Factors associated with longer endocrine therapy use by South Carolina Medicaid-insured breast cancer survivors.

PURPOSE: The objective of this study is to determine demographic, clinical, and pharmaceutical factors that are associated with longer endocrine therapy usage duration. METHODS: South Carolina Central Cancer Registry incidence data linked with South Carolina Medicaid prescription claims and administrative data were used. The study included a sample (N = 1399) of female South Carolina Medicaid recipients with hormone receptor-positive breast cancer diagnosed between 2000 and 2012 who filled at least one ET prescription. A series of multiple regression models were built to explore the association of demographic, clinical, and pharmaceutical factors with the endocrine therapy usage duration. RESULTS: Multiple linear regression analysis showed that none of the demographic or clinical factors tested were significantly associated with the endocrine therapy usage duration. However, the type of endocrine therapy taken as well as receipt of the prescriptions that could have been used to alleviate side-effects (adrenals, nonsteroidal anti-inflammatory agents, anti-inflammatory agents, and vitamins) were significantly associated. CONCLUSION: Our study highlights the potential value of concurrent prescriptions for improving the endocrine therapy usage duration, with an optimal intervention point before 14 months post ET initiation. This work informs further research needed to test pharmacologic interventions that may significantly increase the endocrine therapy duration as well as other nonpharmacologic strategies for side-effect management.

Endocrine therapy use in the twenty-first century: usage rates and temporal trends illustrate opportunities for improvement for South Carolina Medicaid women.

PURPOSE: This study examines endocrine therapy (ET) non-initiation, non-adherence, and duration by age, race, temporal trend for South Carolina Medicaid-enrolled women diagnosed with estrogen receptor-positive breast cancer between 2000 and 2014 (N = 3830). METHODS: Age, race, relative risk, and median duration of ET use were compared. Temporal trends in ET non-initiation, non-adherence, and duration were observed using linear and logistic regression models, controlling for age and race. RESULTS: Fifty-three percent of women in the sample did not initiate ET, with highest non-initiation rates among African Americans and survivors under age 50. Of those who did initiate ET, 42% were non-adherent with a median ET usage duration of 37 months. Twenty-one percent of initiators continued taking ET for 5 years or more. There was no change in the odds of ET non-initiation from 2000 to 2004 (OR 1.02, p = 0.67). The odds of ET non-initiation decreased from 2005 to 2009 (OR 0.81, p < 0.001) but then increased from 2010 to 2014 (OR 1.08, p = 0.002). There was no change in the odds of ET non-adherence from 2000 to 2006 (OR 1.02, p = 0.53), but from 2007 to 2012, the odds of ET non-adherence decreased each year (OR 0.93, p = 0.02). The average ET usage duration was increasing from 2000 to 2006 (ß = 2.74, p < 0.001) but decreasing from 2006 to 2012 (ß = - 1.46, p < 0.001). CONCLUSIONS: This study provides a realistic picture of the challenges associated with ET usage among South Carolina Medicaid breast cancer patients. It particularly highlights small improvements over time in ET usage rates, indicating more opportunities for improvement in ET initiation, adherence, and duration among younger women of lower socio-economic status.

Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.

BACKGROUND: The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. OBJECTIVE: We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. METHODS: This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. RESULTS: We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. CONCLUSIONS: The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037. (Archived by WebCite at http://www.webcitation.org/6oRyDzqei).

Assessing medical student cultural competence: what really matters.

OBJECTIVES: The study aimed to explore medical students' attitudes and beliefs toward Latino patients, specifically: to assess students' levels of knowledge, cultural competence, and comfort with Latinos; to determine students' exposure to and previous experience with Latinos; and to evaluate whether factors such as study abroad, living abroad, previous clinical experience with Latinos, and language proficiency predict Latino knowledge, cultural competence, and comfort with Latinos. METHODS: This study utilized a cross-sectional survey design. Participants were third and fourth year medical students at three medical schools in the Southeastern United States. Three composite measures: Latino knowledge, Cultural competence, and Comfort with Latino patients, were predicted in a multivariate regression model including individual sociodemographic characteristics and past clinical or social experience with Latinos. RESULTS: A total of 170 medical students completed the survey (43% response rate). Spanish language proficiency was a statistically significant predictor (t(131)=2.72, p<0.05) of Latino knowledge. Social interaction with Latinos in the past year (t(126)=3.09, p<0.01), ever having lived in a Spanish-speaking country (t(126)=2.86,  p<0.01), and Spanish language proficiency (t(126)=3.28, p<0.01) independently predicted cultural competence. Previous clinical experience with Latinos was not significantly associated with the three composite dependent variables, and comfort with Latino patients was not significantly predicted by any of the six Latino-related explanatory variables. CONCLUSIONS: Factors prior to medical school matriculation and during medical education may contribute to increased cultural competence and comfort with multicultural patients. Cultural patient-partner programs may be an effective way to increase cultural competence within the confines of medical school curricula.

Cutting Corners: Provider Perceptions of Interpretation Services and Factors Related to Use of an Ad Hoc Interpreter.

INTRODUCTION: This study assessed health providers' perceptions of factors related to professional interpretation services and the association between these factors and the potential use of ad hoc interpreters. METHOD: Data were collected from a convenience sample of 150 health services providers at a large, regional health system in South Carolina. RESULTS: Providers rated "ability to communicate effectively during a clinical encounter" as paramount regarding the use of interpretation services. The most important factors related to the likely use of ad hoc interpreters (cutting corners) included locating a qualified interpreter, having to wait for a qualified interpreter, and technical difficulties regarding phone and video technology. CONCLUSION: Health care organizations may benefit from increasing staff awareness about patient safety and legal and regulatory risks involved with the use of ad hoc interpreters.

Preparing for patient-centered care: assessing nursing student knowledge, comfort, and cultural competence toward the Latino population.

As the Latino population continues to grow throughout the United States, cultural competence training of nursing students at the baccalaureate level has become a priority. This study aimed to explore undergraduate nursing students' attitudes and beliefs toward Latino patients and their perceived readiness to provide care to Latino patients. A cross-sectional survey was conducted at four major nursing schools in the southeastern United States, which is the region that has seen the highest percentage of growth in the Latino population. Results from multivariable regression suggest that social interaction with Latino individuals and cultural immersion in a Spanish-speaking country predict student knowledge, cultural competence, and comfort with Latino patients. Direct influence by nursing programs, such as clinical experience, coursework, and language proficiency, are positively associated with the designed outcomes, but these relationships are not statistically significant. Our findings suggest that dosage of training matters. Implications for student recruitment, selection, and training are discussed.

Content, placement, and acquisition of cancer education for Latino patient care: a qualitative study of medical and nursing students.

A focus group study was conducted with five medical and nursing education programs in Southeastern USA. Twenty-five third and fourth year students were queried about their experiences, beliefs, and attitudes regarding Latino patients and cancer care. A general inductive process using open coding and content comparison to identify emerging themes was used to analyze the qualitative data. Investigators used a process of constant comparison to identify emerging themes. Themes included: (1) importance of cultural specificity and relevance in cancer training, (2) timing and placement of cancer education in the curriculum, including classes and/or clinical rotations, (3) anatomical system specificity of cancer training-studying cancer in the context of a specific body system, and (4) the prevention-focused nature of cancer training. Results of the focus groups have been used to inform a web-based survey of medical and nursing students to identify gaps in cancer education specific to Latino populations.

Educational and health services innovation to improve care for rural Hispanic communities in the US.

BACKGROUND: Access to comprehensive and quality health care services is difficult for socioeconomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisciplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as Promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural health care initiatives targeting minority groups. This paper reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

Mapping competencies for the multiskilled health care professional: an allied health curriculum reform project.

Health care organizations increasingly face the pressures of meeting the needs of patients while responding to the financial pressures of cost containment and quality optimization. One strategy that health care providers use to adapt to the changing environment is multiskilling. Multi-skilled health care technicians are trained to perform multiple tasks so that they can be deployed more efficiently within health care organizations. Multiskilling can provide numerous benefits to providers, organizations, and patients, but appropriate training for such individuals is critical. The Multiskilled Competencies Development Project was initiated to identify professional standards for entry-level multi-skilled health care technicians. The project was designed to meet the training needs of multiskilled workers through improved allied health curricula. The results of the DACUM (Developing a Curriculum) competency profile for multiskilled health care technicians are presented.

Connecting rural African American and Hispanic women to cancer education and screening: the Avon Health Connector project.

BACKGROUND: Many barriers prevent minority women in rural areas from being screened for breast and cervical cancer. METHODS: A partnership was formed to screen low-income women in a Southern Appalachian area, with particular focus on African American and Hispanic populations. A lay health advisor model was utilized, and 45 LHAs were trained to participate in the program. RESULTS: In this program, 456 women were screened for breast and cervical cancer, 1943 received health education, and 59 health professions students participated. CONCLUSION: A successful partnership model builds on the strengths and assets of partners, provides culturally competent services, and benefits from continual project evaluation.

Integrating bioterrorism education into nursing school curricula.

Due to the events of September 11, 2001 and the bioterrorism-related anthrax episodes, the United States has escalated efforts to better prepare the nation for terrorist attacks. Early recognition and management of a biological attack are largely dependent on the clinical expertise of frontline health care personnel. Nurses are recognized as an integral part of this team. Schools of nursing should integrate bioterrorism education into their curricula to address this growing frontier of health care management. This article outlines the necessary components of bioterrorism education for nurses, reviews examples of available resources to facilitate its inclusion, and suggests ways to integrate this material into nursing curricula.