Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina.

Background: Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population.

Methods: This retrospective cohort study used electronic health record data from a large academic hospital system (2015-2019) to identify adolescents (aged 10-17) and young adults (aged 18-27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions.

Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children.

Objective: The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care.

Methods: Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period.

Naloxone Availability and Cost After Transition to an Over-the-Counter Product.

Importance: The US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone's availability and cost changed since this policy was implemented.

Objective: To evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity.

A pre-visit video/question prompt list intervention to increase youth question-asking about attention deficit hyperactivity disorder during pediatric visits.

Objective: To conduct a pragmatic randomized controlled trial to test the effectiveness of an ADHD question prompt list with video intervention to increase youth question-asking and provider education about ADHD during visits.

Methods: English-speaking youth ages 11-17 with ADHD and their caregivers were enrolled from two pediatric clinics. Youth were randomized to intervention or usual care groups.

Neighborhood context and children's health care utilization and health outcomes: a comprehensive descriptive analysis of national survey data.

While child health and health care disparities arising from unequal distribution of resources are well documented, a nationally representative inventory of health and well-being for children across the spectrum of opportunity is lacking. Using the nationally representative sample of children from pooled 2013-2017 Medical Expenditure Panel Survey data linked to the census-tract-level Child Opportunity Index 2.0, a composite measure of neighborhood health, education, and socioeconomic conditions, we describe US children's socioeconomic characteristics, health care utilization and expenditures across the spectrum of child neighborhood opportunity levels.

Naloxone Accessibility by Standing Order in North Carolina Community Pharmacies.

Background: According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.

Objective: The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC.

Methods: A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023.

Patterns of Mental Health Service Use During the Transition to Adulthood Among Autistic Adolescents and Young Adults.

Background: The time of transition into adulthood, especially when leaving school, is a time when many autistic adolescents and young adults (AYA) may stop receiving mental health services that they have relied on, leading to worse mental health outcomes. The purpose of this study was to describe patterns of mental health service use during transition to adulthood among autistic AYAs.

Methods: We performed a cross-sectional study using electronic health records from years 2015 to 2019 from one large university health care system.

Provision of Patient Care Services and Goals for Expansion in Community and Ambulatory Care Pharmacies in Southeastern North Carolina.

In February 2022, the North Carolina legislature expanded pharmacist dispensing authority without a prescription. We conducted a cross-sectional interview of currently licensed pharmacy managers of outpatient pharmacies located in five counties in southeastern North Carolina. Pharmacy managers were eligible to participate if their pharmacy was either a community pharmacy, clinic-based pharmacy, or outpatient health system pharmacy.

Do African American patients with glaucoma ask their eye providers the questions they have?

Purpose: The objective of this study was to describe what questions patients checked on a glaucoma question prompt list and how often patients asked the same checked questions during medical visits.

Design: A randomized controlled trial was conducted to test the effectiveness of a pre-visit video/glaucoma question prompt list intervention to increase African American patient question-asking during medical visits.

Methods: Adult African American patients with glaucoma and a history of non-adherence to glaucoma medications were enrolled and randomized into intervention and usual care groups from three glaucoma practices.

Quickly identifying people at risk of opioid use disorder in emergency departments: trade-offs between a machine learning approach and a simple EHR flag strategy.

Objectives: Emergency departments (EDs) are an important point of contact for people with opioid use disorder (OUD). Universal screening for OUD is costly and often infeasible. Evidence on effective, selective screening is needed.

Rapid and Deferred Help Seeking Among African American Parents of Children With Emotional and Behavioral Difficulties.

Objective: Little is known about the factors African American parents consider when seeking care for their child after emotional and behavioral difficulties emerge. This study aimed to examine factors associated with seeking professional care within 30 days after identifying a child's need (i.e.

Association of Inadequate Provider Networks with Unmet Need for Health Services and Self-Employment among People with Disabilities.

People with disabilities (PWD) make up over a quarter of the U.S. population and often have complex medical needs.

Comparing Continuous and Binary Group-based Trajectory Modeling Using Statin Medication Adherence Data.

Background: Of 58 medication adherence group-based trajectory modeling (GBTM) published studies, 74% used binary and 26% used continuous GBTM. Few studies provided a rationale for this choice. No medication adherence studies have compared continuous and binary GBTM.

Predictors of Unmet Family Support Service Needs in Families of Children with Special Health Care Needs.

Objectives: This study describes rates of perceived and unmet need for family support services (care coordination, respite care, and family mental health care) among a national sample of children with special health care needs (CSHCN), distinguishing children with emotional, behavioral, or developmental problems (EBDPs) from children with primarily physical chronic conditions. It also examines if a child having EBDPs is associated with perceived and unmet family support service needs and investigates public versus private health insurance's moderating effect on this association.

Methods: Using data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010), this cross-sectional study uses multi-level, fixed effects logistic regression.

Parent Activation and Child Mental Health Service use in African American Families in a Large Cross-Sectional Study.

Objectives: 1) To describe activation skills of African American parents on behalf of their children with mental health needs. 2) To assess the association between parent activation skills and child mental health service use.

Methods: Data obtained in 2010 and 2011 from African American parents in North Carolina raising a child with mental health needs (n = 325) were used to identify child mental health service use from a medical provider, counselor, therapist, or any of the above or if the child had ever been hospitalized.

Access to Effective Communication Aids and Services among American Sign Language Users across North Carolina: Disparities and Strategies to Address Them.

Objective: To examine the extent to which communication aids and services used by American Sign Language (ASL) users and their healthcare providers aligns with preferences, satisfaction, and unmet needs; and to elicit from stakeholders strategies to address disparities.

Methods: A cross-sectional study was conducted of ASL users in North Carolina. Respondents completed an online survey presented in ASL and English (N = 189).

Effects of Estimated Community-Level Health Literacy on Treatment Initiation and Preventive Care Among Older Adults with Newly Diagnosed Diabetes.

Purpose: Individual measures of health literacy are not feasible for administration on a large scale, yet estimates of community-level health literacy in the US recently became available. We sought to investigate whether community-level health literacy estimates are associated with the initiation of oral antihyperglycemic agents (OHA) and the use of standard preventive care services among older adults with newly diagnosed diabetes.

Patients And Methods: We conducted a retrospective cohort study of 169,758 patients, ≥65 years old with hypertension and newly diagnosed type 2 diabetes using 2007-2011 data from the Center for Medicare and Medicaid Services Chronic Conditions Warehouse.

Opening the black box of the group-based trajectory modeling process to analyze medication adherence patterns: An example using real-world statin adherence data.

Purpose: The rationale for choosing a final group-based trajectory modeling (GBTM) specification and evaluations of patient adherence patterns within groups are often omitted in the GBTM medication adherence literature. We aimed to (1) reveal the complexity of GBTM and (2) assess model discrimination of patient medication adherence patterns.

Methods: Medicare administrative claims were used to measure statin medication adherence as a continuous value in the 6 months before an acute myocardial infarction (AMI) hospitalization.

Preparing pharmacy students to communicate effectively with adolescents.

Objectives: To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

Methods: Academics from three universities in three countries collaborated on the workshop development and evaluation.

Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.

Objective: To evaluate shared decision-making (SDM) and delineate SDM processes in audio-recorded conversations between language congruent Spanish-/English-speaking clinicians and parents of pediatric mental health patients.

Methods: Transcripts from audio-recorded consultations were rated using the 5-Item Observing Patient Involvement in Decision Making (Observer OPTION) instrument. One hundred encounters between seventeen clinicians and 100 parents were rated.

Applying machine learning to predict real-world individual treatment effects: insights from a virtual patient cohort.

Objective: We aimed to investigate bias in applying machine learning to predict real-world individual treatment effects.

Materials And Methods: Using a virtual patient cohort, we simulated real-world healthcare data and applied random forest and gradient boosting classifiers to develop prediction models. Treatment effect was estimated as the difference between the predicted outcomes of a treatment and a control.

It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All-Cause Mortality.

Background Many older patients have a change in statin adherence-either an increase or a decrease-from before to after an acute myocardial infarction ( AMI ), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre- AMI and 180 days post- AMI and categorized as severely nonadherent, moderately nonadherent, or adherent.

Incidence of and Risk Factors for Severe Adverse Events in Elderly Patients Taking Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers after an Acute Myocardial Infarction.

Study Objective: To assess the incidence of and risk factors associated with severe adverse events in elderly patients who used angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) after an acute myocardial infarction (AMI).

Design: Retrospective cohort study.

Data Sources: Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse (Medicare service claims database), American Community Survey of the U.

Changes in Statin Adherence Following an Acute Myocardial Infarction Among Older Adults: Patient Predictors and the Association With Follow-Up With Primary Care Providers and/or Cardiologists.

Background: Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change.

Methods And Results: This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI.

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction.

Background: Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some, but not all, therapies.

Objectives: The authors investigated the effect of tradeoffs in adherence to ACE inhibitors/ARBs, beta-blockers, and statins on survival among older people after AMI.