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Salt Lake City, UT, United States

Clark E.,Geriatric Research | Clark E.,Mount Sinai School of Medicine | Fitzgerald J.T.,Geriatric Research | Fitzgerald J.T.,University of Michigan | And 6 more authors.
Gerontology and Geriatrics Education

Current geriatrics workforce projections indicate that clinicians who care for adults will need basic geriatrics knowledge and skills to address the geriatric syndromes and issues that limit functional independence and complicate medical management. This is most evident for the clinicians caring for veterans in the Department of Veterans Affairs hospitals and clinics nationwide. Geriatric Research, Education and Clinical Centers (GRECCs), whose staff are geriatric-content experts, have developed a number of programs to tackle this daunting educational task. This article introduces three different programs designed and implemented by GRECCs to train currently practicing health care providers in the Veterans Health Administration medical clinics. It also describes the successes and lessons learned from these three programs. © Taylor & Francis Group, LLC. Source

Alder S.,University of Utah | Wuthrich A.,University of Utah | Haddadin B.,University of Utah | Donnelly S.,HealthInsight | And 6 more authors.
American Journal of Health Education

Background: The Inter-Mountain Project on Antibiotic Resistance and Therapy (IMPART) is an intervention that addresses emerging antimicrobial resistance and the reduction of unnecessary antimicrobial use. Purpose: This study assesses the design and implementation of the community intervention component of IMPART. Methods: The study was conducted in 12 rural Utah and Idaho communities. Following initial implementation, the intervention was evaluated and redesigned based on health behavior theory. Community penetration and intercept interview data were analyzed using multi-level logistic regression. Results: Over 10% of interview respondents were familiar with IMPART. Those exposed to intervention materials tended to be younger, female, and more likely to have had a family member with recent respiratory illness. Of those who had seen the project Self-Care Guide, 62% reported having a copy and 32% had talked to others about the information it contained. Correct responses to antibiotic knowledge questions were higher among those with high (OR=2.02) and low exposure (OR=1.27) to the intervention versus no exposure. Discussion: Theoretically-based community interventions such as IMPART can be used to promote appropriate, positively framed health behaviors. Translation to Health Education Practice: IMPART serves as an example of how health interventions can benefit from health behavior theory. Source

Bakdash J.Z.,Center for Human Factors in Patient Safety | Bakdash J.Z.,Decision Enhancement and Surveillance Center | Bakdash J.Z.,University of Utah | Drews F.A.,Center for Human Factors in Patient Safety | And 2 more authors.
Human Factors and Ergonomics In Manufacturing

Use of current health care equipment for medical procedures (e.g., central line insertions and central line care) is primarily dependent on the cognition of the health care worker. That is, the present design of equipment (typically numerous, separately packaged individual items) provides minimal information about the optimal order of procedure steps and no defenses against human error, such as omitting steps in procedure. In this article, we propose patient safety may be improved by redesigning equipment to integrate a "checklist" using sequencing, color coding, and visual icons. We hypothesize this reduces cognitive demand by off-loading knowledge into the world, creating affordances that provide guidance reducing the likelihood of errors and promoting adherence to best practices. © 2011 Wiley Periodicals, Inc. Source

Sauer B.,Decision Enhancement and Surveillance Center | Nebeker J.,Decision Enhancement and Surveillance Center | Shen S.,Decision Enhancement and Surveillance Center | Rupper R.,Decision Enhancement and Surveillance Center | And 5 more authors.

Purpose: We present a framework for detecting possible adverse drug reactions (ADRs) using the Utah Medicaid administrative data. We examined four classes of ADRs associated with treatment of dementia by acetylcholinesterase inhibitors (AChEIs): known reactions (gastrointestinal, psychological disturbances), potential reactions (respiratory disturbance), novel reactions (hepatic, hematological disturbances), and death. Methods: Our cohort design linked drug utilization data to medical claims from Utah Medicaid recipients. We restricted the analysis to 50 years-old and older beneficiaries diagnosed with dementia-related diseases. We compared patients treated with AChEI to patients untreated with anti-dementia medication therapy. We attempted to remove confounding by establishing propensity-score-matched cohorts for each outcome investigated; we then evaluated the effects of drug treatment by conditional multivariable Cox-proportional-hazard regression. Acute and transient effects were evaluated by a crossover design using conditional logistic regression. Results: Propensity-matched analysis of expected reactions revealed that AChEI treatment was associated with gastrointestinal episodes (Hazard Ratio [HR]: 2.02; 95%CI: 1.28-3.2), but not psychological episodes, respiratory disturbance, or death. Among the unexpected reactions, the risk of hematological episodes was higher (HR: 2.32; 95%CI: 1.47-3.6) in patients exposed to AChEI. AChEI exposure was not associated with an increase in hepatic episodes. We also noted a trend, identified in the case-crossover design, toward increase odds of experiencing acute hematological events during AChEI exposure (Odds Ratio: 3.0; 95% CI: 0.97 - 9.3). Conclusions: We observed an expected association between AChEIs treatment and gastrointestinal disturbances and detected a signal of possible hematological ADR after treatment with AChEIs in this pilot study. Using this analytic framework may raise awareness of potential ADEs and generate hypotheses for future investigations. Early findings, or signal detection, are considered hypothesis generating since confirmatory studies must be designed to determine if the signal represents a true drug safety problem. © 2014 Sauer B et al. Source

LaFleur J.,University of Utah | LaFleur J.,Decision Enhancement and Surveillance Center | Nelson R.E.,Decision Enhancement and Surveillance Center | Nelson R.E.,University of Utah | And 3 more authors.

Background: The healthy user bias is usually overlooked as an explanation in studies in which a strong association is found between poor patient medication adherence and worse disease outcomes. Such studies are increasing in frequency across disease states and influence clinical practice. Adherence to antihypertensive medications was studied to illustrate confounding in such studies. Methods: Using data from veterans with hypertension starting antihypertensive treatment, causal models were developed that predicted the risks of hospitalisation, myocardial infarction (MI) and death associated with poor adherence (<80%) while adjusting for patient demographics, baseline disease severity and disease comorbidity. In a second set of otherwise identical models, adjustment was made for time-varying blood pressure (BP), thus controlling for adherence effects that were mediated through the main pharmacological effects of the drugs. It was hypothesised that the second set of models would reveal a positive association between poor adherence and adverse disease outcomes that is largely explained by unmeasured confounders, including health-related behaviours. Results: The models that did not adjust for time-varying BP levels showed that patients with poor adherence had statistically significantly increased risks of 3.7% for hospitalisation, 28.1% for MI and 23.3% for death. These estimates exceed the benefits of these drugs demonstrated by clinical trials. When controlling for time-varying BP, the increased risks were similar (3.4% for hospitalisation, 27.7% for MI and 23.4% for death). The findings were consistent across a range of adherence thresholds (50-90%) and when allowing disease status variables to vary. Conclusions: The associations between poor adherence and outcomes are largely independent of the pharmacological effects of the drugs on BP control as well as commonly measured patient covariates. This finding suggests that even carefully designed observational adherence studies using rich clinical data are impossibly confounded and probably overestimate the true magnitude of the effect. Clinical practice guidelines based on reported adherence effects should be reconsidered. Source

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