American Journal of Health-system Pharmacy, Jul 15, 2003
Page 1. MANAGEMENT CASE STUDIES Vaccination program 1471 Am J Health-Syst PharmVol 60 Jul 15, 20... more Page 1. MANAGEMENT CASE STUDIES Vaccination program 1471 Am J Health-Syst PharmVol 60 Jul 15, 2003 MANAGEMENTCASESTUDIES Management Case Studies describe approaches to real-life management problems in health systems. ...
OBJECTIVES: To identify facilitators of and barriers to vaccination in patients from a range of s... more OBJECTIVES: To identify facilitators of and barriers to vaccination in patients from a range of socioeconomic levels. DESIGN: A survey was conducted in 2001 using computerassisted telephone interviewing. SETTING: Patients from inner-city health centers and suburban practices were interviewed. PARTICIPANTS: Inclusion criteria were aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Self-reported influenza and pneumococcal vaccination status and facilitating conditions, attitudes, social influences, and perceived consequences from the Triandis model were assessed. RESULTS: Overall, 557 interviews were completed with 775 eligible patients (72%). Patients who reported having received pneumococcal vaccine more frequently believed that their physicians recommended the vaccine than did the unvaccinated (97% vs 49%; P 5.001). This was also true for influenza vaccine (99% vs 80%; Po.001). More unvaccinated patients than vaccinated patients felt that obtaining either vaccine was more trouble than it is worth (pneumococcal 19% vs 1%; P 5.04, influenza 20% vs 1%; P 5.004). The vaccinated were more likely to be willing to obtain the influenza and pneumococcal vaccines at the same time (pneumococcal 91% vs 59%; P 5.002, influenza 91% vs 55%; P 5.014). CONCLUSION: Physicians should take every opportunity to recommend vaccination to their eligible adult patients. Offering influenza and pneumococcal vaccines at the same visit is an acceptable means to ensure that adults are fully vaccinated.
medRxiv (Cold Spring Harbor Laboratory), Oct 5, 2021
Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and ... more Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and complications. We compared the magnitude and duration of serologic response to trivalent influenza vaccine in adults aged 50-80 with and without type 2 diabetes mellitus. Serologic response to influenza vaccination was similar in both groups: greater fold-increases in antibody titer occurred among individuals with lower pre-vaccination antibody titers. Waning of antibody titers was not influenced by diabetes status.
This study compared subjects' self-reported rates of compliance to self-monitoring of blood gluco... more This study compared subjects' self-reported rates of compliance to self-monitoring of blood glucose (SMBG) with an objective measure based on a "marked-item" technique. We followed 25 obese patients with type II diabetes who were participating in a behavorial weight control program and monitoring their blood glucose with Chemstrips bG (Bio-Dynamics, Inc., Indianapolis, Indiana). Subjects' selfreport significantly overestimated actual compliance as assessed by the marked-item technique. Moreover, the self-report measure failed to identify 35-45% of the noncompliant patients. Compliance decreased steadily over the course of the 37-wk program. Accuracy of SMBG was less problematic than compliance; 83% of patients were able to read Chemstrips bG within 20% of actual blood sugar, and the average blood sugar reading obtained from 2 mo of SMBG correlated highly (r = 0.78, P < 0.01) with HbA,. Our data suggest that objective measures such as the marked-item technique described in this article should be used to assess compliance to SMBG and behavioral strategies to improve compliance should be developed, DIABETES CARE 1985; 8:456-60.
This study was designed to determine whether family history of diabetes affects the response to a... more This study was designed to determine whether family history of diabetes affects the response to a therapeutic intervention in obese Type II diabetic patients. Seventy-seven Type II diabetics were treated in a 12–16 week behavioral weight control program with follow-up one year later. No significant differences in weight loss or glycemic responses were observed between patients with and without a first degree relative with diabetes, or between patients with 0, 1, or 2 diabetic parents. Although family history of Type II diabetes affects the chances of developing the disease, these data suggest that family history does not affect the response to treatment.
Infection Control and Hospital Epidemiology, Aug 1, 2013
This study used hierarchical linear modeling to determine the relative contribution of hospital p... more This study used hierarchical linear modeling to determine the relative contribution of hospital policies and state laws to healthcare worker (HCW) influenza vaccination rates. Hospital mandates with consequences for noncompliance and race were associated with 3%-12% increases in HCW vaccination; state laws were not significantly related to vaccination rates.
Patients with diabetes are usually placed on exchange system diets to ensure a nutritionally adeq... more Patients with diabetes are usually placed on exchange system diets to ensure a nutritionally adequate intake. However, there have been few studies which have actually compared the nutritional adequacy of diets selected by patients on exchange system diets, with that selected by patients on the calorie-counting diets typically used in behavioral weight control programs. This study compared the nutritional adequacy of the diets selected by overweight patients with Type II diabetes who had been randomly assigned to either an exchange system diet or a calorie-counting diet. Three-day food diaries were completed by all patients at the start and end of a 16-week weight control program. No significant differences were observed between patients on the calorie-counting diet compared to those on the exchange system diet with respect to nutrient intake, macronutrient distribution, or percent of the RDA obtained. Patients on both types of diet reported decreases in the proportion of calories from fat. The average intake exceeded 100% of the RDA for all nutrients except calcium. This study suggests that patients are able to improve the nutritional adequacy of their intake while following either a calorie-counting or an exchange system diet.
Infection Control and Hospital Epidemiology, May 1, 2008
Background.Standing order programs (SOPs), which allow for vaccination without an individual phys... more Background.Standing order programs (SOPs), which allow for vaccination without an individual physician order, are the most effective mechanism to achieve high vaccination rates. Among the suggested settings for the utilization of SOPs are hospital inpatient units, because they provide care for those most likely to benefit from vaccination. The cost-effectiveness of this approach for elderly hospitalized persons is unknown. The purpose of this study was to estimate the cost-effectiveness of SOPs for pneumococcal polysaccharide vaccine (PPV) vaccination for patients 65 years of age or older in 2 types of hospital.Methods.In 2004, a 1,094-bed tertiary care hospital implemented a pharmacy-based SOP for PPV, and a 225-bed community hospital implemented a nursing-based SOP for PPV. Newly admitted patients 65 years of age or older were screened for PPV eligibility and then offered PPV. Vaccination rates before and after initiation of SOPs in the United States, incidence rates of invasive pneumococcal disease in the United States, and US economic data were the bases of the cost-effectiveness analyses. One-way and multivariate sensitivity analyses were conducted.Results.PPV vaccination rates increased 30.5% in the tertiary care hospital and 15.3% in the community hospital. In the base-case cost-effectiveness analysis, using a societal perspective, we found that both pharmacy-based and nursing-based SOPs cost less than $10,000 per quality-adjusted life-year gained, with program costs (pharmacy-based SOPs cost $4.16 per patient screened, and nursing-based SOPs cost $4.60 per patient screened) and vaccine costs ($18.33 per dose) partially offset by potential savings from cases of invasive pneumococcal disease avoided ($12,436 per case). Sensitivity analyses showed SOPs for PPV vaccination to be cost-effective, compared with PPV vaccination without SOPs, unless the improvement in vaccination rate was less than 8%.Conclusion.SOPs do increase PPV vaccination rates in hospitalized elderly patients and are economically favorable, compared with PPV vaccination rates without SOPs.
American Journal of Health-system Pharmacy, Jul 15, 2003
Page 1. MANAGEMENT CASE STUDIES Vaccination program 1471 Am J Health-Syst PharmVol 60 Jul 15, 20... more Page 1. MANAGEMENT CASE STUDIES Vaccination program 1471 Am J Health-Syst PharmVol 60 Jul 15, 2003 MANAGEMENTCASESTUDIES Management Case Studies describe approaches to real-life management problems in health systems. ...
OBJECTIVES: To identify facilitators of and barriers to vaccination in patients from a range of s... more OBJECTIVES: To identify facilitators of and barriers to vaccination in patients from a range of socioeconomic levels. DESIGN: A survey was conducted in 2001 using computerassisted telephone interviewing. SETTING: Patients from inner-city health centers and suburban practices were interviewed. PARTICIPANTS: Inclusion criteria were aged 66 and older and an office visit after September 30, 1998. MEASUREMENTS: Self-reported influenza and pneumococcal vaccination status and facilitating conditions, attitudes, social influences, and perceived consequences from the Triandis model were assessed. RESULTS: Overall, 557 interviews were completed with 775 eligible patients (72%). Patients who reported having received pneumococcal vaccine more frequently believed that their physicians recommended the vaccine than did the unvaccinated (97% vs 49%; P 5.001). This was also true for influenza vaccine (99% vs 80%; Po.001). More unvaccinated patients than vaccinated patients felt that obtaining either vaccine was more trouble than it is worth (pneumococcal 19% vs 1%; P 5.04, influenza 20% vs 1%; P 5.004). The vaccinated were more likely to be willing to obtain the influenza and pneumococcal vaccines at the same time (pneumococcal 91% vs 59%; P 5.002, influenza 91% vs 55%; P 5.014). CONCLUSION: Physicians should take every opportunity to recommend vaccination to their eligible adult patients. Offering influenza and pneumococcal vaccines at the same visit is an acceptable means to ensure that adults are fully vaccinated.
medRxiv (Cold Spring Harbor Laboratory), Oct 5, 2021
Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and ... more Individuals with type 2 diabetes mellitus experience high rates of influenza virus infection and complications. We compared the magnitude and duration of serologic response to trivalent influenza vaccine in adults aged 50-80 with and without type 2 diabetes mellitus. Serologic response to influenza vaccination was similar in both groups: greater fold-increases in antibody titer occurred among individuals with lower pre-vaccination antibody titers. Waning of antibody titers was not influenced by diabetes status.
This study compared subjects' self-reported rates of compliance to self-monitoring of blood gluco... more This study compared subjects' self-reported rates of compliance to self-monitoring of blood glucose (SMBG) with an objective measure based on a "marked-item" technique. We followed 25 obese patients with type II diabetes who were participating in a behavorial weight control program and monitoring their blood glucose with Chemstrips bG (Bio-Dynamics, Inc., Indianapolis, Indiana). Subjects' selfreport significantly overestimated actual compliance as assessed by the marked-item technique. Moreover, the self-report measure failed to identify 35-45% of the noncompliant patients. Compliance decreased steadily over the course of the 37-wk program. Accuracy of SMBG was less problematic than compliance; 83% of patients were able to read Chemstrips bG within 20% of actual blood sugar, and the average blood sugar reading obtained from 2 mo of SMBG correlated highly (r = 0.78, P < 0.01) with HbA,. Our data suggest that objective measures such as the marked-item technique described in this article should be used to assess compliance to SMBG and behavioral strategies to improve compliance should be developed, DIABETES CARE 1985; 8:456-60.
This study was designed to determine whether family history of diabetes affects the response to a... more This study was designed to determine whether family history of diabetes affects the response to a therapeutic intervention in obese Type II diabetic patients. Seventy-seven Type II diabetics were treated in a 12–16 week behavioral weight control program with follow-up one year later. No significant differences in weight loss or glycemic responses were observed between patients with and without a first degree relative with diabetes, or between patients with 0, 1, or 2 diabetic parents. Although family history of Type II diabetes affects the chances of developing the disease, these data suggest that family history does not affect the response to treatment.
Infection Control and Hospital Epidemiology, Aug 1, 2013
This study used hierarchical linear modeling to determine the relative contribution of hospital p... more This study used hierarchical linear modeling to determine the relative contribution of hospital policies and state laws to healthcare worker (HCW) influenza vaccination rates. Hospital mandates with consequences for noncompliance and race were associated with 3%-12% increases in HCW vaccination; state laws were not significantly related to vaccination rates.
Patients with diabetes are usually placed on exchange system diets to ensure a nutritionally adeq... more Patients with diabetes are usually placed on exchange system diets to ensure a nutritionally adequate intake. However, there have been few studies which have actually compared the nutritional adequacy of diets selected by patients on exchange system diets, with that selected by patients on the calorie-counting diets typically used in behavioral weight control programs. This study compared the nutritional adequacy of the diets selected by overweight patients with Type II diabetes who had been randomly assigned to either an exchange system diet or a calorie-counting diet. Three-day food diaries were completed by all patients at the start and end of a 16-week weight control program. No significant differences were observed between patients on the calorie-counting diet compared to those on the exchange system diet with respect to nutrient intake, macronutrient distribution, or percent of the RDA obtained. Patients on both types of diet reported decreases in the proportion of calories from fat. The average intake exceeded 100% of the RDA for all nutrients except calcium. This study suggests that patients are able to improve the nutritional adequacy of their intake while following either a calorie-counting or an exchange system diet.
Infection Control and Hospital Epidemiology, May 1, 2008
Background.Standing order programs (SOPs), which allow for vaccination without an individual phys... more Background.Standing order programs (SOPs), which allow for vaccination without an individual physician order, are the most effective mechanism to achieve high vaccination rates. Among the suggested settings for the utilization of SOPs are hospital inpatient units, because they provide care for those most likely to benefit from vaccination. The cost-effectiveness of this approach for elderly hospitalized persons is unknown. The purpose of this study was to estimate the cost-effectiveness of SOPs for pneumococcal polysaccharide vaccine (PPV) vaccination for patients 65 years of age or older in 2 types of hospital.Methods.In 2004, a 1,094-bed tertiary care hospital implemented a pharmacy-based SOP for PPV, and a 225-bed community hospital implemented a nursing-based SOP for PPV. Newly admitted patients 65 years of age or older were screened for PPV eligibility and then offered PPV. Vaccination rates before and after initiation of SOPs in the United States, incidence rates of invasive pneumococcal disease in the United States, and US economic data were the bases of the cost-effectiveness analyses. One-way and multivariate sensitivity analyses were conducted.Results.PPV vaccination rates increased 30.5% in the tertiary care hospital and 15.3% in the community hospital. In the base-case cost-effectiveness analysis, using a societal perspective, we found that both pharmacy-based and nursing-based SOPs cost less than $10,000 per quality-adjusted life-year gained, with program costs (pharmacy-based SOPs cost $4.16 per patient screened, and nursing-based SOPs cost $4.60 per patient screened) and vaccine costs ($18.33 per dose) partially offset by potential savings from cases of invasive pneumococcal disease avoided ($12,436 per case). Sensitivity analyses showed SOPs for PPV vaccination to be cost-effective, compared with PPV vaccination without SOPs, unless the improvement in vaccination rate was less than 8%.Conclusion.SOPs do increase PPV vaccination rates in hospitalized elderly patients and are economically favorable, compared with PPV vaccination rates without SOPs.
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