Prescription medication borrowing among adult patients at an urban medical center.

Prescription medication borrowing can result in adverse health outcomes. We aimed to study the patterns of borrowing prescription medications in an adult urban population seeking healthcare in the outpatient, emergency, and inpatient units of an urban medical center. Participants indicated whether they (1) had a primary care doctor, medical insurance, a prior history of substance abuse, psychiatric disorders, or chronic pain; and (2) had borrowed a prescription medication. If so, they noted the medication obtained, source, frequency of use, and reasons why they had not obtained a prescription from a licensed medical provider. Of the 641 participants, most were African American (75%), urban residents (75%), high school educated or less (71%), and lacked full-time employment (68%). Many had health insurance (90%) and had recently seen their primary medical provider (75%). Eighteen percent reported ever borrowing a prescription medication. On multivariate analysis, history of chronic pain was marginally associated with increased medication borrowing (odds ratio [OR] = 1.58) while having Medicare insurance (OR = 0.436) or a primary care medical provider routinely ask about medication usage (OR = 0.589) were significantly associated with decreased medication borrowing. The most commonly obtained medications were for pain (74%), usually in the form of opioids, and were obtained from a family member (49%) or friend (38%). Thirty-five percent of those who borrowed medications did so more than once a year, with lack of convenient access to medical care the most frequently cited reason for use (67%). Only a third of those who borrowed medications had informed their primary medical providers of the behavior. In conclusion, borrowing prescription medications is a common behavior in the population studied. Further research is warranted into interventions to reduce such use, especially the impact of methods to improve the convenience of contacting licensed medical providers.

Resident physicians' perceptions of barriers and facilitators to colorectal cancer screening for African Americans.

BACKGROUND: African Americans experience disproportionately higher morbidity and mortality from colorectal cancer (CRC), yet they complete screening at lower rates than Caucasians. While studies have identified barriers and facilitators to CRC screening among African Americans, no study has examined physician perceptions of these barriers. OBJECTIVE: The purpose of this study was to determine how resident physicians view barriers and facilitators to CRC screening among their African American patients, and to compare residents' perceptions with barriers and facilitators that have been reported in studies with African Americans. DESIGN: Both quantitative and qualitative data were obtained during in-depth interviews with 30 upper-year residents from an urban academic internal medicine program. RESULTS: Residents recognized the low levels of awareness of CRC that have been reported among African American patients. The most common barriers reported by residents were lack of knowledge, fears, personal/social circumstances, and colonoscopy-specific concerns. Residents reported a need for increased education, increased public awareness, and easier scheduling as facilitators for screening. Residents failed to appreciate some key perceptions held by African Americans that have been documented to either impede or facilitate CRC screening completion, particularly the positive beliefs that could be used to overcome some of the perceived barriers. CONCLUSIONS: Residents may be missing opportunities to more effectively communicate about CRC screening with their African American patients. Residents need more explicit education about African Americans' perceptions to successfully promote screening behaviors in this high-risk population.

African Americans' perceptions of physician attempts to address obesity in the primary care setting.

BACKGROUND: Obesity disproportionately affects African Americans and leads to several major co-morbidities. While guidelines recommend physicians identify obese patients and counsel them on weight management, little is known about how these efforts are received by patients. OBJECTIVE: To elucidate how obese, urban African American patients perceive the physician role in the treatment of obesity and to identify specific provider behaviors that may motivate or hinder attempts at weight loss. DESIGN: Qualitative study involving eight focus groups. PARTICIPANTS: Forty-three obese African-American patients recruited from academic internal medicine practices participated in focus groups between September 2007 and February 2008. MEASUREMENTS AND MAIN RESULTS: Four broad themes emerged: (1) dislike of the word obese, (2) importance of the physician manner and timing when discussing weight, (3) necessity of a personalized approach in discussing weight management issues, and (4) variable response to scare tactics. Within each theme participants identified specific physician behaviors that were perceived as either motivating or hindering attempts at weight loss. CONCLUSIONS: Physicians must be cognizant of the potential unintended consequences of the techniques they use to educate and counsel African-American men and women on obesity, particularly those that may be perceived as negative and act to further alienate obese patients from seeking the care they need.

Increasing colorectal cancer screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians.

Colorectal cancer (CRC) screening remains significantly underutilized by African Americans despite their increased risk compared to whites. The purpose of this article is to review recent research on patterns of screening, perceptions of CRC screening methods and outcomes of seven intervention trials specifically designed to increase screening among African Americans in light of the recommendation of the American College of Gastroenterologists to make colonoscopy the screening method of choice for this population. This review shows that progress has been made in understanding the complexity of perceived barriers to CRC screening among African Americans. Interventions that used community-based education targeting individuals and clinically based education targeting clinicians showed modest increases in screening rates. Targeting entire communities did not show significant results. However, because intervention studies use not only different types of interventions but different screening outcome measures, results are not easily comparable. While there is growing evidence that interventions can increase the use of fecal occult blood test (FOBT), it is not yet known if similar interventions can increase rates of screening colonoscopy. Clinicians, patients and policymakers also need to consider the array of social, cultural and financial issues associated with CRC screening in African-American communities.