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ABSTRACT: BACKGROUND: Centrally active (CA) angiotensin-converting enzyme inhibitors (ACEIs) are able to cross the blood-brain barrier. Small observational studies and mouse models suggest that use of CA versus non-CA ACEIs is associated with a reduced incidence of Alzheimer's disease and related dementias (ADRD). OBJECTIVE: The aim of this research was to assess the effect of CA versus non-CA ACEI use on incident ADRD. DESIGN: This is a retrospective cohort study with a non-equivalent control group. SETTING AND PATIENTS: This study used a national random sample of Medicare beneficiaries enrolled in Part D with an ACEI prescription. A prevalent ACEI user cohort included beneficiaries (n = 107 179) with an ACEI prescription prior to 30 April 2007; beneficiaries without an ACEI prescription before this date were defined as incident ACEI users (n = 9840). MEASUREMENTS: The main outcome was time until first diagnosis of ADRD in Medicare claims. RESULTS: The unadjusted, propensity-matched and instrumental variable analyses of both the prevalent and incident ACEI user cohorts consistently showed similar time until incident ADRD in those taking CA ACEIs compared with those who took non-CA ACEIs. LIMITATIONS: The limitations of this study include the use of observational data, relatively short follow-up time and claims-based measure of cognitive decline. CONCLUSIONS: In this analysis of Medicare beneficiaries who were prevalent or incident users of ACEIs in 2007-2009, the use of CA ACEIs was unrelated to cognitive decline within 3 years of index prescription. Continued follow-up of these patients and more sensitive measures of cognitive decline are necessary to determine whether a cognitive benefit of CA ACEIs is realized in the long term. Copyright © 2013 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety 04/2013; · 2.53 Impact Factor
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Medical care 04/2013; · 3.24 Impact Factor
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ABSTRACT: OBJECTIVE: To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research. DATA SOURCES/STUDY SETTING: Veterans Affairs (VA) administrative data and Medicare claims in 2001-2004 for 11,123 Medicare-eligible VA primary care users in 2000. STUDY DESIGN: We compared means and distributions of VA reliance (the proportion of all VA/Medicare primary care visits occurring in VA) predicted from beta-binomial, binomial, and ordinary least-squares (OLS) models. PRINCIPAL FINDINGS: Beta-binomial model fits the bimodal distribution of VA reliance better than binomial and OLS models due to the nondependence on normality and the greater flexibility in shape parameters. CONCLUSIONS: Increased awareness of beta-binomial regression may help analysts apply appropriate methods to outcomes with bimodal or U-shaped distributions.
Health Services Research 03/2013; · 2.16 Impact Factor
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JAMA internal medicine. 03/2013;
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ABSTRACT: PURPOSE: We examined how the choice of historic medication use criteria for identifying prevalent users may bias estimated adherence changes associated with a medication copayment increase. METHODS: From pharmacy claims data in a retrospective cohort study, we identified 6,383 prevalent users of oral diabetes medications from four VA Medical Centers. Patients were included in this prevalent cohort if they had one fill both 3 months prior and 4-12 months prior to the index date, defined as the month in which medication copayments increased. To determine whether these historic medication use criteria introduced bias in the estimated response to a $5 medication copayment increase, we compared adherence trends from cohorts defined from different medication use criteria and from different index dates of copayment change. In an attempt to validate the prior observation of an upward trend in adherence prior to the date of the policy change, we replicated time series analyses varying the index dates prior to and following the date of the policy change, hypothesizing that the trend line associated with the policy change would differ from the trend lines that were not. RESULTS: Medication adherence trends differed when different medication use criteria were applied. Contrary to our expectations, similar adherence trends were observed when the same medication use criteria were applied at index dates when no copayment changes occurred. CONCLUSION: To avoid introducing bias due to study design in outcomes assessments of medication policy changes, historic medication use inclusion criteria must be chosen carefully when constructing cohorts of prevalent users. Furthermore, while pharmacy data have enormous potential for population research and monitoring, there may be inherent logical flaws that limit cohort identification solely through administrative pharmacy records.
Health Services Research 02/2013; · 2.16 Impact Factor
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ABSTRACT: BACKGROUND: While there has been extensive research into patient-specific predictors of medication adherence and patient-specific interventions to improve adherence, there has been little examination of variation in clinic-level medication adherence. OBJECTIVE: We examined the clinic-level variation of oral hypoglycemic agent (OHA) medication adherence among patients with diabetes treated in the Department of Veterans Affairs (VA) primary care clinics. We hypothesized that there would be systematic variation in clinic-level adherence measures, and that adherence within organizationally-affiliated clinics, such as those sharing local management and support, would be more highly correlated than adherence between unaffiliated clinics. DESIGN: Retrospective cohort study. SETTING: VA hospital and VA community-based primary care clinics in the contiguous 48 states. PATIENTS: 444,418 patients with diabetes treated with OHAs and seen in 158 hospital-based clinics and 401 affiliated community primary care clinics during fiscal years 2006 and 2007. MAIN MEASURES: Refill-based medication adherence to OHA. KEY RESULTS: Adjusting for patient characteristics, the proportion of patients adherent to OHAs ranged from 57 % to 81 % across clinics. Adherence between organizationally affiliated clinics was high (Pearson Correlation = 0.82), and adherence between unaffiliated clinics was low (Pearson Correlation = 0.04). CONCLUSION: The proportion of patients adherent to OHAs varied widely across VA primary care clinics. Clinic-level adherence was highly correlated to other clinics in the same organizational unit. Further research should identify which factors common to affiliated clinics influence medication adherence.
Journal of General Internal Medicine 01/2013; · 2.83 Impact Factor
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ABSTRACT: BACKGROUND: Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. METHODS: We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both ("dual") settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans' baseline dialysis date. RESULTS: Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. CONCLUSIONS: VA expenditures for "buying" outsourced dialysis are high and increasing relative to "making" dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans' access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.
BMC Health Services Research 01/2013; 13(1):26. · 1.66 Impact Factor
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ABSTRACT: OBJECTIVE: To examine whether the recent increasing prevalence of obesity was accompanied by variations in energy and macronutrient intakes by weight status. DESIGN: Time series of cross-sectional surveys. SETTING: National Health and Nutrition Examination Surveys (NHANES) in the USA. SUBJECTS: Adult participants of NHANES I (1971-1974), II (1976-1980), III (1988-1994) and continuous (1999-2004). RESULTS: Daily energy intake increased over time for men (9832 to 11 652 kJ, P < 0·01) and women (6418 to 8142 kJ, P < 0·01) in all BMI classes. Percentage of energy intake from carbohydrate increased over time (men: 42·7 % to 48·0 %, P < 0·01; women: 45·4 % to 50·6 %, P < 0·01), whereas percentage of energy intake from fat (men: 36·7 % to 33·1 %, P < 0·01; women: 36·1 % to 33·8 %, P < 0·01) and protein (men: 16·4 % to 15·1 %, P < 0·01; women: 16·9 % to 14·7 %, P < 0·01) decreased. With surveys combined, daily energy intake varied among BMI classes for women (underweight/normal weight: 7460 kJ; overweight: 6799 kJ; obese I: 7033 kJ; obese II/III: 7401 kJ; P < 0·01) but not men. Percentage of energy intake from carbohydrate decreased with increasing BMI class (men: 46·6 % to 45·5 %, P < 0·01; women: 49·0 % to 48·6 %, P < 0·01) whereas percentage of energy intake from fat (men: 34·3 % to 36·5 %, P < 0·01; women: 34·4 % to 35·4 %, P < 0·01) and protein (men: 15·3 % to 16·5 %, P < 0·01; women: 15·2 % to 16·0 %, P < 0·01) increased. Interactions of survey period and BMI class were not statistically significant. CONCLUSIONS: Time trends in energy and macronutrient intakes were similar across BMI classes. Research examining how individuals respond differently to varying dietary compositions may provide greater insight about contributors to the rise in obesity.
Public Health Nutrition 01/2013; · 2.17 Impact Factor
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ABSTRACT: Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight loss clinic by veterans.
We examined clinic use by 44,411 new patients seen in a Veterans Affairs (VA) MOVE! weight management clinic before the copayment elimination and clinic use by 64,398 new patients seen in the year after copayment elimination. We examined clinic use via mixed-effects models for patients who were already exempt from copayment and patients who were newly exempt from copayment. We used 2 outcomes before and after copayment elimination: 1) the ratio of number of clinic visits by new users with the mean number of MOVE! clinic visits by all users, and 2) the number of clinic visits by each new user in the 6 months after their first visit. All models were adjusted for patient and clinic factors.
Among newly exempt patients, the clinic-standardized rate of new use increased by 2.2% after the copayment was eliminated but increased 12% among already exempt veterans. This finding was confirmed in adjusted analyses. Analysis of number of clinic visits adjusted for patient and clinic factors also found that exempt and nonexempt veterans had similar numbers of repeat clinic visits.
We saw an unexpected larger increase in demand among veterans who receive all VA care for free. These results suggest that VA should not assume that copayment reductions for selective preventive services will motivate patient change and achieve intended system-level outcomes.
Preventing chronic disease 01/2013; 10:E49. · 1.82 Impact Factor
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ABSTRACT: BACKGROUND: Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence. METHODS: This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey---Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression. RESULTS: We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck. CONCLUSIONS: Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.
BMC Health Services Research 11/2012; 12(1):391. · 1.66 Impact Factor
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ABSTRACT: BACKGROUND: Self-report measures of medication nonadherence confound the extent of and reasons for medication nonadherence. Each construct is assessed with a different type of psychometric model, which dictates how to establish reliability and validity. OBJECTIVES:: To evaluate the psychometric properties of a self-report measure of medication nonadherence that assesses separately the extent of nonadherence and reasons for nonadherence. RESEARCH DESIGN:: Cross-sectional survey involving the new measure and comparison measures to establish convergent, discriminant, and predictive validity. The new measure was readministered 2-21 days later. SUBJECTS:: A total of 202 veterans with treated hypertension were recruited from the Durham Veterans Affairs Medical Center. MEASURES:: A new self-report measure assessed the extent of nonadherence and reasons for nonadherence. Comparison measures included self-reported medication self-efficacy, beliefs about medications, impression management, conscientiousness, habit strength, and an existing nonadherence measure. RESULTS:: Three items assessing the extent of nonadherence produced reliable scores for this sample, α=0.84 (95% confidence interval, 0.80-0.87). Correlations with comparison measures provided evidence of convergent and discriminant validity. Correlations with systolic (r=0.27, P<0.0001) and diastolic (r=0.27, P<0.0001) blood pressure provided evidence of predictive validity. Reasons for nonadherence were assessed with 21 independent items. Intraclass correlations were 0.58 for the extent score and ranged from 0.07 to 0.64 for the reasons. CONCLUSIONS:: The dual conceptualization of medication nonadherence allowed a stronger evaluation of the reliability and validity than was previously possible with measures that confounded these 2 constructs. Measurement of self-reported nonadherence consistent with psychometric principles will enable reliable, valid evaluation of interventions to reduce nonadherence.
Medical care 08/2012; · 3.24 Impact Factor
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Corrine I Voils,
Cynthia J Coffman,
David Edelman, Matthew L Maciejewski,
Janet M Grubber,
Azita Sadeghpour,
Alex Cho,
Jamiyla McKenzie,
Francoise Blanpain,
Maren Scheuner,
Margarete Sandelowski,
M Patrick Gallagher,
Geoffrey S Ginsburg,
William S Yancy
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ABSTRACT: We describe the study design, procedures, and development of the risk counseling protocol used in a randomized controlled trial to evaluate the impact of genetic testing for diabetes mellitus (DM) on psychological, health behavior, and clinical outcomes.
Eligible patients are aged 21 to 65 years with body mass index (BMI) ≥27 kg/m(2) and no prior diagnosis of DM. At baseline, conventional DM risk factors are assessed, and blood is drawn for possible genetic testing. Participants are randomized to receive conventional risk counseling for DM with eye disease counseling or with genetic test results. The counseling protocol was pilot tested to identify an acceptable graphical format for conveying risk estimates and match the length of the eye disease to genetic counseling. Risk estimates are presented with a vertical bar graph denoting risk level with colors and descriptors. After receiving either genetic counseling regarding risk for DM or control counseling on eye disease, brief lifestyle counseling for prevention of DM is provided to all participants.
A standardized risk counseling protocol is being used in a randomized trial of 600 participants. Results of this trial will inform policy about whether risk counseling should include genetic counseling.
ClinicalTrials.gov Identifier NCT01060540.
Trials 08/2012; 13:121. · 2.02 Impact Factor
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ABSTRACT: Dosing is potentially the most important decision that must be made when building or refining behavioral interventions. In this paper, we propose standardized terminology and reporting of dosing information, which would inform intervention development, refinement for dissemination, and systematic reviews of dose-response relationships. Dosing of interventions may be characterized by duration, frequency, and amount. To illustrate the value of operationalizing these three parameters to evaluate dose-response relationships, 31 published reports of behavioral interventions to increase adherence to antiretroviral therapy (ART) were reviewed. The ART literature was characterized by under-reporting of dosing parameters, heterogeneity in dosing schedules, and heterogeneity in type of control group, which complicate analysis of dose-response relationships in systematic review and determination of the optimal dose for intervention dissemination. Improved reporting of the three dosing parameters and comparison of intended to actual delivery can inform the identification of the most effective intervention doses and the efficient implementation of efficacious interventions in clinical practice.
Contemporary clinical trials 07/2012; 33(6):1225-30. · 1.51 Impact Factor
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ABSTRACT: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation.
We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses.
Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant.
The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.
BMC Medical Informatics and Decision Making 07/2012; 12:69. · 1.48 Impact Factor
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ABSTRACT: To determine whether bariatric surgery is associated with reduced health care expenditures in a multisite cohort of predominantly older male patients with a substantial disease burden.
Retrospective cohort study of bariatric surgery. Outpatient, inpatient, and overall health care expenditures within Department of Veterans Affairs (VA) medical centers were examined via generalized estimating equations in the propensity-matched cohorts.
Bariatric surgery programs in VA medical centers.
Eight hundred forty-seven veterans who were propensity matched to 847 nonsurgical control subjects from the same 12 VA medical centers.
Bariatric surgical procedures.
Health expenditures through December 2006.
Outpatient, inpatient, and total expenditures trended higher for bariatric surgical cases in the 3 years leading up to the procedure and then converged back to the lower expenditure levels of nonsurgical controls in the 3 years after the procedure.
Based on analyses of a cohort of predominantly older men, bariatric surgery does not appear to be associated with reduced health care expenditures 3 years after the procedure.
Archives of surgery (Chicago, Ill.: 1960) 07/2012; 147(7):633-40. · 4.32 Impact Factor
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Evidence-based medicine 06/2012;
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ABSTRACT: More than half of veterans who use Veterans Health Administration (VA) care are also eligible for Medicare via disability or age, but no prior studies have examined variation in use of outpatient services by Medicare-eligible veterans across health system, type of care or time.
To examine differences in use of VA and Medicare outpatient services by disability-eligible or age-eligible veterans among veterans who used VA primary care services and were also eligible for Medicare.
A retrospective cohort study of 4,704 disability- and 10,816 age-eligible veterans who used VA primary care services in fiscal year (FY) 2000. We tracked their outpatient utilization from FY2001 to FY2004 using VA administrative and Medicare claims data. We examined utilization differences for primary care, specialty care, and mental health outpatient visits using generalized estimating equations.
Among Medicare-eligible veterans who used VA primary care, disability-eligible veterans had more VA primary care visits (p < 0.001) and more VA specialty care visits (p < 0.001) than age-eligible veterans. They were more likely to have mental health visits in VA (p < 0.01) and Medicare-reimbursed visits (p < 0.01). Disability-eligible veterans also had more total (VA+Medicare) visits for primary care (p < 0.01) and specialty care (p < 0.01), controlling for patient characteristics.
Greater use of primary care and specialty care visits by disability-eligible veterans is most likely related to greater health needs not captured by the patient characteristics we employed and eligibility for VA care at no cost. Outpatient care patterns of disability-eligible veterans may foreshadow care patterns of veterans returning from Afghanistan and Iraq wars, who are entering the system in growing numbers. This study provides an important baseline for future research assessing utilizations among returning veterans who use both VA and Medicare systems. Establishing effective care coordination protocols between VA and Medicare providers can help ensure efficient use of taxpayer resources and high quality care for disabled veterans.
BMC Health Services Research 03/2012; 12:51. · 1.66 Impact Factor
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ABSTRACT: Prior research found that in the Veterans Affairs health care system (VA), the proportion of patients adherent to oral hypoglycemic agents varies from 50% to 80% across primary care clinics. This study examined whether variation in patient and facility characteristics determined those differences.
Retrospective cohort study of 444,418 VA primary care patients with diabetes treated in 559 clinics in fiscal year (FY) 2006-2007. Patients' adherence to each oral hypoglycemic agent was computed for the first 3 months of FY2007, and averaged across agents to produce an adherence score for the patient's overall regimen. Patients with an adherence score over 0.8 were defined as adherent. Risk adjustment used hierarchical logistic regression accounting for patient factors and facility effects by clustering patients within clinics and clinics within parent VA medical centers. We then assessed the influence of risk adjustment using observed-to-expected (O/E) ratios computed for each clinic.
The mean unadjusted proportion of adherent patients in clinics was 0.715 (interdecile range 0.559-0.826). The percent variation in patient's likelihood of being adherent explained at the patient, clinic, and parent VA medical center levels was 2.94%, 0.27%, and 0.76%, respectively. The mean clinic-level observed-to-expected ratio was 1.001 (interdecile range 0.975-1.027).
The variation in the proportion of patients adherent across clinics remained large after risk adjustment. As patient and facility effects explained only 4% of the variance in adherence, comparing clinics based on unadjusted scores is a reasonable starting point unless more predictive patient, provider, and facility factors are identified.
Medical care 02/2012; 50(7):591-8. · 3.24 Impact Factor
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ABSTRACT: Objective: To examine the relationship between adherence to antipsychotics and adherence to medications for cardiometabolic conditions (diabetes, hypertension, and hyperlipidemia) and subsequent health care utilization and expenditures in patients with schizophrenia and preexisting cardiometabolic conditions.Method: Medstat MarketScan Medicaid databases from 2004 to 2008 were used to identify a retrospective cohort of schizophrenia patients (ICD-9-CM codes 295.1-295.3, 295.6, or 295.9) with preexisting cardiometabolic medication use who had initiated antipsychotic treatments. Patients who initiated a second-generation antipsychotic between July 1, 2004, and December 31, 2006, were identified as the new user cohort. Comorbid conditions were identified if patients had at least 1 inpatient or 2 outpatient claims for hypertension, hyperlipidemia, and/or diabetes (ICD-9-CM codes 401.xx to 405.xx inclusive, 272.xx inclusive, and 250.xx inclusive, respectively) and were using medication to manage these conditions prior to antipsychotic initiation. Adherence to cardiometabolic medications was compared between adherent and nonadherent patients taking antipsychotics using the proportion of days covered over 8 quarters categorized as phases of treatment to reflect initiation (1, days 1-90), continuation (2-4, days 91-360), and maintenance (5-8, days 361-520). Proportion of days covered values ≥ 0.80 were deemed adherent. Prior period antipsychotic adherence was used to predict cardiometabolic medication adherence, health care utilization, and expenditures using generalized estimating equations and negative binomial regressions.Results: The final population represented 1,006 patients. Antipsychotic adherence during continuation was a significant predictor of medication adherence for hypertension (odds ratio [OR] = 2.40, 95% CI = 1.67-3.44), diabetes (OR = 2.28, 95% CI = 1.43-3.67), and hyperlipidemia (OR = 2.16, 95% CI = 1.11-4.20) during maintenance. Antipsychotic adherence during continuation resulted in significantly lower emergency room use (OR = 0.67, 95% CI = 0.52-0.87), lower inpatient use (OR = 0.77, 95% CI = 0.56-1.06, not significant), and significantly higher outpatient ($996, 95% CI = $663-$1,330), medication ($652, 95% CI = $542-$762), and total health ($1,371, 95% CI = $490-$2,252) expenditures during maintenance.Conclusion: Antipsychotic adherence was associated with better adherence to cardiometabolic medications and a potential reduction in emergency room and inpatient service utilization. Clinicians should consider adherence to both antipsychotic and cardiometabolic medications when caring for patients with schizophrenia and comorbid conditions.
The primary care companion to CNS disorders. 01/2012; 14(3).
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ABSTRACT: We estimated the association between state policy changes and adolescent soda consumption and body mass index (BMI) percentile, overall and by race/ethnicity.
We obtained data on whether states required or recommended that schools prohibit junk food in vending machines, snack bars, concession stands, and parties from the 2000 and 2006 School Health Policies and Programs Study. We used linear mixed models to estimate the association between 2000-2006 policy changes and 2007 soda consumption and BMI percentile, as reported by 90 730 students in 33 states and the District of Columbia in the Youth Risk Behavior Survey, and to test for racial/ethnic differences in the associations.
Policy changes targeting concession stands were associated with 0.09 fewer servings of soda per day among students (95% confidence interval [CI] = -0.17, -0.01); the association was more pronounced among non-Hispanic Blacks (0.19 fewer servings per day). Policy changes targeting parties were associated with 0.07 fewer servings per day (95% CI = -0.13, 0.00). Policy changes were not associated with BMI percentile in any group.
State policies targeting junk food in schools may reduce racial/ethnic disparities in adolescent soda consumption, but their impact appears to be too weak to reduce adolescent BMI percentile.
American Journal of Public Health 09/2011; 101(9):1769-75. · 3.93 Impact Factor
