Pathways of Teach-Back Communication to Health Outcomes Among Individuals With Diabetes: A Pathway Modeling

Teach-back method can help promote interactive communication between patients and providers. However, the mechanism of how teach-back operates in routine care is uninvestigated. Using pathway analysis, we explored the potential pathways of patient teach-back to health outcomes among individuals with diabetes. Study sample included 2901 US adults with diabetes ascertained from the 2011 to 2016 Longitudinal Medical Expenditure Panel Survey. Our pathway model analysis showed that patient teach-back was associated with better interaction with providers, shared decision-making, and receiving lifestyle advice. Teach-back had a direct negative effect on condition-specific hospitalization and indirect negative effects through lifestyle advice and diabetic complication. Teach-back method may promote active interactions between patients and providers by creating an opportunity to be more engaged in shared decision-making and receive additional health advice from providers. These improvements seem to be associated with a reduction in risks for complications and related hospitalization.

The Impacts of the COVID-19 Pandemic on the Medical Expenditure Panel Survey

The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). The MEPS is widely used to study how policy changes and major shocks, such as the COVID-19 pandemic, affect insurance coverage, access, and preventive and other health care utilization and how these relate to population health. We describe how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules. The impact of the pandemic on response rates varied considerably across the MEPS. Investigations to date show little effect on the quality of data collected. However, lower response rates may reduce the statistical precision of some estimates. We also describe several enhancements made to the MEPS that will allow researchers to better understand the impact of the pandemic on US residents, employers, and the US health care system. (Am J Public Health. 2021;111(12):2157–2166. https://doi.org/10.2105/AJPH.2021.306534 )

Does Closing the Donut Hole Reduce Financial Burdens Among Medicare Part D Beneficiaries?

The Medicare Part D donut hole has been gradually closed since 2010. But it is still unclear how it has impacted the beneficiaries’ relative financial burdens, especially in the later stage of the closing plan. The measurement of catastrophic health expenditure induced by prescription drugs (CHE-Rx) reflects the relative financial burdens to beneficiaries’ household income, which bears more information than the measure of dollar-value expenses or the absolute poverty line used in prior studies. Using the Medical Expenditure Panel Survey 2008-2017 longitudinal national representative data and the method of difference-in-differences, this study found that the donut hole closing policy was associated with more usage of prescription drugs (b=2.84, p=0.023) and a higher likelihood of experiencing CHE-Rx (b=2.4%, p=0.011) among those who fell in the donut holes. Besides, the results show that the donut hole closing policy did not generate any immediate effects on prescription drug usage, CHE, and CHE-Rx. For the first time, this paper examined both the aggregated and marginal impact of the policy implementation, which had closed by an additional 35% between 2013 and 2017, on the relative financial burden among the beneficiaries.

Disparities in Cognition Among U.S. and Foreign-Born Minority Populations With and Without Diabetes

Adults with cognitive limitations and diabetes may be less able to adhere to treatment recommendations. Our aims were to: 1) estimate and compare the prevalence of cognitive limitations and diabetes among foreign-born non-Hispanic whites, blacks, Hispanics, Asians, and Arab Americans to US-born non-Hispanic whites; and 2) examine associations after controlling for covariates. We linked 2002-2016 National Health Interview Survey and 2003-2017 Medical Expenditure Panel Survey data (ages >=45 years, n=122,898). The prevalence of cognitive limitations was highest among foreign-born non-Hispanic whites (9.71%) and Arab Americans (9.40%) and lowest among foreign-born blacks (5.19%). Foreign-born non-Hispanic whites had higher odds (OR=1.36; 95% CI=1.05-1.49) of cognitive limitations than their US-born counterparts. Foreign-born Hispanics with diabetes had greater odds of cognitive limitations (OR=1.91; 95% CI=1.63, 2.24) compared to US-born non-Hispanic whites. Additional findings will be discussed focused on stressors that may contribute to cognition disparities using the immigrant health paradox framework.

Disability Profile and Accessibility Limitations among Persons with Physical Disability in Nigeria

Purpose: To evaluate disability profile and accessibility limitations among Persons Living with Disabilities (PLWDs) in Nigeria. Methods: 61 PLWDs (44 men, 17 women) consented for this study. World Health Organization Disability Assessment Schedule 2.0, Facilitators and Barriers Survey for People with Mobility Limitations version 2, Barthel Index, and Medical Expenditure Panel Survey Questionnaires were used to obtain data on physical disability profile, level of access barriers, activities of daily living and quality of access to health care respectively. A proforma was used to collect information on socio-demographic characteristics. Data were analyzed using descriptive and inferential statistics. Alpha level set at p< 0.05. Results: Prevalence of mobility, visual and hearing impairments were 60.7%, 21.3% and 6.6% respectively, There was a 11.5% rate of functional limitation while mild difficulty with ‘cognition’ and ‘life activities’ were reported among 96.7% and 65.6% of the respondents. 24.6% of the respondents had partial mobility dependence. There was low quality of access to health care (67.2%), high access barrier to home environment (73.8%) and transportation (93.4%). Conclusion: The PLWDs have high mobility impairment and face barriers in accessing healthcare, transportation and environment.

The accuracy and completeness of drug information in Google snippet blocks

Introduction: Consumers commonly use the Internet for immediate drug information. In 2014, Google introduced the snippet block to programmatically search available websites to answer a question entered into the search engine without the need for the user to enter any websites. This study compared the accuracy and completeness of drug information found in Google snippet blocks to US Food and Drug Administration (FDA) medication guides.Methods: Ten outpatient drugs were selected from the 2018 Clinical Drugstats Database Medical Expenditure Panel Survey. Six questions in the medication guide for each drug were entered into the Google search engine to find the snippet block. The accuracy and completeness of drug information in the Google snippet block were quantified by two different pharmacists using a scoring system of 1 (less than 25% accurate/complete information) to 5 (100% accurate/complete information). Descriptive statistics were used to summarize the scores.Results: For five out of the six questions, the information in the Google snippets had less than 50% accuracy and completeness compared to the medication guides. The average accuracy and completeness scores of the Google snippets were highest for “What are the ingredients of [the drug]?” with scores of 3.38 (51–75%) and 3.00 (51–75%), respectively. The question on “How to take [drug]?” had the lowest score with averages of 1.00 (<25%) for both accuracy and completeness.Conclusion: Google snippets provide inaccurate and incomplete drug information when compared to FDA-approved drug medication guides. This aspect may cause patient harm; therefore, it is imperative for health care and health information professionals to provide reliable drug resources to patients and consumers if written information may be needed.

Patterns of Healthcare Expenditures among Older United States Adults with Pain and Different Perceived Health Status

The objective of this study was to assess the pattern of healthcare expenditures among United States (U.S.) adults aged ≥ 50 years with pain and annual total positive healthcare expenditures with different levels of perceived health. The study used the 2018 Medical Expenditure Panel Survey data. Unadjusted and adjusted linear regression models were used to compare logarithmically transformed total healthcare expenditures between those with excellent, very good, good, and fair/poor health. The a priori alpha value was 0.05. The study included 5123 U.S. adults aged ≥50 with self-reported pain (excellent = 8.9%, very good = 28.3%, good = 36.2%, fair/poor = 26.6%). In adjusted analyses, compared to fair/poor health, those with excellent health had the greatest adjusted reduction in expenditures (55% lower), followed by very good health (36.5% lower) and good health (24.9% lower). In conclusion, total positive healthcare expenditures were comparatively lower among those with better perceived health status for older (≥ 50 years) U.S. adults with pain that interfered with normal work in the past four weeks.