tempo para o Tratamento/estatística & dados numéricos , Overdose de Opiáceos/epidemiologia , Fatores de TempoRESUMO
BACKGROUND: More than a dozen studies have reported a reduced rate of childbearing after caesarean delivery (CD). It has been hypothesised that this is because women who deliver by CD are less likely to intend to have subsequent children than women who deliver vaginally - either before childbirth or as a consequence of CD. Little research has addressed either of these hypotheses. METHODS: As part of an ongoing prospective study, we interviewed 3006 women in their third trimester and 1 month after first childbirth to assess subsequent childbearing intentions. RESULTS: Women who delivered by CD were similar to those who delivered vaginally in intent to have at least one additional child, both before childbirth (90.1% vaginal, 89.9% CD; P = 0.97) and after (87.8% vaginal, 87.1% CD; P = 0.87); however, women who had CD were less likely to intend two or more additional children, both before childbirth (34.7% vaginal, 29.2% CD; P = 0.03) and after (32.2% vaginal, 26.1% CD; P = 0.01). Among women who intended to have at least one additional child before childbirth, 5.0% reported intending to have no additional children 1 month after delivery (5.1% vaginal, 4.6% CD; P = 0.52). CONCLUSIONS: Women whose first delivery is by CD are less likely to intend a relatively large family of three or more children than those who deliver vaginally, but delivery by CD does not decrease women's intentions to have at least one more child any more than does vaginal delivery, at least in the short term.
Assuntos
Cesárea/psicologia , Parto/psicologia , Gestantes/psicologia , Nascimento Vaginal Após Cesárea/psicologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Comportamento de Escolha , Estudos de Coortes , Características da Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pennsylvania , Gravidez , Estudos Prospectivos , Fatores de Tempo , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto JovemRESUMO
Using the 2008-2013 Medicaid Analytic eXtract files, this retrospective cohort study was to evaluate the effect of Medicaid home and community-based services (HCBS) waiver programs on emergency department (ED) utilizations among youth with autism spectrum disorder (ASD). Our study showed that the annual ED utilization rates were 13.5% and 18.8% for individuals on autism specific and intellectual and developmental disabilities (IDD) waivers respectively, vs. 28.5% for those without a waiver. Multivariable logistic regression showed that, compared to no waiver, autism specific waivers (adjusted odds ratio: 0.62; 95% Confidence Interval: [0.58-0.66]) and IDD waivers (0.65; [0.64-0.66]) were strongly associated with reduced ED. These findings suggest that HCBS waivers are effective in reducing the incidence of ED visits among youth with ASD.
Assuntos
Transtorno do Espectro Autista , Serviço Hospitalar de Emergência , Medicaid , Adolescente , Transtorno do Espectro Autista/economia , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/terapia , Serviços de Saúde Comunitária/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Assistência Domiciliar/economia , Humanos , Deficiência Intelectual/economia , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/terapia , Medicaid/economia , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
Women with chronic medical conditions are at increased risk for pregnancy-related complications, yet little research has addressed how women with diabetes, hypertension, and obesity perceive their pregnancy-associated risks or make reproductive health decisions. Focus groups were conducted with 72 non-pregnant women stratified by chronic condition (diabetes, hypertension, obesity) and by previous live birth. Participants discussed their intention for future pregnancy, preconception health optimization, perceived risk of adverse pregnancy outcomes, and contraceptive beliefs. Four major themes were identified, with some variation across medical conditions and parity: (1) Knowledge about pregnancy risks related to chronic medical conditions was limited; (2) Pregnancy intentions were affected by diabetes and hypertension, (3) Knowledge about optimizing preconception health was limited; and (4) Lack of control over ability to avoid unintended pregnancy, including limited knowledge about how medical conditions might affect contraceptive choices. Women with diabetes and hypertension, but not obesity, were generally aware of increased risk for pregnancy complications, and often expressed less intention for future pregnancy as a result. However, diabetic and hypertensive women had little knowledge about the specific complications they were at risk for, even among those who had previously experienced pregnancy complications. Neither chronic condition nor perceived risk ensured intent to engage in preconception health promotion. We observed knowledge deficits about pregnancy-related risks in women with diabetes, hypertension, and obesity, as well as lack of intent to engage in preconception health promotion and pregnancy planning. These findings have important implications for the development of preconception care for women with chronic medical conditions.
Assuntos
Doença Crônica/prevenção & controle , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Concepcional , Complicações na Gravidez/prevenção & controle , Comportamento Reprodutivo/psicologia , Adulto , Fatores Etários , Complicações do Diabetes/prevenção & controle , Feminino , Grupos Focais , Humanos , Hipertensão/prevenção & controle , Pessoa de Meia-Idade , Obesidade/prevenção & controle , Paridade , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa , Risco , Adulto JovemRESUMO
CONTEXT: Although reproductive life planning (RLP) is recommended in federal and clinical guidelines and may help insured women make personalized contraceptive choices, it has not been systematically evaluated for effectiveness. METHODS: In 2014, some 984 privately insured women aged 18-40 who were not intending to become pregnant in the next year were randomly assigned to receive RLP, RLP with contraceptive action planning (RLP+) or information only (the control group). Women's contraceptive use, prescription contraceptive use, method adherence, switching to a more effective method, method satisfaction and contraceptive self-efficacy were assessed at six-month intervals during the two-year follow-up period. Differences between groups were identified using binomial logistic regression, linear regression and generalized estimating equation models. RESULTS: During the follow-up period, the proportion of women using any contraceptive method increased from 89% to 96%, and the proportion using a long-acting reversible contraceptive or sterilization increased from 8% to 19%. Contraceptive adherence was high (72-76%) in all three groups. In regression models, the sole significant finding was that women in the RLP+ group were more likely than those in the RLP group to use a prescription method (odds ratio, 1.3). No differences were evident between the intervention groups and the control group in overall contraceptive use, contraceptive adherence, switching to a more effective method, method satisfaction or contraceptive self-efficacy. CONCLUSIONS: The study does not provide evidence that web-based RLP influences contraceptive behaviors in insured women outside of the clinical setting. Further research is needed to identify strategies to help women of reproductive age identify contraceptive methods that meet their needs and preferences.
Assuntos
Comportamento de Escolha , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Seguro Saúde , Intervenção Baseada em Internet , Cooperação do Paciente , Satisfação do Paciente , Autoeficácia , Adolescente , Adulto , Anticoncepcionais Femininos/uso terapêutico , Eficácia de Contraceptivos , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Community-based health studies rely on the ability of researchers to successfully recruit and retain participants from target populations, rather than from clinical settings. Many prior women's health studies have recruited in urban and suburban areas, but rural populations pose specific challenges. We describe the recruitment strategies employed in the Central Pennsylvania Women's Health Study to recruit 692 women in 15 low-income rural communities to a randomized trial of a behavioral intervention for pre- and interconceptional women. METHODS: The organization of the project is described. Qualitative (e.g., focus groups of local project facilitators) and quantitative methods (e.g., surveys of participants) were used to assess the effectiveness of various recruitment techniques and the characteristics of the final enrolled sample. RESULTS: A triangular recruitment approach was used in 15 communities, which included partnering with local community organizations and use of both active and passive recruitment techniques. The most effective recruitment methods were (1) actively recruiting women in social service and childcare settings, (2) use of a toll-free project telephone number printed on all passive recruitment material, and (3) the combination of passive and active recruitment in educational settings. Together, these methods successfully achieved the recruitment goals: enrolling participants who were more likely to be rural, poor or near poor, non-white, and to have less access to health care than their counterparts residing in the target communities. CONCLUSIONS: Successful recruitment of typically hard-to-reach women, such as low-income rural women, is possible through implementation of a triangular recruitment approach in local communities.
Assuntos
Comportamento Materno , Seleção de Pacientes , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Adulto , Feminino , Humanos , Bem-Estar Materno/estatística & dados numéricos , Pennsylvania/epidemiologia , Gravidez , Atenção Primária à Saúde/organização & administração , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
PURPOSE: Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest-posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women. METHODS: Nonpregnant pre- and interconceptional women ages 18-35 were recruited in 15 low-income rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change. MAIN FINDINGS: Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid. CONCLUSIONS: The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Natal/métodos , População Rural/estatística & dados numéricos , Adulto , Feminino , Nível de Saúde , Humanos , Comportamento Materno , Pennsylvania/epidemiologia , Gravidez , Resultado da Gravidez , Autocuidado/métodos , Autoimagem , Inquéritos e Questionários , Saúde da Mulher , Adulto JovemRESUMO
OBJECTIVE: Proportion of Days Covered (PDC) is a measure of medication adherence that uses prescription claims data to describe the proportion of days that the patient possessed medication. The objective of this study is to compare PDC and self-report as measures of oral contraceptive pills (OCPs) adherence and to identify individual-level predictors of adherence. STUDY DESIGN: In a sample of 384 OCP users, self-report was compared with PDC as measures of adherence over the past 3 months. Patient-level variables were examined for associations with adherence using multivariable logistic regression models. RESULTS: High adherence, defined as missing ≤1 pill per month, was 76%, 68% and 54% as measured by self-report, PDC and both measures, respectively. Younger women (ages 18-25 and 26-33 years) were significantly less likely to have high adherence on both measures than women in the 34-40 age group [adjusted odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08-0.51 and adjusted OR 0.26, 95% CI 0.11-0.62, respectively). Other predictors of high adherence on both self-report and PDC measures included being in a relationship (adjusted OR 2.30, 95% CI 1.14-4.64, compared with unpartnered women), Protestant religion (adjusted OR 2.08, 95% CI 1.07-4.06, compared with women with no religious affiliation) and higher contraceptive self-efficacy (adjusted OR 1.63, 95% CI 1.03-2.58). CONCLUSION: PDC derived from pharmacy claims, or a combination of PDC and self-report measures, may be an alternative to self-report alone for measuring OCP adherence. IMPLICATIONS: PDC may be a potential tool for measuring women's adherence to OCPs and should be validated in future studies.
Assuntos
Anticoncepção , Anticoncepcionais Orais Hormonais/uso terapêutico , Adesão à Medicação , Adolescente , Adulto , Fatores Etários , Humanos , Assistência Farmacêutica , Religião , Autoeficácia , Autorrelato , Adulto JovemRESUMO
Several states have passed Medicaid home and community-based services waivers that expand eligibility criteria and available services for children with autism spectrum disorder. Although previous research has shown considerable variation in these waivers, little is known about the programs' impact on parents' workforce participation. We used nationally representative survey data combined with detailed information on state Medicaid waiver programs to determine the effects of waivers on whether parents of children with autism spectrum disorder had to stop working because of the child's condition. Increases in the Medicaid home and community-based services waiver cost limit and enrollment limit significantly reduced the likelihood that a parent had to stop working, although the results varied considerably by household income level. These findings suggest that the Medicaid waivers are effective policies to address the care-related needs of children with autism spectrum disorder.
Assuntos
Transtorno do Espectro Autista/economia , Emprego/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pais , Adolescente , Transtorno do Espectro Autista/etnologia , Criança , Pré-Escolar , Definição da Elegibilidade/economia , Inquéritos Epidemiológicos , Humanos , Renda/estatística & dados numéricos , Medicaid/legislação & jurisprudência , Estados UnidosRESUMO
This research aims to describe the characteristics of 1915(c) Home- and Community-Based Services waivers for children with autism spectrum disorder across states and over time. While increasingly popular, little is known about these Medicaid waivers. Understanding the characteristics of these programs is important to clinicians and policymakers in designing programs to meet the needs of this vulnerable population and to set the stage for evaluating changes that occur with the implementation of health-care reform. Home- and Community-Based Services waiver applications that included children with autism spectrum disorder as a target population were collected from the Centers for Medicare and Medicaid Services website, state websites, and state administrators. A data extraction tool was used to document waiver inclusions and restrictions, estimated service provision and institutional costs, and the inclusion of four core autism spectrum disorder services: respite, caregiver support and training, personal care, and evidence-based treatments. Investigators identified 50 current or former waivers across 29 states that explicitly included children with autism spectrum disorder in their target populations. Waivers differed substantially across states in the type and breadth of autism spectrum disorder coverage provided. Specifically, waivers varied in the populations they targeted, estimated cost of services, cost control methods employed, and services offered to children with autism spectrum disorder. Home- and Community-Based Services waivers for children with autism spectrum disorder are very complex and are not consistent across states or over time. Further efforts are needed to examine the characteristics of programs that are associated with improved access to care and clinical outcomes to maximize the benefits to individuals with autism spectrum disorder and their families.
Assuntos
Transtorno do Espectro Autista/terapia , Serviços de Saúde Comunitária/organização & administração , Acessibilidade aos Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Medicaid/organização & administração , Adolescente , Cuidadores , Criança , Pré-Escolar , Prática Clínica Baseada em Evidências , Humanos , Cuidados Intermitentes , Estados UnidosRESUMO
BACKGROUND: Frequency of administration (once daily versus more than once daily) is believed to be an important consideration affecting drug choice. OBJECTIVE: The aim of this study was to describe the characteristics of patients with non-valvular atrial fibrillation (NVAF) and the extent to which they take chronic medications, other than anticoagulants, more frequently than once daily. METHODS: Using data from a large, national database of health insurance claims, patients with a diagnosis of NVAF between 1 July 2008 and 30 September 2011 were identified, along with their prescription medications, to determine the proportion of patients taking chronic medications more than once a day. Prescription medications, co-morbidities, and CHADS2 and CHA2DS2-VASc scores were evaluated. CHADS2 assesses the risk of stroke in NVAF patients with the following risk factors: Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, and history of prior Stroke or transient ischemic attack. The CHA2DS2-VASc score adds the following risk factors to the CHADS2 score: Age 65-74 years, Vascular Disease, and Sex Category (Female). RESULTS: Overall, 324,172 patients with NVAF with mean CHADS2 and CHA2DS2-VASc scores of 1.51 and 3.08, respectively, were included in the study. Of these patients, 299,716 (92.5 %) took chronic medications, with an average of 6.9 medications per patient, and 215,527 (66.5 % of all patients or 71.9 % of those taking chronic medications) took medications more than once per day. CONCLUSION: Use of chronic medications other than anticoagulants is common among patients with NVAF, and medications are typically taken multiple times per day. The average number of medications per patient and multiple therapeutic classes prescribed underscore the clinical complexity of NVAF patients. Hence, the choice of a once daily anticoagulant versus a more than once daily anticoagulant may be less relevant in a real world NVAF population in terms of a potential convenience benefit.
RESUMO
OBJECTIVE: The objective was to test the hypothesis that among privately insured women who have contraceptive coverage without cost-sharing, using prescription contraception is predicted primarily by pregnancy intentions. STUDY DESIGN: Participants are 987 women ages 18-40 who wish to avoid pregnancy for at least the next 12 months and are enrolled in Highmark Health plans in Pennsylvania. Data are from the baseline survey of MyNewOptions, an ongoing randomized controlled trial testing an intervention to help insured women make optimum contraceptive choices. Primary type of contraception used [categorized as long-acting reversible contraception (LARCs), other prescription methods, nonprescription methods or no method] is modeled using multinomial logistic regression, with predictors representing the timing and strength of pregnancy intentions, pregnancy history, pregnancy risk exposure and sociodemographics. RESULTS: LARCs were used by 8.4% of the sample; other prescription methods (primarily oral contraceptives), 49.6%; nonprescription methods (primarily condoms), 30.4%; and no method, 11.5%. Pregnancy intentions predicted use of LARCs and other prescription methods compared with no method. The most consistent predictors of using all categories of contraception were pregnancy risk exposure measures (partnership type and frequency of sexual intercourse). CONCLUSIONS: In the absence of cost-sharing for contraception, women's choice of prescription contraception was a function primarily of pregnancy risk exposure rather than pregnancy intentions. IMPLICATIONS: This study is among the first to examine privately insured women's contraception choices in the context of contraceptive coverage without cost-sharing; it shows that use of prescription contraception is predicted by pregnancy risk exposure and pregnancy intentions.
Assuntos
Comportamento de Escolha , Comportamento Contraceptivo/psicologia , Anticoncepção/economia , Cobertura do Seguro , Seguro Saúde , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Orais/uso terapêutico , Custo Compartilhado de Seguro , Características da Família , Feminino , Humanos , Modelos Logísticos , Pennsylvania , Gravidez , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adulto JovemRESUMO
BACKGROUND: The Affordable Care Act mandates that most women of reproductive age with private health insurance have full contraceptive coverage with no out-of-pocket costs, creating an actionable time for women to evaluate their contraceptive choices without cost considerations. The MyNewOptions study is a three-arm, randomized, controlled trial testing web-based interventions aimed at assisting privately insured women with making contraceptive choices that are consistent with their reproductive goals. METHODS: Privately insured women between the ages of 18 and 40 not intending pregnancy were randomly assigned to one of three groups: 1) a reproductive life planning (RLP) intervention, 2) a reproductive life planning enriched with contraceptive action planning (RLP+) intervention, or 3) an information only control group. Both the RLP and RLP+ guide women to identify their individualized reproductive goals and contraceptive method requirements. The RLP+ additionally includes a contraceptive action planning component, which uses if-then scenarios that allow the user to problem solve situations that make it difficult to be adherent to their contraceptive method. All three groups have access to a reproductive options library containing information about their contraceptive coverage and the attributes of alternative contraceptive methods. Women completed a baseline survey with follow-up surveys every 6 months for 2 years concurrent with intervention boosters. Study outcomes include contraceptive use and adherence. ClinicalTrials.gov identifier: NCT02100124. DISCUSSION: Results from the MyNewOptions study will demonstrate whether web-based reproductive life planning, with or without contraceptive action planning, helps insured women make patient-centered contraceptive choices compared with an information-only control condition.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Educação de Pacientes como Assunto , Gravidez não Planejada , Gravidez não Desejada , Saúde Reprodutiva/educação , Adulto , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Internet , Cooperação do Paciente , Patient Protection and Affordable Care Act/economia , Gravidez , Avaliação de Processos em Cuidados de Saúde , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Excessive gestational weight gain (GWG) is associated with increased risk of pregnancy-related complications, postpartum weight retention, and long-term obesity. Little is known about the behavioural habits of pregnant women who achieve and exceed recommended GWG. METHOD: In 2011, qualitative interviews were conducted in Pennsylvania with postpartum women who were overweight or obese prior to pregnancy to ascertain their behaviours and attitudes regarding dietary habits, physical activity, and self-monitoring during pregnancy. Thematic analysis identified the habits of women who achieved and exceeded recommended GWG guidelines. RESULTS: Of the 29 women interviewed, 11 had appropriate GWG and 18 had excessive GWG. Women achieving appropriate GWG reported modest increases in caloric intake if at all, with deliberate meal and snack planning, while women with excessive GWG described "eating-for-two." Nearly all women with excessive GWG reported exercising less during pregnancy (or remaining sedentary), while women with appropriate GWG largely increased or maintained pre-pregnancy physical activity levels. About half of the sample reported self-monitoring weight gain during pregnancy, but women achieving recommended GWG tied their weight monitoring with GWG goals consistent with recommended guidelines. CONCLUSIONS: Women who achieved appropriate GWG reported deliberate dietary habits and physical activity planning, with appropriate GWG goals during pregnancy. Women exceeding recommended GWG described "eating-for-two," were sedentary, and either had no goals for GWG or intended to gain more weight than recommended.