Medication Services Research Articles

Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review.

As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Out of 29 studies, 16 (55%) studies examined phone-based interventions, 9 (31%) studies focused on tele- and e-based interventions, and 4 (14%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa.

Tackling Inequalities in Access to Medicines for People Experiencing Homelessness: A Meta-Ethnography and Qualitative Systematic Review.

Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta-ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap. A systematic literature search was undertaken in October and re-ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines. This meta-ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third-order constructs (termed 'themes') were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities. This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived-experience narratives and co-design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population. Not applicable, as this is a systematic review. Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity.

Evaluation of a Pharmacist-Driven Discharge Medication Reconciliation Service Pilot at a Children’s Hospital

OBJECTIVE The purpose of this study was to evaluate the feasibility of a pharmacist-driven discharge medication reconciliation (DMR) service at our children’s hospital by completing a 2-week pilot on a general pediatrics unit. METHODS This was a prospective study and included patients discharged during pilot hours whose DMR was completed by the pharmacist. The primary outcome was evaluation of time required for a pharmacist to complete the DMR. Secondary outcomes included classification of pharmacist interventions made and their associated cost-avoidance, medication-related problems reported within 14 days of discharge, hospital readmission due to medication problems within 30 days of discharge, and medical resident satisfaction assessed via prepilot and postpilot surveys. RESULTS A total of 67 patients had their DMR completed by a pharmacist during the pilot. The pharmacist spent an average of 30 minutes completing each DMR, although this was variable, as evidenced by an SD of 36.4 minutes. Pharmacists documented 89 total interventions during the study period. The most common intervention types were therapeutic optimization (32.6%) and modification of directions (29.2%). Total estimated cost-avoidance during the study pilot was $84,048.01. For the pilot population, 1 medication-related problem was identified within 14 days of discharge. There were no medication-related readmissions identified. Medical residents reported increased confidence that the DMR was completed accurately and satisfaction with the DMR process during the pilot compared with before the pilot. CONCLUSIONS Implementing a pharmacist discharge medication service requires consideration of ­pharmacist time and salary, which may be offset by cost-avoidance.

All-cause mortality risk in long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis.

Patients with schizophrenia receiving antipsychotic treatment present lower mortality rates than those who do not. However, the non-adherence rate is high, which can be partially addressed using long-acting injectable (LAI) antipsychotics. The impact of LAI treatments on all-cause mortality compared to oral antipsychotics remains unclear. To fill that gap, a random effects meta-analysis was conducted to analyze the odds ratio (OR) of all-cause, suicidal, and non-suicidal mortality among patients taking LAI antipsychotics compared to oral antipsychotics (PROSPERO:CRD42023391352). Individual and pooled LAI antipsychotics were analyzed against pooled oral antipsychotics. Sensitivity analyses were performed for study design, setting, and industry sponsorship. Meta-regressions were conducted for gender, age, antipsychotic dose, and race. Seventeen articles, total sample 12,042 patients (N = 5795 oral, N = 6247 LAI) were included. Lower risk of all-cause mortality for patients receiving LAI antipsychotics vs receiving oral antipsychotics was found (OR = 0.79; 95%CI = 0.66-0.95). Statistical significance was maintained when only studies comparing the same LAI and oral antipsychotic were included (OR = 0.79; 95%CI = 0.66-0.95; p = <0.01), as well as for non-suicidal mortality (OR = 0.77: 95%CI = 0.63-0.94; p = 0.01), but not for suicidal mortality (OR = 0.86; 95%CI = 0.59-1.26; p = 0.44). Mortality reduction was more pronounced for LAI antipsychotics in first-episode psychosis (FEP) (OR = 0.79; 95%CI = 0.66-0.96) compared to chronic psychosis. No individual LAI reported statistically significant differences against all pooled oral antipsychotics. LAI antipsychotics are associated with a lower risk of all-cause and non-suicidal mortality in individuals with schizophrenia compared to oral antipsychotics. Better adherence to the medication and health services may explain this difference. Whenever possible, the use of LAIs should be considered from the FEP.

Levels of Telehealth Use, Perceived Usefulness, and Ease of Use in Behavioral Healthcare Organizations After the COVID-19 Pandemic.

The use of telehealth in behavioral healthcare increased significantly since the start of the COVID-19 pandemic and remains high even as a return to in-person care is now feasible. The use of telehealth is a promising strategy to increase access to behavioral healthcare for underserved and all populations. Identifying opportunities to improve the provision of telehealth is vital to ensuring access. An online survey about the current use of, and attitudes toward, telehealth was conducted by five Mental Health Technology Transfer Center (MHTTC) regional centers and the MHTTC Network Coordinating Office. The national MHTTC network provides training and technical assistance, to support the behavioral health workforce to implement evidence-based treatments. Three hundred and sixty-five respondents from 43 states and Puerto Rico participated. The majority of respondents were clinical providers (69.3%). Nearly all (n = 311) respondents reported providing at least one telehealth service at their organization, but the number and type of services varied substantially. Respondents had positive views of both video-based and phone-based services, but most had some preference for video-based telehealth services. Other services, including text message reminders, medication services, and mobile apps for treatment or recovery, were offered via telehealth by ~ 50% or fewer of respondents' organizations. Many organizations have areas where they could expand their telehealth use, allowing them to extend the reach of their services and increase access for populations that experience barriers to service access, though organizational barriers may still prevent this.

Temporal trends in medication and service use patterns for mental health issues among men with prostate cancer.

Prostate cancer can significantly impact mental wellbeing, creating uncertainty and morbidity. This study described patterns of psychotropic medication and mental health service use, as a proxy measure for mental health problems, 5years before and 5years after prostate cancer diagnosis. Population-based registry data were linked with Pharmaceutical Benefits Scheme and Medicare Benefits Schedule data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020 (n=13,693). We estimated the proportion and rates of psychotropic medication and mental health service use before and after diagnosis. Multivariable adjusted interrupted time series analyses (ITSA) were conducted to uncover temporal patterns. Fifteen percent of men commenced psychotropic medications and 6.4% sought out mental health services for the first time after diagnosis. Psychotropic medication use rose from 34.5% 5years before to 40.3% 5years after diagnosis, including an increase in use of antidepressants (from 20.7% to 26.0%) and anxiolytics (from 11.3% to 12.8%). Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits (from 7.8% to 10.6%). Multivariable ITSA indicated a significant rise in medication and service utilisation immediately before and in the first 2years following prostate cancer diagnosis. There is a clear increase in psychotropic medication use and mental health service use around the time of prostate cancer diagnosis. Mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.

A randomized controlled trial of an acceptance-based, insight-inducing medication adherence therapy (AIM-AT) for adults with early-stage psychosis

This study aimed to test the effectiveness of an acceptance-based medication adherence intervention for people with early-stage psychosis. An assessor-blind, three-arm randomized controlled trial design was used. One hundred and twenty-six participants who were adults with ≤3 years of psychosis were recruited from four district Integrated Community Centers for Mental Wellness in Hong Kong. They were randomly assigned to receive a 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) intervention, a conventional psychoeducation group program, or usual treatment (n = 42 per group). Primary outcomes were medication adherence and insight into the illness/treatment. All study outcomes were measured at recruitment and immediately, 6 months, and 12 months post-intervention. Participants in the AIM-AT experienced statistically significant improvements in the primary outcomes (levels of medication adherence and insight into illness/treatment), when compared to those in the other two groups over the 12-month follow-ups. The AIM-AT group also had significantly greater improvements in psychotic symptoms, psychosocial functioning, service satisfaction, length of rehospitalization, and total number of patients hospitalized over the follow-up period. These findings support the effectiveness of the AIM-AT to improve medication adherence, psychosocial health, and service satisfaction in people with early-stage psychosis.

Medication Error Prevention Using Healthcare Failure Mode And Effect Analysis At Clinical Pharmacy Installation

Medication error is the second most common patient safety incident worldwide. Medication errors can be defined as unintentional failures in medication services that have the potential to cause harm to patients. Maintaining safe health services is highly dependent on the ability of service providers to proactively conduct patient safety risk analysis, one of which is using the Healthcare Failure Mode and Effect Analysis (HFMEA) method. This study was aimed at obtaining the HFMEA design as an effort to prevent medication errors at Company X Clinical Pharmacy Installation. The research method used is qualitative research with a specific type of Operations Research. Data collected by in-depth interviews, observation, secondary data analysis, and focus group discussion. The results of this study found factors that cause medication errors to occur from organizational factors and staff factors. These results then analyzed for the HFMEA design which obtained 11 risks that required attention and then 14 action plans are made to overcome them. This study successfully developed HFMEA design to prevent medication error in Company X Clinical Pharmacy Installation.

Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life

BackgroundOne factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes. ObjectivesThe study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS. MethodsData on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL. ResultsA total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared to 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, p < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, p = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = −0.072, −0.022) between PEwP and HRQoL via respondents' PMU. ConclusionsMetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.

Use of antipsychotic medication, benzodiazepines, and psychiatric hospitalization in cannabis-related versus cannabis-unrelated schizophrenia - a nationwide, register-based cohort study.

Evidence suggests that cannabis may be a causal factor for development of schizophrenia. We aimed to investigate whether use of antipsychotic medication, benzodiazepines, and psychiatric service use differs among patients with schizophrenia depending on whether psychosis was precipitated by a diagnosis of cannabis use disorder (CUD). We utilized the nationwide Danish registries to identify all individuals with an incident diagnosis of schizophrenia from 1995 to 2016. We also collected information on whether first CUD diagnosis preceded schizophrenia and thus defined a group of potentially cannabis-related schizophrenia. We compared the cannabis-related schizophrenia group both with all non-cannabis-related patients with schizophrenia and with non-cannabis-related patients with schizophrenia that were propensity-score matched to cases using a range of potentially confounding variables. We included 35 714 people with incident schizophrenia, including 4116 (11.5%) that were cannabis-related. In the unmatched-comparison analyses, there were no clear differences over time in use of antipsychotics and benzodiazepines related to whether the diagnosis of schizophrenia was cannabis-related. After propensity-score matching, use of antipsychotics and benzodiazepines was significantly lower among cannabis-related cases of schizophrenia. In the unmatched comparison, the cannabis-related group had significantly more days admitted than the non-cannabis-related group. This was markedly attenuated after propensity-score matching. Our findings indicate the importance of considering cannabis-related cases of schizophrenia as a potentially distinct disorder in terms of prognosis. It is unclear, however, if these differences are due to different biological types of schizophrenia being compared or if they rather indicate behavioral differences such as reduced adherence and treatment-seeking.

Needs assessment study for management of menopause in the community.

To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs. A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured. Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences. A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available. The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

Understanding Risk Factors for Complaints Against Pharmacists: A Content Analysis.

Pharmacists constitute a crucial component of the healthcare system, significantly influencing the provision of medication services and ensuring patient safety. This study aims to understand the characteristics and risk factors for complaints against pharmacists through Health and Disability Commissioner (HDC) published decisions. This study adopts a retrospective, qualitative approach. An inductive content analysis technique was used to analyze 37 complaints against pharmacists published decisions from the New Zealand Health and Disability Commissioner website to investigate a range of underlying risk factors contributing to the occurrence of complaints against pharmacists. A set of 20 categories of risk factors emerged through the content analysis and were subsequently grouped into five overarching themes: pharmacist individual factors, organizational factors, system factors, medication-specific factors, and external environmental factors. The findings of this study provide valuable insights that expand the understanding of risk management in pharmacist practice, serving as a valuable resource for regulatory bodies, policymakers, educators, and practitioners. It is recommended not only to focus solely on individual pharmacists but also to consider integrating their environment and individual behaviors to proactively address situations prone to errors and subsequent complaints.

Complexity of patients with mental healthcare needs cared for by mental health clinical pharmacist practitioners in Veterans Affairs.

The complexity of patients with mental healthcare needs cared for by clinical pharmacists is not well delineated. We evaluated the complexity of patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD) in Veterans Affairs (VA) cared for by mental health clinical pharmacist practitioners (MH CPPs). Patients at 42 VA sites with schizophrenia, bipolar disorder, or MDD in 2016 through 2019 were classified by MH CPP visits into those with 2 or more visits ("ongoing MH CPP care"), those with 1 visit ("consultative MH CPP care"), and those with no visits ("no MH CPP care"). Patient complexity for each condition was defined by medication regimen and service utilization. For schizophrenia, more patients in ongoing MH CPP care were complex than those with no MH CPP care, based on all measures examined: the number of primary medications (15.3% vs 8.1%), inpatient (13.7% vs 9.1%) and outpatient (42.6% vs 29.7%) utilization, and receipt of long-acting injectable antipsychotics (36.7% vs 25.8%) and clozapine (20.5% vs 9.5%). For bipolar disorder, more patients receiving ongoing or consultative MH CPP care were complex than those with no MH CPP care based on the number of primary medications (27.9% vs 30.5% vs 17.7%) and overlapping mood stabilizers (10.1% vs 11.6% vs 6.2%). For MDD, more patients receiving ongoing or consultative MH CPP care were complex based on the number of primary medications (36.8% vs 35.5% vs 29.2%) and augmentation of antidepressants (56.1% vs 54.4% vs 47.0%) than patients without MH CPP care. All comparisons were significant (P < 0.01). MH CPPs provide care for complex patients with schizophrenia, bipolar disorder, and MDD in VA.

Out-of-pocket prescription drug costs for adults with cardiovascular risk factors under Amazon's direct-to-consumer pharmacy service

US adults often overpay for generic prescription medications, which can lead to medication nonadherence that negatively impacts cardiovascular outcomes. As a result, new direct-to-consumer online medication services are growing in popularity nationwide. Amazon recently launched a $5/month direct-to-consumer medication subscription service (Amazon RxPass), but it is unclear how many US adults could save on out-of-pocket drug costs by using this new service. To estimate out-of-pocket savings on generic prescription medications achievable through Amazon's new direct-to-consumer subscription medication service for adults with cardiovascular risk factors and/or conditions. Cross-sectional study of adults 18-64 years in the 2019 Medical Expenditure Panel Survey. Of the 25,280,517 (SE ± 934,809) adults aged 18-64 years with cardiovascular risk factors or conditions who were prescribed at least 1 medication available in the Amazon RxPass formulary, only 6.4% (1,624,587 [SE ± 68,571]) would achieve savings. Among those achieving savings, the estimated average out-of-pocket savings would be $140 (SE ± $15.8) per person per year, amounting to a total savings of $228,093,570 (SE ± $26,117,241). In multivariable regression models, lack of insurance coverage (adjusted odds ratio [OR] 3.5, 95%CI 1.9-6.5) and being prescribed a greater number of RxPass-eligible medications (2-3 medications versus 1 medication: OR 5.6, 95%CI 3.0-10.3; 4+ medications: OR 21.8, 95%CI 10.7-44.3) were each associated with a higher likelihood of achieving out-of-pocket savings from RxPass. Changes to the pricing structure of Amazon's direct-to-consumer medication service are needed to expand out-of-pocket savings on generic medications to a larger segment of the working-age adults with cardiovascular risk factors and/or diseases.

Public Medication and Health Services Demand in Greece: The Relationship between Generics and Prototype Drugs

Public Medication and Health Services Demand in Greece: The Relationship between Generics and Prototype Drugs

Use of the BRANT-MERQS scoring table for the quality assessment of type 3 medication review in patients with rheumatoid arthritis and those with type 2 diabetes mellitus.

A type 3 medication review (MR3) is a patient-centred medication service primarily provided by pharmacists and is presently employed routinely in several countries. In this process, pharmacists interview patients and collaborate with the treating physician to optimize the patient's pharmacotherapy, taking into account the patient's medication history and other medical data including laboratory values. The need to maintain the quality of such interventions during and after their initial implementation cannot be overstated. The objective of this study was to refine and assess a scoring table to evaluate the quality of MR3 conducted in Belgian community pharmacies. The comprehensive quality of MR3s was assessed by scoring its various components using a previously developed scoring table, called BRANT-MERQS, Brussels Antwerp Medication Review Quality Score. MR3s were analysed from an implementation study with patients suffering from rheumatoid arthritis (RA, subproject 1) and type 2 diabetes mellitus (T2DM, subproject 2). Additional information was obtained during a telephone call with a subset of participating pharmacists of subproject 1 who finalized their first MR3. In subproject 1, a total of 21 MR3s of patients with RA were examined. The assessment showed favourable scores for elements such as a well-organized medication schedule, treatment adherence, and the elaboration of specific interventions. However, certain other quality criteria posed challenges in the evaluation, for example, the use of simple and understandable language. Pharmacists faced time constraints, and elderly general practitioners (GPs) displayed limited enthusiasm, which were notable barriers observed for this subproject. In the context of subproject 2 that investigated 41 MR3s in patients with T2DM, the quality criteria of interaction between pharmacist and GP, and used sources and tools received high scores. However, there was still room for improvement, especially in areas such as accurate dosing, handling kidney function, QT prolongation, correctly associating laboratory values with relevant drugs and medical conditions, and optimisation of medication schedules for patients. This study demonstrated the feasibility of MR3 quality assessment through a scoring system. However, it also unveiled the tool's current imperfections and highlighted the ongoing need for refinement, something expected of a new service in an implementation phase.

Behaviour of Community Pharmacy Service Provider towards Self Medication Services: Study in Two Cities in West Java

Self-medication behavior is currently increasing in Indonesia. Community pharmacy service provider have an important role as the main source of information and recommendations for the community in self-medication. To be able to provide good self-medication services, good knowledge, attitudes, and practices are needed from pharmacists. This study was aimed to measure the knowledge, attitudes, and practices of pharmacists in providing self-medication services. The study was conducted with a cross-sectional design in pharmacies in Bandung City and Cianjur Regency in the period March-April 2021. A valid and reliable questionnaire was administered to 141 respondents who worked in pharmacies that were selected randomly, to measure the knowledge, attitudes, and practices related to self-medication. The inclusion criteria were community pharmacy service provider who worked permanently and were willing to fill out questionnaires. Exclusion criteria were intern worker and incomplete questionnaires. Results showed that community pharmacy service provider in Bandung City and Cianjur Regency had an average knowledge of 65.04% (moderate), attitudes 78.40% (good), and practice 85.59% (very positive) towards self-medication services. In self-medication behavior, knowledge of community pharmacy service provider was influenced by type of position (p0.05), self-medication attitude was influenced by type of pharmacies (p0.05), and self-medication service practice was influenced by location (p0.05). This study concludes that community pharmacy service provider in Bandung City and Cianjur Regency have a moderate knowledge, and good attitudes and very positive practices in self-medication services.

Psychotropic Medication and Psychosocial Service Use Among Transition Age Youth With Autism Spectrum Disorder.

People with autism spectrum disorder (ASD) experience high rates of psychotropic medication utilization and barriers to psychosocial services, yet limited literature explores use of these services and the association between a mental health condition (MH) and use. Using national multipayer claims data, this study estimates a multinomial logistic regression model to discern psychotropic medication and psychosocial service use among transition age youth (TAY) with ASD (12-26 years; N = 52,083) compared to a matched cohort of those without ASD (12-26 years; N = 52,083). Approximately one-third of TAY with ASD and no MH condition receive only psychotropic medication and the likelihood of using both psychosocial services and medication is higher only when TAY with ASD have a co-occurring MH condition.

The Phenomenon and Determinants of Healthcare Service Utilization for Older Adults With Multimorbidity in China: An Explanatory, Mixed-Method Study.

The objective of this study was to explore the phenomenon and determinants of healthcare service utilization in Chinese older adults with multimorbidity. We adopted a mixed-methods explanatory design from July 2022 to May 2023. The quantitative research was a social network analysis to explore the phenomenon of healthcare service utilization in target participants. The quantitative results were further interpreted as the participant's propensity for healthcare services and the potential for information sharing between healthcare providers through shared patients. Logistic regression was conducted to identify individual determinants for healthcare service utilization. The quantitative research was followed by qualitative interviews with stakeholders to deeply understand the phenomenon of interest from the individual, healthcare system, and societal perspectives. We recruited 321 participants for the quantitative study. They preferred using medication services from primary healthcare providers, pharmacists at private pharmacies, and hospital specialists, and preferred using other services from hospital specialists. Dense relationships arose from shared patients among healthcare providers across various professions and settings, making it possible to share patient information. Primary healthcare providers were particularly important in the process, as they were closely related to others through patient sharing. Health status was identified through logistic regression and qualitative interviews as an individual determinant for healthcare service utilization. More determinants were explored in qualitative interviews with 30 stakeholders, including trust, resource allocation, healthcare accessibility, medical treatment process, and healthcare awareness. Strategies should be proposed to intervene with patients' nonoptimal propensity toward healthcare services and promote information sharing among healthcare providers.

Influenza vaccination uptake among at-risk patients in Switzerland-The potential of national claims data for surveillance.

Swiss national surveillance of influenza vaccination uptake rates (VURs) relies on self-reported vaccination status. The aim of this study was to determine VURs among at-risk patients, namely, patients ≥65 of age and adult patients with chronic diseases, using claims data, instead of self-reported measures, to investigate factors of vaccine uptake, and to assess different methodological approaches to conduct vaccination surveillance. In this retrospective cross-sectional analysis, we determined VURs in three influenza seasons (2015/2016-2017/2018). Medication, diagnosis, or medical services claims were used as triggers to identify patients. For the calculation of VURs in patients with chronic diseases, we identified those by triggers in the given season only (Model 1) and in the given and previous seasons (Model 2). Regression analysis was used to identify factors associated with vaccination status. Data from 214,668 individual patients were analyzed. VURs over all seasons ranged from 18.4% to 19.8%. Most patients with chronic diseases were identified with the medication trigger, and we found no clinical significant differences in VURs comparing both models. Having a chronic disease, age, male gender, and regular health care provider visits were associated with increased odds of being vaccinated. VURs were below the recommended thresholds, and our analysis highlighted the need for efforts to increase VURs. We assessed the identification of chronic diseases by medication claims and the calculation of VURs based on data of the given season only as an effective approach to conduct vaccination surveillance. Claims data-based surveillance may complete the national surveillance.