Age Bias in Physicians\u27 Recommendation for Physical Activity, Adherence, and Health Related Quality of Life Among Individuals with Arthritis

The association between individuals\u27 ages, physicians\u27 recommendations for physical activity, adherence, and health related quality of life among individuals with arthritis was examined using the 2007 Behavioral Risk Factor Surveillance System. The sample included 33,071 individuals with self-reported, physician-diagnosed arthritis who were 45 years or older. To answer the research questions, three sets of data were created: a whole sample (n=33,071), those 45-64 years old (n=17,607), and those 65 years or older (n=15,464). The conceptual framework for the study was based on the Behavioral Model of Health Services Utilization. The variables of interests were physicians\u27 recommendations for physical activity, adherence to physical activity guidelines, health related quality of life (measured as physically and mentally unhealthy days), age, sex, race, education, marital status, employment, income, health insurance, personal physician, emotional support, body mass index, activity limitations, health status, and co-morbidities. The analysis included univariate, bivariate statistics, logistic regression, and negative binomial regression models. Results indicated that older adults were less likely (OR=0.86) to receive physicians\u27 recommendations for physical activity compared to the group 45-64 years old. Those who did not receive physicians\u27 recommendations were less likely (OR=0.94) to adhere to physical activity guidelines compared to those who adhered. Those who did not adhere to physical activity guidelines had higher physically (14%) and mentally unhealthy days (12%) compared to those who adhered to physical activity guidelines. In both age groups, the number of physically unhealthy days was 12%-18% higher, for those who did not adhere to physical activity guidelines than those who adhered to physical activity guidelines. However, the associations between physicians\u27 recommendations and adherence, and adherence and mentally unhealthy days, were different for the age groups

Racial/ethnic and geographic differences in access to a usual source of care that follows the patient-centered medical home model: Analyses from the Medical Expenditure Panel Survey data

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a USC that followed the PCMH model, 80% were White, 13% Black, 5% Asian, and 12% were of Hispanic ethnicity. Across U.S. regions, 88% percent of those who had a USC that followed the PCMH model resided in metropolitan statistical areas (MSAs), 22% resided in the West, 26% in the Northeast, 25% in the Midwest, and 27% in the South. Results from logistic regression analyses indicated that race and ethnicity were not significant predictors of having a USC that followed the PCMH model. Northeastern U.S. residents (OR: 1.30; 95% CI:1.06-1.61) were more likely to have a USC that followed the PCMH model compared with southern residents. In conclusion, only a small percentage of respondents in our sample had a USC with the PCMH model. Further, race and ethnicity were not predictors of having a USC with the PCMH model

Identifying Physician-perceived Barriers to Apragmatictreatment Trial Inrheumatoid Arthritis

Abstract Objective: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a RA pragmatic trial of anti-TNF biologic vs. non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate (MTX-IR).Methods: Semi-structured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.Results:Physician perceived patient barriers to the implementation ofa RA pragmatic trial. This theme covers three sub-themes: 1) patients’ personal barriers, 2) patients’ treatment-related factors, and 3) trial-related factors (e.g., patient recruitment, side effects, mode of use, etc.). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four sub-themes: 1) clinic-related factors, 2) patient-related factors, 3) research personnel, and 4) facilitators (positive factors of the clinic). Conclusions: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (e.g., coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patient-centered strategies to implement a pragmatic RA trial.</jats:p

Age Bias in Physicians’ Recommendations for Physical Activity: A Behavioral Model of Healthcare Utilization for Adults With Arthritis

Objective:To examine whether age bias exists in physicians’ recommendations for physical activity among individuals with arthritis.Methods:A cross-sectional sample with 33,071 U.S. adults, 45 years or older with physician-diagnosed arthritis was obtained from 2007 Behavioral Risk Factor Surveillance System Survey. We used logistic regression to examine physicians’ recommendations for physical activity as a function of age controlling for gender, race, education, marital status, employment, income, health insurance, personal physician, emotional support, body mass index, activity limitations, health status, and comorbidities.Results:Majority of individuals were females (65%), White (85%), had annual household income &lt; $50,000 (67%), and with comorbidities (86%). Respondents were approximately equal across age groups: middle-aged group (53%) and older group (47%). About 36% were obese and 44% had activity limitations, and 44% did not receive any physicians’ recommendations for physical activity. Results from logistic regression indicated older adults (≥ 65 years old) were less likely (OR = 0.87; 95% CI, 0.82−0.92) to receive physicians’ recommendations for physical activity compared with the middle-aged group (45−64 years old).Conclusions:This study indicates that although the benefits associated with the physical activity is well recognized, there is age bias in physicians’ recommendations for physical activity.</jats:sec

Is type of practice setting associated with physician’s cultural competency training? Analysis from the National Ambulatory Medical Care Survey

Abstract This study examined whether type of physician practice settings was associated with cultural competency training for newly hired physicians. We used data from the 2016 National Ambulatory Medical Care Survey Supplement on Culturally and Linguistically Appropriate Services for Office-based Physician Survey. The survey contains a sample of 397 office-based physician responses completed during the period from August to December 2016 (weighted n = 293306). The outcome variable was whether cultural competency training was required for newly hired physicians. The primary predictor variable was type of physician practice settings. We used logistic regression to analyze the association between physician practice settings and cultural competency training for newly hired physicians adjusting for covariates. About 71% physicians belonged to solo or group practice settings. Among these, only 10.4% required cultural competency training for newly hired physicians. Among other practice settings, 34.8% required the training. Results from logistic regression showed that newly hired physicians in solo or group practices (adjusted odds ratio: 0.22; 95% confidence interval: 0.11–0.44) were less likely to have cultural competency training compared to those in other settings. Practice settings are associated with cultural competency training. Cultural competency training across all practice settings may contribute toward improving patient–physician communication, reducing health disparities, and increasing patient satisfaction.</jats:p