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ABSTRACT: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Prevalence estimates of IBS vary widely, from 10 to 15%, in the U.S. However, few studies have examined constipation predominant IBS (IBS-C), a subtype of IBS. The aim of this study was to assess the effect of IBS-C on health-related quality of life (HRQOL), work productivity and activity impairment, and health care resource use.
Using data from the 2007 U.S. National Health and Wellness Survey, IBS-C patients (n = 789) were compared to a propensity-score matched comparison group (n = 789). Differences between the groups were examined on HRQOL (SF-12v2), work productivity and activity impairment (WPAI questionnaire), and self-reported resource use in the last 6 months.
Patients with IBS-C reported significantly lower levels of HRQOL (physical component summary score: 41.55 [95% CI: 40.72-42.37] versus 44.49 [95% CI: 43.67-45.31]; mental component summary score: 40.58 [95% CI: 39.75-41.40] vs. 45.87 [95% CI: 45.04-46.70]) and significantly higher mean levels of presenteeism (31.72% [95% CI: 28.25%-35.61%] vs. 21.43% [95% CI: 19.03%-24.15%]), overall work impairment (35.54% [95% CI: 31.76%-39.76%] vs. 25.29% [95% CI: 22.59%-28.30%]), and activity impairment (45.78% [95% CI: 43.08%-48.66%] vs. 33.03% [95% CI: 31.08%-35.11%]) than matched comparators (all P values < 0.01). Patients with IBS-C reported significantly more provider visits (8.07 [95% CI: 7.38-8.82] vs. 5.55 [95% CI: 5.07-6.08]) and emergency room visits (0.57 [95% CI: 0.46-0.70] vs. 0.36 [95% CI: 0.29-0.45]) in the past 6 months (all Ps < 0.01). No statistically significant differences between the groups were observed in absenteeism or the number of the days hospitalized.
IBS-C was associated with poorer HRQOL, greater work productivity loss and activity impairment, and greater healthcare resource use. Limitations include the study's cross-sectional design and its self-reported nature. Nevertheless, improved management of IBS-C may reduce the humanistic and economic burden of the condition and benefit patients, employers, and the healthcare system.
Current Medical Research and Opinion 09/2011; 27(11):2213-22. · 2.38 Impact Factor
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ABSTRACT: To determine the association between Alzheimer's disease (AD) symptom severity and caregiver outcomes.
This was a database analysis of the Alzheimer's Disease Caregiver Study, a cross-sectional, caregiver-reported study conducted in 2007. Data were collected nationwide via the Internet and in 8 cities: Detroit, Michigan; Knoxville, Tennessee; Los Angeles, California; Miami, Florida; Philadelphia, Pennsylvania; Phoenix, Arizona; St Louis, Missouri; and Washington, DC. Participants were unpaid adult caregivers of AD patients (N = 1,077). Symptom severity was measured using the Revised Memory and Behavioral Problem Checklist (RMBPC). Caregiver outcomes included the Caregiver Burden Scale, diagnosis of anxiety and depression, use of the emergency room, hospitalization, number of physician visits, and missed workdays in the past 6 months. Linear and logistic regression models were developed to assess effects of AD symptom severity on outcomes. Covariates included caregiver and patient characteristics and interactions of AD symptom severity with covariates based on previous analyses.
Of the 1,077 respondents, 1,034 had valid RMBPC overall symptom severity scores. AD symptom severity was a significant (P < .01) predictor of all caregiver outcomes except physician visits. Each unit increase in RMBPC severity score corresponded with an increase of 0.328 (95% CI, 0.101-0.554) units in caregiver burden. Each unit increase in severity resulted in increases in physician visits (b = 0.343; 95% CI, 0.052-0.635) and absenteeism (b = 1.722; 95% CI, 0.694-2.749). For each unit increase in RMBPC severity score, caregivers had greater likelihood of emergency room use (odds ratio = 1.506; 95% CI, 1.230-1.845), hospitalization (OR = 1.393; 95% CI, 1.091-1.777), anxiety (OR = 1.506; 95% CI, 1.257-1.805), and depression (OR = 1.811; 95% CI, 1.505-2.179).
AD symptom severity is significantly associated with poorer caregiver outcomes. Therefore, treatments that slow AD symptom progression may be beneficial to caregiver outcomes.
The primary care companion to CNS disorders. 01/2011; 13(3).
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ABSTRACT: The objective of this study was to evaluate the economic and humanistic burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA). A database analysis of National Health and Wellness Survey, an annual cross-sectional study of health status and outcomes of US adults, was performed. CINA was defined as experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. No insomnia was defined as not self-reporting insomnia, sleep difficulties, or sleep symptoms. Outcomes included resource utilization in the past 6 months, the Work Productivity and Activity Impairment questionnaire, and the SF-8. Linear regression models were developed to assess the independent effects of CINA on outcomes while controlling for demographics and comorbidity. In all, 1523 respondents met the criteria for CINA and 24,106 met the criteria for no insomnia. Controlling for demographics and comorbidity, CINA sufferers had greater resource utilization (0.1 [P < 0.001] more emergency room visits, 0.2 [P = 0.001] more days hospitalized, and 2.5 [P < 0.001] more provider visits), 22.4% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 6.2 (P < 0.001) and 6.8 (P < 0.001) points lower than those with no insomnia, respectively. Among those employed full time, CINA sufferers had greater work productivity impairment (4.0% due to absenteeism, 17.6% due to presenteeism, and 15.6% greater overall productivity impairment) than those with no insomnia (P < 0.001 for all). CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality 16 of life, and work productivity.
Population Health Management 02/2010; 13(1):15-20. · 1.02 Impact Factor
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ABSTRACT: The purpose of this study was to better understand the characteristics and patterns of treatment of flares of ulcerative colitis (UC) from the patient's perspective. A secondary objective was to determine the predictive value of disease characteristics, particularly disease flares, on current use of biologic therapy.
Study participants were recruited from an Internet panel of self-identified individuals with inflammatory bowel disease (UC or Crohn's disease). The present analysis was limited to individuals who reported having a diagnosis of UC, were aged >or=18 years, resided in the United States, and could speak and write English. Cross-sectional data (demographic characteristics, insurance coverage, incidence of flares, patient experiences, treatment patterns) were collected via a self-reported Internet-based questionnaire during the third quarter of 2008.
A total of 505 individuals with UC completed the survey (72.7% female; 16.6% non-white; 37.2% college graduates; mean [SD] age, 48.6 [2.8] years). The mean time since the diagnosis of UC was 11.9 (10.1) years, and 76.6% of respondents characterized their disease as controlled. Overall, 27.9% of the sample reported >or=1 flare per week, and an additional 25.1% reported >or=1 flare per month. Most disease flares (76.5%) lasted <or=7 days and were classified as moderate in severity (51.9%). Among those reporting >or=1 flare per week, 30.5% classified their overall disease severity as mild, 56.0% as moderate, and 13.5% as severe. The majority of respondents with >or=1 flare per week currently used 5-aminosalicylic acids (5-ASAs) (41.1%) or corticosteroids (49.6%), whereas 19.1% used immunomodulators and 17.0% used biologics. Disease flares were most commonly treated by increasing the dose of the current medication (60.4%) or adding a corticosteroid to the treatment regimen (34.5%).
More than half of these individuals with UC reported experiencing disease flares >or=1 time per week or month. The majority reported using 5-ASAs or corticosteroids as maintenance medications and increasing the dose or adding corticosteroids to control flares in the short term.
Clinical Therapeutics 02/2010; 32(2):238-45. · 2.32 Impact Factor
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ABSTRACT: To identify and quantify the burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA) among depression and anxiety sufferers.
Data were obtained from the 2006 US National Health and Wellness Survey, an annual cross-sectional study of US adults. Analyses were limited to respondents diagnosed with depression or anxiety. The term CINA was defined as experiencing nighttime awakenings, without difficulty falling asleep, at least twice per week for more than 1 month that have moderate-severe impact on daily life. Outcomes included resource utilization in past 6 months, the Work Productivity and Activity Impairment questionnaire, and the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8). Independent effects of CINA on outcomes adjusting for demographics and comorbidity were assessed using linear regression models.
Among depression sufferers, 643 experienced CINA and 1,675 experienced no insomnia. Among anxiety sufferers, 476 experienced CINA and 1,356 experienced no insomnia. Adjusting for demographics and comorbidity, depression sufferers with CINA had 2.4 more provider visits, 13.2% greater work impairment (among full-time employed), 18.2% greater activity impairment, and SF-8 physical and mental summary scores that were 4.8 and 6.7 points lower than noninsomnia sufferers (P < .001 for all). Anxiety sufferers with CINA had 3.0 more provider visits, 15.8% greater work impairment (among full-time employed), 20.4% greater activity impairment, and SF-8 physical and mental summary scores that were 5.4 and 7.6 points lower than noninsomnia sufferers (P < .001 for all).
Among depression and anxiety sufferers, CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality of life, and work productivity.
The Primary Care Companion to The Journal of Clinical Psychiatry 01/2010; 12(2).
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ABSTRACT: Concomitant allergic rhinitis (AR) adds to the symptomatic burden of asthma.
To determine the proportion of adults with concomitant asthma and AR whose AR is diagnosed and/or treated, data were derived from a cross-sectional, stratified, random sample of 26,468 adults from France, Germany and the UK, participants in the 2004 web-based National Health and Wellness Survey. Patients were drawn from the database if they reported (1) experiencing asthma in the prior 12 months, (2) a physician diagnosis of asthma, and (3) ever experiencing 'nasal allergies/hay fever' (physician diagnosed or self-reported symptoms).
Of 1139 patients with asthma who reported AR, 203 (18%) did not have a diagnosis of AR. Of these, 86 (42%) pursued over-the-counter self-treatment for AR, and 117 (58%) remained untreated. Of 936 patients who reported diagnosed AR, 471 (50%) received AR prescriptions, 200 (21%) pursued over-the-counter self-treatment, and 265 (28%) remained untreated. Overall, 34% of patients with asthma and diagnosed or self-reported AR were not treated for AR. There were no significant differences in QoL over the prior 4 weeks, nor healthcare resource use over the prior 6 months between patients treated and those not treated for AR.
Based on self-reported data, despite global treatment guidelines recommending evaluation and treatment of AR among patients with asthma, AR was not diagnosed for 1 in 5 patients, and AR was not treated for 1 in 3 patients with asthma.
Current Medical Research and Opinion 08/2009; 25(7):1721-6. · 2.38 Impact Factor
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ABSTRACT: To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment.
Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders.
A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (-5.40) and mental (-4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all).
Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.
Quality of Life Research 06/2009; 18(4):415-22. · 2.30 Impact Factor
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ABSTRACT: To determine the effect of lower urinary tract symptoms, including overactive bladder/urinary incontinence, on health outcomes.
Data were obtained from the 2006 U.S. National Health and Wellness Survey. Cases (those who reported experiencing a sudden overwhelming urge to urinate, a frequent urge to urinate, or urinating >8 times/d) were matched 1:1 with controls (those not experiencing any symptoms) by age, race, sex, educational attainment, and comorbidity status. The outcome measures assessed included health resource use, work productivity loss/activity impairment, and health-related quality of life.
Of the 62,833 respondents to the 2006 U.S. National Health and Wellness Survey, 13,957 case-control pairs were matched. The presence of lower urinary tract symptoms, including OAB/UI symptoms, was significantly associated with increased resource use (emergency room visits, odds ratio -1.57, 95% confidence interval -1.47-1.68; hospitalizations, odds ratio -1.56, 95% confidence interval 1.43-1.69; medical provider visits, odds ratio -1.52, 95% confidence interval 1.41-1.63), 8.03% greater overall work productivity loss (P < .001), 12.88% greater activity impairment (P < .001), and decreased health- related quality of life (mental scores, 4.07 points lower [P < .001]; physical scores, 4.14 points lower [P < .001]).
The burden of illness associated with lower urinary tract conditions, including OAB/UI, extend beyond the diagnosed population. The appropriate diagnosis and treatment of symptoms could lead to better clinical, economic, and humanistic outcomes.
Urology 06/2009; 74(1):34-8. · 2.43 Impact Factor
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ABSTRACT: Nighttime symptoms of gastroesophageal reflux disease (GERD) are prevalent and have negative effects on sleep quality. We quantified the effects of GERD symptoms on sleep difficulties and their effects on outcomes.
Data were obtained from a patient-reported survey conducted in 2006 among the general US population. Respondents who had experienced GERD symptoms at least twice during the past month were categorized as GERD patients and were subclassified into groups on the basis of nighttime symptoms and sleep difficulties. Outcomes included health care resource use in past 6 months, work productivity and activity impairment (WPAI), and health-related quality of life (HRQOL) based on results of the Short-Form Health Survey (SF-8). Regression analysis was used to adjust for demographics and clinical characteristics.
Of 11,685 survey respondents with GERD, 88.9% experienced nighttime symptoms, 68.3% sleep difficulties, 49.1% difficulty initiating asleep (induction symptoms), and 58.3% difficulty maintaining sleep (maintenance symptoms). Respondents with nighttime GERD symptoms were more likely to experience sleep difficulties (odds ratio, 1.53) and difficulties with induction (odds ratio, 1.43) and maintenance (odds ratio, 1.56) of sleep (P < .001 for all). Sleep difficulties were associated with 0.9 additional provider visits, a 5.5% increase in overall work impairment, a 10.9% increase in activity impairment, and reductions of 3.1 and 3.6 points in SF-8 physical and mental summary scores, respectively.
Nighttime GERD symptoms are associated with interruption of sleep induction and maintenance and result in considerable economic burden and reduction in HRQOL.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2009; 7(9):953-9. · 5.64 Impact Factor
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ABSTRACT: To assess the association of diabetes, hypertension, and high cholesterol with economic and humanistic outcomes among overweight or obese individuals.
Data were from the 2006 National Health and Wellness Survey and were limited to overweight or obese adults (BMI > 27). Outcomes assessed include the SF-8, resource use, and the Work Productivity and Activity Impairment questionnaire. Independent effects of comorbid conditions were determined using linear regression models.
Significant associations between comorbid conditions and outcomes were noted. Comorbid conditions had significant independent effects on outcomes. The presence of all three comorbid conditions was the strongest correlate of work productivity loss (B = 13.992) and activity impairment (B = 13.397) and had the strongest negative association with SF-8 physical (B = -8.239) and mental summary scores (B = -2.605).
Among, overweight or obese individuals, comorbid conditions are associated with greater productivity loss, resource use, and poorer quality of life.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 06/2008; 50(5):542-9. · 1.88 Impact Factor
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ABSTRACT: To identify characteristics of patients diagnosed with unipolar depression who may have undiagnosed bipolar disorder.
Patients diagnosed with unipolar depression by a healthcare provider were identified through the Consumer Health Sciences National Health and Wellness Survey. Manic symptoms, comorbid conditions, psychiatric symptomatology, use of healthcare resources, and patient demographics were identified through Internet-based questionnaires. A self-report adapted version of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria identified symptoms consistent with a manic episode. Psychological well-being was measured by the Psychological General Well-Being Index.
Of the 1,602 respondents who met inclusion criteria, 219 (14% or approximately 1 out of 7) reported symptoms consistent with a manic episode and were considered at risk for undiagnosed bipolar disorder. These respondents were younger and had a lower socioeconomic status. At-risk patients rated their depression as more severe and experienced greater impairment of psychological well-being. More than 70% of those at risk reported speaking with a healthcare provider about their mania symptoms. Comorbid mental disorders, especially anxiety-related conditions, were common in these patients.
These findings underscore the importance of evaluating unipolar patients for bipolar disorder and may help clinicians identify symptoms and comorbidities associated with patients with unipolar depression at risk for undiagnosed bipolar disorder.
CNS spectrums 04/2008; 13(3):216-24. · 2.20 Impact Factor
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ABSTRACT: To compare patient and nurse satisfaction with intravenous patient-controlled analgesia (IV-PCA) to their prospective satisfaction with patient-controlled transdermal delivery system (PCTS) technology.
Nationwide samples of 301 nurses (200 medical-surgical, 101 post-anesthesia care units) and 500 surgery patients (192 abdominal, 119 gynecological, 189 orthopedic) completed self-administered, Internet-based questionnaires. Respondents indicated satisfaction with attributes of IV-PCA and, after reading a description of PCTS, indicated prospective satisfaction with comparable attributes. Within patient and nurse samples, half rated IV-PCA first (and later re-rated overall satisfaction) and half rated PCTS first. Paired comparison t-tests were used to determine significant differences in satisfaction for IV-PCA and PCTS attributes.
Nurses reported significantly higher satisfaction with PCTS for patient and nurse ease of use, safety, and tolerability (p < 0.001 for all); and higher satisfaction with IV-PCA for the ability to vary drugs (p < 0.001) and doses (p < 0.001), deliver basal doses (p < 0.001), and dose tracking accessibility (p = 0.003) and quality (p = 0.002). Patients reported significantly higher satisfaction with PCTS for pain relief (p < 0.001), safety (p = 0.027), self-control (p < 0.001), and patient (p < 0.001) and nurse ease of use (p < 0.001); and higher satisfaction with IV-PCA for correct set-up and programming (p = 0.002). Overall satisfaction did not differ significantly among nurses, but among patients satisfaction with IV-PCA declined after considering PCTS (p < 0.001). Nurses placed greater importance on safety to their overall satisfaction than patients did.
Only respondents with Internet access were included. PCTS satisfaction is hypothetical and may not reflect true product satisfaction.
PCTS is a novel delivery system for postoperative pain and has the potential to improve patient and nurse satisfaction over IV-PCA.
Current Medical Research and Opinion 10/2007; 23(10):2507-16. · 2.38 Impact Factor
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ABSTRACT: To evaluate the effects of individual and condition characteristics on satisfaction with extended release tolterodine or oxybutynin in overactive bladder (OAB).
Data were from the 2005 National Health and Wellness Survey, an annual, nationally representative, self-administered, internet-based survey of 40,000+ US adults (age 18+). Inclusion criteria for analysis were diagnosed OAB and using extended release tolterodine or oxybutynin but no other prescription medications for OAB. Satisfaction with extended release tolterodine or oxybutynin was rated on a five-point scale from 1 = not at all satisfied to 5 = extremely satisfied. Linear regression was used to evaluate independent effects demographics, patient perception of OAB, duration of use, requesting of medication, type of prescribing physician, medication compliance, and mental and physical health-related quality of life (Medical Outcomes Study, Eight-item Short-Form Health Survey; SF-8) on treatment satisfaction.
There were 345 patients who met the inclusion criteria. Apparent predictors of medication satisfaction, in order of magnitude of effect, were: feelings that OAB is just an inconvenience (standardized beta = -0.28; p < 0.001); less impact of OAB on daily life (standardized beta = 0.24; p < 0.001); longer duration of use (standardized beta = 0.10; p = 0.052); overwhelming urges to urinate (standardized beta = 0.10; p = 0.061); younger age (standardized beta = -0.10; p = 0.054); and more frequent medication use (standardized beta = 0.09; p = 0.096).
Data were cross-sectional and self-reported by patients via the internet.
Patient treatment satisfaction is affected by perceptions of OAB symptoms and impact, as well as consistent, long-term use of prescription treatments. Clinicians should reinforce to patients the importance of long-term compliance for successful treatment.
Current Medical Research and Opinion 08/2007; 23(8):1903-12. · 2.38 Impact Factor
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ABSTRACT: The study was conducted to examine the influence of demographics, health-related quality of life (HRQL) and duration of use on satisfaction with the transdermal contraceptive patch or oral contraceptives (OCs).
In this cross-sectional analysis of the 2004 National Health and Wellness Survey (NHWS), women were currently using the patch (n=257) or OCs (n=1824). Outcome variable was a five-point satisfaction scale (1=not at all; 5=extremely). Satisfaction rates were computed as the percentage of patients reporting a 4 or 5. Independent variables included demographics, HRQL (SF-8), duration of use, and treatment (patch or OCs). Logistic regression evaluated association of independent variables.
Patch use was associated with significantly higher satisfaction than OCs (OR=2.05; 95% CI=1.34-3.15; p=.001) in the logistic regression model. Months using product (p<.001), days used product in past month (p<.001) and mental well-being (p=.02) were other variables associated with satisfaction.
Patch use, duration of use and mental well-being were associated with satisfaction.
Contraception 05/2007; 75(4):281-4. · 2.72 Impact Factor
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ABSTRACT: To understand the impact of anemia on health-related quality of life (HRQOL) and healthcare resource utilization (HRU) in patients with HIV/AIDS.
In 2003, adults with HIV/AIDS were recruited through 114 US STD/HIV clinics to complete self-administered questionnaires. Adults reporting anemia as a side-effect of antiretroviral therapy (ART) during the past month were considered anemic. HRU was evaluated by emergency room (ER) visits, days of hospitalization, and healthcare provider visits in the past 6 months. The SF-8 was used to measure HRQOL. Linear regression was used to evaluate independent effects of anemia on HRQOL and HRU controlling for demographics, years since HIV diagnosis, HIV viral load, CD4 + count, and ART use.
2044 patients were enrolled, with 498 (24%) experiencing anemia. Anemic patients had lower SF-8 summary scores (mental: 38.2 +/- 11.6 vs. 42.9 +/- 11.9, p < 0.001; physical: 40.1 +/- 10.0 vs. 45.5 +/- 10.4, p < 0.001) than nonanemic patients. HRU in the anemic group was significantly higher (p < 0.05), with respect to percentage of patients visiting ER, mean number of ER visits, mean number of days hospitalized, and mean number of total visits to providers. In linear regression models, anemic patients had mental and physical HRQOL scores more than 4 points lower than nonanemic patients (p < 0.001 for both). Additionally, anemic patients had 2.7 more visits to healthcare providers (p < 0.001).
Data were cross-sectional, self-reported by patients, and did not include clinical measures of anemia.
Based on this survey, self-reported anemia appears to be associated with worsened HRQOL and greater HRU among HIV/AIDS patients using ART.
Current Medical Research and Opinion 04/2007; 23(4):803-10. · 2.38 Impact Factor
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ABSTRACT: Objective: Bipolar disorder is frequently misdiagnosed as major depressive disorder (MDD). We aim to quantify the prevalence of misdiagnosed bipolar disorder among the depression population and evaluate the quality-of-life (QOL) impact of misdiagnoses.Method: Data were collected from 2 self-administered, cross-sectional studies in 2003. Patients participating in The Bipolar Disorder Misdiagnosis Study (N = 1156) were previously diagnosed with depression, experienced a depressive episode within the past year, and had no previous diagnosis of bipolar disorder or schizophrenia. Patients who experienced a manic episode in the past year, based on DSM-IV criteria, were classified as misdiagnosed. Patients participating in The Bipolar Disorder Project (N = 1214) self-reported a diagnosis of bipolar disorder and were recruited through community mental health centers and support groups. Quality of life was assessed via the Psychological General Well-Being (PGWB) Index and Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8). Demographic differences between groups were controlled using linear regression models.Results: Of the diagnosed MDD sample, 14.3% met criteria for misdiagnosed bipolar disorder. When controlling for demographic differences, the PGWB overall score for the misdiag-nosed averaged 12.77 (p < .001) points lower than that of MDD patients and 9.55 (p < .001) points lower than that of diagnosed bipolar disorder patients. The average SF-8 mental component summary score for the misdiagnosed was 5.85 (p < .001) points lower than that of MDD patients and 3.18 (p = .002) points lower than that of diagnosed bipolar disorder patients.Conclusion: Misdiagnosis is associated with poorer QOL than MDD or diagnosed bipolar disorder, which are recognized as having a considerable impact on QOL.
The Primary Care Companion to The Journal of Clinical Psychiatry 02/2007; 9(3):195-202.
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ABSTRACT: To assess patient preferences across two attributes--effectiveness and convenience--in the selection of an erythropoietic agent to treat chemotherapy-related anemia.
During 2004, 500 adults with solid tumors and anemia were recruited through 50 oncologists' offices across the USA. Data were collected through self-administered questionnaires, divided into two parts. The first, completed by the provider, captured clinical information and providers' perceptions of patient preferences. The second, completed by the patient, recorded knowledge, experiences, and preferences regarding anemia and its treatments. Patient preferences, the relative importance of effectiveness (time to noticeable relief of fatigue) and convenience (number of provider visits required in an 8-week period), were measured using a choice-based conjoint (CBC) analysis. Each attribute was assessed at three levels (4, 6, or 8 weeks/visits).
467 providers (93%) and 438 patients (88%) completed the preference sections. When choosing a medication to treat anemia, 77% of providers viewed effectiveness as more important to patients than convenience. Similarly, patients had a greater preference for effectiveness than convenience. Relative preference weights were significantly higher for 4- versus 6-week effectiveness (0.61 vs. 0.09, p < 0.001) and 6- versus 8-week effectiveness (0.09 vs. -0.70, p = 0.004). Overall, time to effectiveness was twice as important to patients as the number of visits.
Only two attributes were included in the CBC, which did not control for bias from respondent characteristics or experiences.
When evaluating an erythropoietic agent to treat chemotherapy-related anemia, both providers and patients view effectiveness as more important than convenience.
Current Medical Research and Opinion 01/2007; 23(1):85-92. · 2.38 Impact Factor
