Model of Health Services Utilization with a focus on marital status. ... 1Brown University School of Public Health, Providence, RI, USA, 2Harvard University, ...
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sample consisted of adults (≥ 21 years), with co-existing depression and arthritis (N = 1692). HRQoL was assessed in the baseline and follow-up years. Depression treatment (only antidepressants, psychotherapy with or without antidepressants and neither antidepressants nor psychotherapy (no treatment)) was used as the main independent variable. Ordinary Least Square (OLS) regression models were built to examine the association between depression treatment categories and the HRQoL scores after controlling for the biological, psychological and socio-economic factors. Results: A majority of individuals reported taking only antidepressants, 23% reported receiving psychotherapy with or without antidepressants and 21% did not receive any depression treatment. Individuals who reported using only antidepressants or psychotherapy with or without antidepressants had lower follow-up mean [SE] PCS scores (38.13[0.54] and 39.76 [0.78] respectively) as compared to those without depression treatment (40.44[0.78]). Adjusted analyses showed no significant association between PCS scores and depression treatment. The mean [SE] follow-up MCS scores were higher for individuals taking only antidepressants as compared to those reporting no depression treatment (42.71[0.58] vs 40.79[0.78]). Adjusted analysis revealed that those with psychotherapy had lower MCS scores compared to those without depression treatment (beta= -1.51,P= 0.009). Conclusions: RCTs have shown improved HRQoL in individuals with co-existing arthritis and depression who are treated for depression. However, such findings are not replicated in real world settings. PHS65 The Impact of Different Approaches to Addressing Missing Items in Cancer Experience Surveys Roydhouse JK1, Gutman R1, Keating NL2, Mor V1, Wilson IB1 University School of Public Health, Providence, RI, USA, 2Harvard University, Boston, MA, USA
1Brown
Objectives: Proxy respondents are often used in multi-item national health care experience surveys when the desired respondents are unable to answer, including in surveys whose results are used for pay for performance. Missing items are often addressed through complete case analysis (CCA) or using the mean score if at least half of the scale items are completed (half scale imputation, “HSI”). However, item nonresponse may differ for proxies and patients. Different adjustment approaches may produce different results, with implications for payment. The research aims to determine if the choice of imputation method affects the impact of proxy reports on experience and quality scores. Methods: We analyzed nationally representative cross-sectional survey data from patients (or their proxies) with incident lung or colorectal cancer. Linear regression models included an independent variable for proxy status (0/1, patient as reference group), and additional patient, site and clinical covariates. Four outcomes were evaluated, with higher responses reflecting better reports/ratings: medical care, nursing care, and care coordination (all multi-item scales, 0-100), and care quality rating (single item, 0-4). Three different imputation methods for missing outcome item data were compared: CCA, HSI, and multiple imputation (MI). Results: Adjusted analyses revealed similar average proxy scores across imputation methods. The largest differences for proxy scores were seen for the medical care outcome: MI= +1.28 (SE 0.63) points, HSI= +1.57 (SE 0.63) points, CCA= +1.70 (SE 0.65) points. For care quality rating, the MI and CCA proxy scores were both statistically not significant. Conclusions: The impact of proxy reports on care experience and quality outcomes is minimally affected in this dataset by the imputation method for item nonresponse. The ability to impute covariates and include a larger number of participants under MI makes findings more representative, thus MI is recommended. Simulation analyses to identify when different methods may affect results are needed.
HEALTH SERVICES – Health Care Use & Policy Studies PHS66 Consequences of Medicare Part D Plan Switching: Gain or Loss Han J1, Ko D2 Dickinson University, Florham Park, NJ, USA, 2University of Pittsburgh at Greensburg, Greensburg, NJ, USA
1Fairleigh
Objectives: Medicare Part D beneficiaries’ tendency to stay with their initially chosen plan has been reported in many studies. Previous studies have focused on identifying factors associated with plan switching and little attention has been given to consequences of plan switching. This study aims to explore whether beneficiaries’ switching decisions are aligned with their preferences and how much beneficiaries benefit from plan switching. Methods: The Health Retirement Study 2009 Health and Well-Being Study (HWB) and 2007 Prescription Drug Study (PDS) were used. The analysis included subjects who responded to both 2007 and 2009 surveys, and who continued to enroll in Part D. Descriptive statistics were obtained focusing on the differences in premium, out-of-pocket (OOP) costs, cost-related non-adherence, drug utilization (prescription drug and over the counter drug), and plan characteristics. T-test and chi-square test were used to examine statistical significance of the difference. Results: Of 5,333 2009 survey respondents, 599 PartD enrollees were included in the analysis. Only a few beneficiaries (7.9%) switched plan for 2009, even though half of them answered to 2007 survey they considered switching. Regardless of whether to switch, majority of beneficiaries (75%) paid higher premium in 2009 compared to 2007. However, a larger percentage of switchers (50%) than non-switchers (44%) paid lower OOP in 2009 compared to 2007. Eleven% of switchers answered that their plans did not pay for some drugs as opposed to 29% of non-switchers. The percentage of switchers who did not take medication properly because of the cost slightly went down (from 23.4% to 21.28%) while that of non-switchers slightly increased (from 20.55% to 22.36%). Conclusions: It appears that there is little benefit of plan switching in premium but some benefits in OOP costs. Lower cost-related non-adherence and OOP costs among the switchers suggest that plan switching improves the beneficiaries’ medication taking behavior and spending in medications.
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PHS67 Assessing Patient-Perceived Barriers to Routine Counseling Services offered by Community Pharmacists Brinkerhoff A1, Pinto S2 1The University of Toledo, Toledo, OH, USA, 2University of Toledo, Toledo, OH, USA
Objectives: Pharmacists in community settings have embraced patient-centered roles. Literature suggests community pharmacists misunderstand patient perceptions of these counseling roles. This creates challenges for pharmacists. The objectives of this study are to (1) assess patient perceived barriers to pharmacy counseling services, (2) measure the extent of participation in routine counseling services, (3) assess whether barriers to routine counseling services are associated with personal or pharmacist related factors. Methods: This is an on-going, two-phase study. In the first phase, elicitation interviews were held with 53 English speaking adult patients. Patients were asked if they filled a prescription recently and why they accepted or declined counseling. In the second phase, patients will be surveyed and asked how often they use eleven routine counseling services, scored from (1) Never to (5) Always. Patients scoring (1) Never or (2) Rarely for a service will be provided an assorted list of sixteen personal and pharmacist barriers. Patients will select any barriers they perceive for that service. Each counseling service will be assessed using the frequency of personal and pharmacist barriers identified. Results: Results of phase-one data suggested a primary barrier to counseling was having more confidence with their physician. Additional barriers included lacking a relationship with pharmacy staff, and lack of privacy. A majority of patients (70%) reported a counseling barrier. The second-phase will measure the extent each counseling service is used, and whether barriers to each counseling service are more associated with personal or pharmacist factors. Conclusions: Patient responses suggested patients’ perceive both personal and pharmacist barriers to counseling in community settings. The second-phase will hope to add clarity as to how often each of these services is utilized, and the perceived barriers with each routine counseling service. A more clear understanding of barriers to routine counseling services will aid pharmacists in better providing counseling to patients. PHS68 Utilization of Cervical Cancer Preventive Care Services: Does Marital Status Matter? Gunjal SS1, Mgbere O2, Wang X3, Essien EJ3 1Mayo Clinic, Rochester, MN, USA, 2Houston Department of Health and Human Services, Houston, TX, USA, 3University of Houston, Houston, TX, USA
Objectives: Marriage has been associated with positive health outcomes/lower mortality and here we studied whether marital status affects use of cervical cancer screening (CCS) in U.S. Methods: A cross-sectional study was conducted using Medical Expenditure Panel Survey (MEPS) data from 2006 to 2011. The study included women eligible for CCS belonging to the age category 21-65 years according to the U.S. Preventive Services Task Force prescribed guidelines. The use of Pap smear test was the outcome of interest. The independent variables were categorized into predisposing, enabling, and need characteristics according to the Andersen Behavioral Model of Health Services Utilization with a focus on marital status. Descriptive statistics and chi-square tests were performed to examine group differences. Multivariate logistic regression was performed to investigate the effect of independent factors on CCS use. Results: A total of 547,749,778 women (average age: 42.59 years) constituted the study cohort. About 58.80% of married, 26.92% of unmarried and 14.27% of divorced women received CCS. Among those who received CCS, the majority were non-Hispanic Whites (67.18%), followed by Hispanics (13.66%) and non-Hispanic Blacks (12.61%). Multivariate logistic regression indicated that married (OR: 3.54, 95%CI: 2.97-4.21) or divorced women (OR: 3.98, 95%CI: 2.88-5.49) were more likely to receive screening compared to unmarried ones. Older women (OR: 1.05, 95%CI: 1.04-1.06) with public insurance (OR: 1.77, 95%CI: 1.36-2.31) and private insurance (OR: 2.07, 95%CI: 1.64-2.61) were more likely to receive CCS compared to those who were uninsured. In addition, region, education level, race, income, usual source of health care, smoking status, comorbidity of asthma, and BMI were identified as significant predictors of CCS. Conclusions: Marital status is associated with seeking preventive care services for cervical cancer. Outreach strategies focusing on identified predictors may be effective in targeting underserved women to improve their access to CCS. PHS69 Systematic Review of International Models of Care on Rare Diseases Chirveches MA1, Aroca A1, Otálora M1, Quirland-Lazo C2, Pacheco B1, Polanía MJ1, Zamora M1, Barrera L1, Holguín A1, Castañeda-Cardona C3, Rueda MA1, González V1, Cifuentes E1, Lozano L1, Díaz J1, Salinas JG1, Alfonso K1, Estupiñán N1, Lasalvia P1, Rosselli D4 1Pontificia Universidad Javeriana, Medical School, Bogota, Colombia, 2Universidad de Chile, Santiago, Chile, 3Neuroeconomix, Bogota, Colombia, 4Pontificia Universidad Javeriana, Bogota, Colombia
Objectives: Rare diseases affect a significant proportion of global population. Several challenges exist for healthcare systems trying to provide integral care for rare diseases patients, as well as for the inclusion of orphan drugs. The purpose of this article is to perform a systematic review of the literature of the alternatives used by health care systems worldwide, in order to identify and synthesize their components and processes. This is an essential step to develop a healthcare model for Colombia. Methods: We created a multidisciplinary panel composed by 30 methodological experts, clinicians and different stakeholders from patient associations and institutions involved in rare diseases. This panel validated the PICOT question and the search strategy in the selected electronic databases for the systematic review. Quality of evidence was evaluated with NOTARI tool. We then synthesized available information and organized it in analytical components. Subsequent contributions by experts were then incorporated using a modified Delphi technique. Results: A total of 147 papers were included in the analysis. Ten key components were identified after analyzing international models: policy and legislation, definition and coding,
