Retrospective descriptive analysis of an urban pediatric collaborative care program.

Objective: The prevalence of mental health conditions in pediatric patients in the United States is approximately 15%. Concerningly, nearly half go untreated, with lower treatment rates among children of color. Collaborative care can increase access to care and has an emerging evidence base for pediatrics.

Novel Approach to Integrating Mental Health Care into a Primary Care Setting: Development, Implementation, and Outcomes.

It is now widely accepted that there is a growing discrepancy between demand and access to adequate treatment for behavioral or mental health conditions in the United States. This results in immense personal, societal, and economic costs. One rapidly growing method of addressing this discrepancy is to integrate mental health services into the primary care setting, which has become the de facto service provider for these conditions.

Addressing Academic Concerns: A Survey of Primary Care Providers.

Given new clinical recommendations, we sought to better understand the perspectives and practices of primary care providers (PCPs) around pediatric academic concerns. Practicing PCPs were recruited to complete an 8-item self-report survey; 163 PCPs were included in the final analysis. Results indicated that 84% of PCPs perceived their role in addressing patients' academic concerns as highly important; yet there was variability in the frequency with which PCPs reported engaging in activities around these educational needs.

How do Black Caribbean-born Women Living in the UK Construct Their Experience of Retirement? A Discursive Psychology Analysis.

The present research explores Caribbean-born women's constructions of retirement. Eight participants (self-identified as retired) were recruited using purposive and snowball sampling. Data were obtained using individual semi-structured interviews and analyzed using discursive psychology.

Development of an animal-assisted activity program on a pediatric behavioral health unit.

Animal-assisted activities (AAA), a form of animal-assisted interaction, have the potential to improve positive coping for youth with significant psychiatric symptoms admitted to acute behavioral health units. However, little is known regarding the appropriateness of an AAA program in short-term mental health hospital settings. The goal of this investigation is to describe and report on the feasibility and acceptability of embedding a canine-AAA program within the therapeutic programming of a pediatric behavioral health unit.

The effects on patient retention after opioid weaning in an internal medicine residency clinic.

A retrospective, cross-sectional study was completed on 220 patients to determine the effects of implementation of an aggressive policy to curb opioid misuse/abuse in an internal medicine residency clinic. Our findings suggest that the development of a clear and consistent protocol for approaching patients on chronic controlled substances, as well as the initiation of regular didactic sessions addressing chronic pain and pain management, led to a dramatic reduction in the number or opioid prescriptions written by our resident providers without much reduction in patient volume.

Prospective Postmarketing Surveillance of Acute Myocardial Infarction in New Users of Saxagliptin: A Population-Based Study.

Objective: The cardiovascular safety of saxagliptin, a dipeptidyl-peptidase 4 inhibitor, compared with other antihyperglycemic treatments is not well understood. We prospectively examined the association between saxagliptin use and acute myocardial infarction (AMI).

Research Design And Methods: We identified patients aged ≥18 years, starting from the approval date of saxagliptin in 2009 and continuing through August 2014, using data from 18 Mini-Sentinel data partners.

The impact of FDA regulatory activities on incident dispensing of LABA-containing medication: 2005-2011.

Objective: Evidence of safety issues associated with long-acting beta-agonist (LABA) treatment has led to multiple regulatory activities by the U.S. Food and Drug Administration (FDA) on this class of medications.

Seasonal patterns of Asthma medication fills among diverse populations of the United States.

Objective: Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity.

Methods: We conducted a retrospective cohort study of asthmatics 4-50 years of age and enrolled in three diverse health insurance plans.

Racial disparities in family-provider interactions for pediatric asthma care.

Objective: Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity.

Methods: This was a cross-sectional study of parent surveys of asthmatic children within the Population-Based Effectiveness in Asthma and Lung Diseases Network.

High rates of severe hypoglycemia among African American patients with diabetes: the surveillance, prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.

Aims: Seven-year surveillance study (2005-2011) to evaluate race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes.

Methods: SH events were identified via any primary or principal diagnosis from emergency department or inpatient encounters among African American, Asian, Latino and White adult diabetes patients treated with insulin or secretagogues (Sulfonylureas or Meglitinides), receiving care from integrated healthcare delivery systems across the United States. We calculated age- and sex-standardized annual SH rates and average annual percent change (AAPC) in SH rates.

Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban.

Objective: To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants.

Setting: Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls). We included children with asthma aged 4-17 years with commercial coverage from 2007 to 2010.

Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction.

OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008.

Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children with Asthma.

Background: Underuse of controller medicines among children with asthma remains widespread despite national guidelines.

Objectives: To (1) assess provider prescribing patterns for asthma controller medications; (2) assess how frequently parents' reports of their child's asthma controller medicine use were mismatched with their provider's recommendations; and (3) evaluate parent attitudes and demographic characteristics associated with these mismatches.

Methods: In this cross-sectional study, we conducted linked surveys of parents and providers of children with probable persistent asthma in a Medicaid program and 4 commercial health plans in 2011.

Improved continuity of care in a resident clinic.

Background: For residents in the out-patient clinic, continuity in patient care is an integral and vital aspect of internal medicine training, but is frequently compromised by resident in-patient schedules, the structure of the out-patient clinic and the need to comply with the increasing regulation of duty hours.

Method: In this study, we examined whether the creation and implementation of a new team approach, the Firms Model, would improve the continuity of patient care in the internal medicine resident out-patient clinic.

Results: Before the implementation of the Firms Model, an examination of a consecutive clinic sample indicated that patients were seen by their assigned resident providers 41.

Changing patterns of asthma medication use related to US Food and Drug Administration long-acting β2-agonist regulation from 2005-2011.

Background: Safety concerns associated with long-acting β2-agonists (LABAs) have led to many US Food and Drug Administration (FDA) regulatory activities for this class of drugs. Little is known about the effect of these regulatory activities on use of LABA-containing agents or other asthma medications.

Methods: We created rolling cohorts of pediatric and adult asthmatic patients in the Mini-Sentinel Distributed Database between January 2005 and June 2011.

Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study.

Background: Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates.

Methods And Results: We conducted an observational cohort study from 2005 to 2011 among 1.25 million diabetic subjects and 1.

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes.

Background: Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes.

Relation of Acute Heart Failure Hospital Length of Stay to Subsequent Readmission and All-Cause Mortality.

Heart failure (HF) hospitalization length of stay (LOS) has been associated with the risk of subsequent readmission and mortality. We identified 19,927 hospitalized patients with HF who were discharged alive from 2008 to 2011 from 3 Kaiser Permanente regions. In adjusted Cox models using LOS 3 to 4 days as the reference category, shorter LOS was not significantly associated with hospital readmissions.

Prevalence of chronic kidney disease among individuals with diabetes in the SUPREME-DM Project, 2005-2011.

Aims: Diabetes is a leading cause of chronic kidney disease (CKD). Different methods of CKD ascertainment may impact prevalence estimates. We used data from 11 integrated health systems in the United States to estimate CKD prevalence in adults with diabetes (2005-2011), and compare the effect of different ascertainment methods on prevalence estimates.

Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis.

Objective: The objective of this study was to assess the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C), high blood pressure (BP), and current smoking.

Research Design And Methods: Study subjects included 859,617 adults with diabetes enrolled for more than 6 months during 2005-2011 in a network of 11 U.S.