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PubMed2002

Measuring perceptions of innovation adoption: the diffusion of a federal drug prevention policy.

The purpose of this paper is to describe the testing of a new scale to assess the perceived attributes of a federal drug prevention policy. The 17-item scale was administered to 107 Safe and Drug Free Schools (SDFS) coordinators in 12 states as a part of a larger investigation examining the diffusion of a federal drug prevention policy. In developing this scale, the authors drew from theory, previously validated measures, expert review and pre-testing with SDFS coordinators. Factor analysis revealed three underlying constructs representing relative advantage/compatibility, complexity and observability. The constructs found were internally consistent with a Cronbach's alpha ranging from a high of 0.89 for relative advantage/compatibility to a low of 0.71 for observability. Each of these constructs was correlated with a district's adoption of the policy in predictable ways. The construct of relative advantage/compatibility appears to be especially useful in assessing policy adoption. This scale was developed to assess a specific innovation; however, we believe that it can be easily adapted to understand the adoption of other health education interventions.

Diffusion of Innovation↗
PubMed2006

Identifying determinants of protocol adoption by midwives: a comprehensive approach.

Adoption of potentially effective preventive interventions often fails. This study aimed to identify factors that determine why midwifery practices decide to use a smoking cessation protocol, using a comprehensive model of both organizational and psychosocial factors. A cross-sectional survey was conducted among representatives of all 446 Dutch midwifery practices, of whom 251 (56%) responded. The results show that adoption of the protocol was facilitated by the presence of practice assistants and impeded by a large proportion of clients of foreign ethnic origin. The most successful information channel was the midwives' professional association. A consistent positive attitude (perceiving a lot of advantages, few disadvantages and a low level of ambivalence) and positive social norms toward using the protocol, a perceived large proportion of midwives who use the protocol and knowledge about the protocol significantly increased the likelihood of adoption. The decision to use the protocol was better explained by personal awareness and motivation factors than by organizational factors.

Adult↗
PubMed2006

Recruitment and proliferation of CD4+ T cells in synovium following adoptive transfer of adjuvant-induced arthritis.

Adjuvant-induced arthritis can be transferred to naive Dark Agouti (DA) strain (DA.CD45.1) rats by thoracic duct (TD) lymphocytes. Disease can be re-induced in convalescent rats by further transfer of arthritogenic cells, suggesting that resolution of the adoptive disease is not due to active regulation. To examine whether resolution is due to exhaustion of effector cells, we transferred the disease to DA.CD45.1 recipients, using CD4+ T cells from DA.CD45.2 donors. At the height of the adoptively transferred disease, donor cells comprised only 5-10% of recirculating CD4+ T cells but they accounted for approximately 40% of the CD4+ T cells in synovium-rich tissues of the hind paws. Approximately 65% of the donor cells in the synovium expressed a marker of proliferation (Ki-67 antigen). Division of CD4+ T cells continued in shielded paws after suppression of the recirculating pool of lymphocytes by selective irradiation. Intravenously injected CD4+ TD T lymphoblasts from arthritic donors were recruited to normal paws and, in greater numbers, to paws of animals with existing arthritis. Survival of the [125I]iodo-deoxyuridine-labeled lymphoblasts was greater in animals with existing arthritis. We conclude that effector CD4+ T cells in target tissues can proliferate in response to autoantigens and exhibit enhanced survival. However, without a continuous supply, adoptively transferred effector cells do not produce autonomous local disease, due to limits to their lifespan and ability to replicate indefinitely.

Adjuvants, Immunologic↗
PubMed2002

Biotechnology and the European corn borer: measuring historical farmer perceptions and adoption of transgenic Bt corn as a pest management strategy.

A 3-yr, multi-state survey of farmers who had planted transgenic Bacillus thuringiensis (Bt) corn was conducted to evaluate perceptions of Bt corn performance and its utility as a management option for European corn borer, Ostrinia nubilalis (Hübner). A questionnaire was sent to farmers in Illinois, Iowa, Kansas, Minnesota, Nebraska, and Pennsylvania who had grown Bt corn during the growing seasons of 1996, 1997, or 1998. There were 7,427 usable questionnaires returned with the following response percentages: 1996 (42.1%), 1997 (35.0%), and 1998 (22.6%). Adoption rates, based on percentage of acreage planted to Bt corn, increased dramatically from 1996 (10.5%) to 1998 (40.7%). The states growing the highest percentage of Bt corn were Minnesota, Iowa, and then Nebraska However, Illinois, was adopting Bt corn at the fastest rate. Historical use of insecticides did not influence the adoption of Bt corn. In addition, of those farmers who used insecticides to control European corn borer, the percentage that decreased their use of insecticides nearly doubled from 13.2% (1996) to 26.0% (1998) over this 3-yr period. The primary reason farmers planted Bt corn was to eliminate the yield loss caused by European corn borer. Scouting for European corn borers decreased from 91% (scouting 2.2 times a year) in 1996 to 75% (scouting 1.8 times a year) in 1998. The percentage of farmers not scouting for European corn borers increased from 9.6% (1996) to 25% (1998). Most farmers believed yields of Bt hybrids were either similar to or greater than the yields of non-Bt hybrids. Minnesota farmers perceived the greatest yield advantages. Farmers are becoming more aware of insect resistance management guidelines; however, they also clearly show preferences for having the flexibility to use different spatial plantings of Bt and non-Bt corn. Finally, after having planted Bt corn and obtained excellent control of European corn borer, most farmers believed that this insect had been causing more yield loss than they previously had suspected in their non-Bt corn. The data represented here provide an historical foundation for how transgenic Bt corn was used by farmers during the first 3 yr of commercial availability, their initial perceptions on the performance of this technology, and their attitudes regarding management of the European corn borer.

Animals↗
PubMed1991

Detection of triple-helix related structures adopted by poly(dG)-poly(dC) sequences in supercoiled plasmid DNA.

Negative superhelical strain induces the poly(dG)-poly(dC) sequence to adopt two totally different types of triple-helices, either a dG.dG.dC triplex in the presence of Mg(+)+ at both neutral and acidic pHs or a protonated dC+.dG.dC triplex in the absence of Mg(+)+ ions at acidic pH (1). To examine whether there are still other types of non-B DNA structures formed by the same sequence, we constructed supercoiled plasmid DNAs harboring varying lengths of the poly(dG) tract, and the structures adopted by each supercoiled plasmid DNA were studied with a chemical probe, chloroacetaldehyde. The potential of a poly(dG)-poly(dC) sequence to adopt non-B DNA structures depends critically on the length of the tract. Furthermore, in the presence of Mg(+)+ and at a mildly acidic pH, in addition to the expected dG.dG.dC triplex detected for the poly(dG) tracts of 14 to 30 base pairs (bp), new structures were also detected for the tracts longer than 35 bp. The structure formed by a poly(dG) tract of 45 bp revealed chemical reaction patterns consistent with a dG.dG.dC triplex and protonated dC+.dG.dC triple-helices fused together. This structure lacks single-stranded stretches typical of intramolecular triplexes.

Acetaldehyde↗
PubMed1995

Predictors of adopting leisure-time physical activity among a biracial community cohort.

Literature on the correlates and predictors of leisure-time physical activity among African-American population is sparse. This cohort study assessed correlates of leisure-time physical activity (specific large muscle activities during the past month at least three times a week) in a biracial population in 1987 and predictors for the adoption of this behavior 4 years later among those initially inactive. Random digit dialing methods were used to identify residents of two South Carolina communities in 1987. In 1991, 3,223 of these residents were resurveyed (62% response rate). In general, the correlates of leisure-time physical activity (education, > or = 12 years; nonsmoking; weight loss behaviors; and physician advice) were similar for each sex and race group. In 1987, the definition of leisure-time physical activity was not met by 831 (54% of 1,542) white women, 374 (76% of 489) African-American women, 586 (59% of 991) white men, and 126 (63% of 201) African-American men. Among those who were inactive in 1987, 22-24% of white adults and African-American men and 14% of African-American women adopted physical activity 4 years later. Twelve years or more of education was a predictor among white women (risk ratio = 1.7, 95% confidence interval 1.2-2.6) and African-American women (risk ratio = 3.1, 95% confidence interval 1.4-6.9), but not among men. Having a physician discuss physical activity was a predictor among white women (risk ratio = 1.9, 95% confidence interval 1.3-2.7), African-American women (risk ratio = 1.7, 95% confidence interval 0.9-3.2), white men (risk ratio = 2.0, 95% confidence interval 1.3-3.1), and African-American men (risk ratio = 2.7, 95% confidence interval 1.0-7.6). These results highlight the strong effect of educational attainment on adoption of healthy behaviors and support the involvement of physicians to promote physical activity among all race and sex groups.

Adult↗
PubMed2000

Adoption and failure of the "Boyer model" at the University of Louisville.

In the 1990s two factors had a major impact on the promotion and tenure process at the University of Louisville (UL) School of Medicine. Clinical reimbursements declined, and as they did, faculty hired as income-generating clinicians continued to be evaluated as researchers. In addition, with legislation ending mandatory retirement, accountability and the requirement for demonstrations of continued competency increased. In part because of the need to recognize service and the need to evaluate post-tenure faculty, the Board of Trustees launched several ambitious initiatives that were collectively entitled "Redefinition of Faculty." The eventual acceptance of the policies under this umbrella included the adoption of the four kinds of scholarship defined by Ernest Boyer. However, because of faculty unrest regarding other facets of this initiative, compromises in the way that the Boyer model was adopted rendered the governance documents untenable. The difficulties with how the UL School of Medicine adopted the Boyer model are detailed, as are some of the lessons learned. Despite the difficulties, the concepts in Boyer's treatise have not been abandoned; the UL School of Medicine has embraced the need for a broadened view of scholarship in its newly emerging governance documents in which, for example, clinical service, formerly unrecognized as a promotable activity, is now recognized as such.

Career Mobility↗
PubMed1990

Adoption of intraosseous infusion technique for prehospital pediatric emergency care.

A telephone survey was conducted, contacting 51 designated state EMS offices, to determine the extent of use of intraosseous (IO) infusions in prehospital pediatric emergency care nationally and to identify common means of promoting IO adoption, training EMS personnel, and monitoring intraosseous field use. Less than half of the respondents reported actual prehospital use of IO infusions in pediatric patients, and an additional third indicated that they were unaware of any future plans for introducing the technique into EMS practice. This study's documentation of the current limited prehospital use of intraosseous infusions indicates a need for concerted efforts to promote broad adoption and continued evaluation of the IO technique in prehospital pediatric emergency care. Suggestions to enhance adoption include increased utilization of existing successful IO teaching approaches, development of national EMS standards regarding intraosseous infusions, active involvement of EMS regulatory agencies for widespread practice changes, and consistent quality assurance activities.

Bone and Bones↗
PubMedDate not supplied

Early adoption of BRCA1/2 testing: who and why.

PURPOSE: Relatively little is known about the characteristics of women who chose to undergo BRCA1/2 testing soon after testing became available, including how they became aware of and chose to pursue testing. Diffusion of innovation theory states that acceptance of an innovation is a function of the potential adopter's value for innovation and perceptions of the compatibility, complexity, and relative advantage of the innovation. These factors may contribute to early uptake of BRCA1/2 testing. The purpose of this study was to describe the characteristics of women who were "early adopters" of clinical BRCA1/2 testing and to determine whether diffusion theory explains variation in uptake of testing after participation in genetic counseling for BRCA1/2 testing. METHODS: A retrospective cohort study of participants in genetic counseling for BRCA1/2 testing was conducted at a clinical program in a large academic health system. Measures included components of diffusion of innovation theory (participant's value for innovation, i.e., "innovativeness," and perceptions of the compatibility, complexity, and relative advantage of BRCA1/2 testing), characteristics of how the participant became aware of and sought BRCA1/2 testing, and decisions about testing after counseling. RESULTS: From the 229 respondents, 71 (31%) had undergone testing at the time of the survey. Fifty-seven women (25%) had sought BRCA1/2 testing because a family member had breast or ovarian cancer and 37 (16%) because they had breast or ovarian cancer. Only 15 women (7%) reported seeking testing because of a physician's recommendation. After multivariate adjustment, higher innovativeness and higher ratings of the compatibility of BRCA1/2 testing were associated with undergoing testing after counseling [relative risk (RR) 1.76, 95% confidence interval (CI) 1.2-2.6]. However, ratings of the complexity or relative advantage of testing were not associated with testing decisions. Higher innovativeness was associated with being the first in the family to undergo testing (RR 4.85, 95% CI 1.6-14.9), becoming aware of BRCA1/2 testing through the media (RR 1.50, 95% CI 1.0-2.4), and being aware of BRCA1/2 testing prior to counseling (RR 1.25, 95% CI 1.1-1.4). CONCLUSIONS: The uptake of BRCA1/2 testing among women undergoing genetic counseling was associated with innovative characteristics of the participant and the perceived compatibility of the test with existing values and needs, but not with the complexity or relative advantage of the test. Most "early adopters" had heard of BRCA1/2 testing from a source other than their physician and had sought testing because of a personal or family member's cancer diagnosis. These findings can inform predictions surrounding the introduction of future genetic susceptibility tests and strategies for guiding the further diffusion of BRCA1/2 testing.

Decision Making↗
PubMed2004

Posttrial HIV vaccine adoption: concerns, motivators, and intentions among persons at risk for HIV.

BACKGROUND: Suboptimal uptake of existing vaccines, potential obstacles specific to HIV/AIDS stigma and mistrust, and marked health disparities suggest that it is vital to investigate consumer concerns, motivations, and adoption intentions regarding posttrial HIV vaccines before a vaccine is publicly available. METHOD: Nine focus groups were conducted with participants (n = 99; median age, 33 years; 48% female; 22% African American, 44% Latino, and 28% white) recruited from 7 high-risk venues in Los Angeles using purposive venue-based sampling. A semistructured interview guide elicited concerns, motivators, and adoption intentions regarding hypothetical U.S. Food and Drug Administration-approved HIV vaccines. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. RESULTS: Concerns included vaccine efficacy, vaccine-induced infection, vaccine-induced HIV seropositivity, side effects, cost/access, trustworthiness, and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partial efficacy vaccines and likelihood of increased sexual risk behaviors in response to vaccine availability. CONCLUSION: Tailored interventions to facilitate uptake of future U.S. Food and Drug Administration-approved HIV vaccines and to prevent risk behavior increases may be vital to the effectiveness of vaccines in controlling the AIDS pandemic.

AIDS Vaccines↗
PubMed2006

Do maternal depressive symptoms, stress and a lack of social support influence whether mothers living in deprived circumstances adopt safety practices for the prevention of childhood injury?

BACKGROUND: Maternal depressive symptoms are common, as are childhood injuries, particularly among the socio-economically disadvantaged. Maternal depression may be associated with lesser engagement in injury prevention practices. Providing support to mothers can reduce the risk of child injury, but the mechanism by which this occurs is unclear. The aim of this study was to examine the relationship between maternal depressive symptoms, social support and stress, and engagement in home safety practices to prevent injuries to pre-school children living in socio-economically deprived families in the UK. METHODS: Three questionnaires were posted to mothers of young children living in deprived areas in the city of Nottingham, UK, who were enrolled in the control group of a randomized controlled trial (RCT). The questionnaires assessed socio-demographic characteristics at baseline; depressive symptoms, perceived social support and self-reported stress 21 months later and engagement in home safety practices 24 months post baseline. The mothers in the control group received no intervention. Main outcome measures were the use of fireguards, stair gates, smoke alarms, window locks and safe storage of medicines, sharp objects and cleaning products. RESULTS: One-third (36.4%) of mothers reported depressive symptoms. The most widely adopted safety practices were safe storage of medicines (93.5%) and use of smoke alarms (86.2%). The majority of mothers did not use fireguards (60.7%) or store sharp objects safely (63.8%). Depressive symptoms were not independently associated with any of the seven safety practices. Mothers reporting some lack of social support were more likely not to store medicines safely [odds ratio, OR, 4.08 (95% confidence interval, CI, 1.79-9.30) compared with those reporting no lack of social support] and mothers reporting moderate or large amounts of stress were more likely not to store sharp objects safely [OR 1.77 (95% CI 1.11-2.83) compared with mothers reporting no or little stress] after controlling for confounders. CONCLUSIONS: Our results suggest that depressive symptoms, stress and a lack of social support are not important influences on the adoption of safety practices by mothers living in deprived areas in the UK, at least in the short term. Further work is required to explore the effects of chronic maternal depressive symptoms on the adoption of safety practices.

Child Care↗
PubMed2005

The adoption of new endodontic technology amongst Danish general dental practitioners.

AIM: To assess the adoption of new endodontic technology in a population of Danish practitioners. METHODOLOGY: Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen. RESULTS: Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam. CONCLUSIONS: The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.

Denmark↗
PubMed2005

Adoption of celecoxib and rofecoxib: a nationwide database study.

BACKGROUND AND OBJECTIVE: Cyclooxygenase 2-selective non-steroidal anti-inflammatory drugs (NSAIDs, coxibs) are recommended primarily for patients at high risk of gastrointestinal bleeding, most of them being elderly. Our objective was to describe and analyse patient- and physician-related factors affecting the adoption of celecoxib and rofecoxib 2 years after their launch in Finland. METHODS: Retrospective analysis of the nationwide Prescription Register. Physicians who had issued at least 200 reimbursed prescriptions in 2002 (n = 12 033, 80% of working-age Finnish physicians) were involved in the analysis. RESULTS AND DISCUSSION: Excluding patients with rheumatoid arthritis (RA), almost one-fifth (18%) of NSAIDs prescriptions were for coxibs. In patients with RA the share was 25%. The share of coxib prescriptions of all NSAIDs increased with age of the patient. Over one half (58%) of coxib prescriptions were issued for patients under 65 years of age. Specialists in physical and rehabilitation medicine were the fastest adopters of coxibs: one-third of their NSAID prescriptions in 2002 were for coxibs. Primary care physicians were the most conservative both in adopting and favouring coxibs. CONCLUSIONS: Coxibs have gained the status of standard prescription NSAIDs within a few years. Their use should be restricted to patients who could benefit most from the use. Routine prescribing of expensive new drugs increases the drug bill without additional health gain.

Age Factors↗
PubMed2004

Learning in a clinical education programme in primary care: the Maastricht Adoption Programme.

INTRODUCTION: At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an 'Adoption Programme', where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme. METHOD: Data from the evaluation questionnaires of 188 medical students were used to test a causal model of learning in the programme. A distinction was made between 'action' and 'reflection on action'. We examined the relationships between perceived instructiveness (the programme's value as a learning experience) and the following variables: comprehensibility; feasibility and execution of the assignments; time spent on the assignments, and the direct and indirect influences of the hosting general practitioner (GP) and the practical medical coaching group. RESULTS: Performing the assignments had little effect on perceived instructiveness. Coaching by the hosting GP influenced the execution of assignments mainly by its effect on feasibility. Coaching by the GP and in the practical medical coaching groups barely affected perceived instructiveness. DISCUSSION AND CONCLUSION: The model gives insight into the contribution of aspects of the Adoption Programme to student learning. The results are probably negatively influenced by the insufficient priority given to the Adoption Programme in the practical medical coaching groups and by inadequate instruction given to the GPs for the purposes of their coaching role. More careful planning of patient-related assignments is recommended. Reflection on assignments and feedback on procedures are needed to lift practical experience onto a higher educational level.

Attitude of Health Personnel↗
PubMed2004

Priority for children in cadaveric kidney sharing: the strategy adopted in Sao Paulo, Brazil.

Early kidney transplantation is crucial in order to accomplish both optimal mental development and the best adult height in children with end-stage renal disease. The aim was to evaluate the efficacy of the child priority policy for cadaveric kidney sharing adopted in the State of Sao Paulo (Brazil). We performed a retrospective study of data collected by the Government Transplant Department in São Paulo, involving all patients included in the waiting list from August 13, 1998 to December 31, 2001. During the study period, the child priority policy had been changed giving: period A--from the outset up to March 14, 2001, where the rule was to direct cadaveric kidneys obtained from children <12 yr, to recipients <12 yr; period B--from March 14, 2001 onwards, where the policy had been broadened to include cadaveric donors <18 yr, destined for recipients <18 yr. We performed the analysis of the data comprising 8940 patients, 8622 being adults (mean age = 48.6 +/- 14.1 yr, 3594 females) and 318 children (mean age = 11.9 +/- 5.1 yr, 156 females). Over the 3.5-yr follow-up there were 1964 deaths [1933 adults and 31 children, odds ratio (OR) 0.37; 95% CI 0.25-0.55], 1032 living donor kidney transplants (963 adults and 69 children, OR 2.20; 95% CI 1.66-2.93), and 556 cadaveric kidney transplants (444 adults and 112 children, OR 10.11; 95% CI 7.75-12.94). Three and a half years after being enrolled on the list, 24% of the children and 75% of the adults, respectively, were still awaiting a cadaveric kidney transplant (log rank test = 539, p < 0.00001). The analysis of period A vs. period B, suggests that the raising of the inclusion age upper limit to 18 yr, resulted in a twofold increase in the percentage of children being grafted within 6 months of enrollment. Overall, our data shows a slow rate of cadaveric kidney transplantation activity in Sao Paulo. Children's chances of receiving a living donor kidney almost doubled. Moreover, 19.5% of pediatric recipients had received their kidney within the first year of being enrolled on the waiting list. The scheme adopted in Sao Paulo is encouraging, but the results remain less favorable than those observed in other countries. The adoption of the priority policy did not result in an unacceptable increase of adult waiting time, given that the number of adults on our waiting list outweighs by far the number of children.

Adolescent↗
PubMedDate not supplied

Eliciting stated preferences for health-technology adoption criteria using paired comparisons and recommendation judgments.

OBJECTIVES: The principal aim of this study was to illustrate applying discrete-choice methods for eliciting preferences for technology adoption criteria, including threshold values for cost-effectiveness ratios. A secondary objective was to compare the criteria weights of a sample of industry stakeholders with the results obtained from a study of National Institute for Health and Clinical Excellence (NICE) recommendations. METHODS: We administered a two-stage stated-preference (SP) question format to a sample of respondents who have expertise in applying economic analysis to technology adoption decisions. We elicited paired comparisons and recommendation judgments for similar criteria from a sample of International Society for Pharmacoeconomics and Outcomes Research members. Respondents evaluated nine pairs of hypothetical drugs, first indicating which drug was "better," then indicating what they would recommend to a reimbursement authority such as the National Health Service. Stated-choice studies often obtain only paired-comparison judgments. RESULTS: Parameter estimates from the initial paired-comparison question indicate only incremental cost-effectiveness ratio and number of affected patients influence evaluations. These two factors have identical weights in the second recommendation question, but all four factors were considered in determining the recommendation threshold. Our sample was more willing than NICE to accept trade-offs between cost-effectiveness and other drug features and was less concerned about cost-effectiveness ratios and information uncertainty. Nevertheless, our sample was in agreement with NICE about the importance of the number of patients who would benefit as a criterion for influencing adoption recommendations. CONCLUSION: This study demonstrates that including a question allowing respondents the opportunity to reject both alternatives in a forced-choice paired comparison can be important for obtaining accurate preference estimates. Our results demonstrate that SP methods offer a feasible means of quantifying a broad set of valuations that incorporate the preferences of patient, citizen, payer, and other stakeholder groups.

Academies and Institutes↗
PubMed2005

The cost effect of newer medication adoption in an older Medicaid cohort.

OBJECTIVES: State Medicaid programs struggle with rapidly increasing expenditures for pharmaceuticals, and Medicare will likely face the same challenge. This article demonstrates how the adoption of newer drugs across diverse therapeutic classes contributed to one state's Medicaid expenditures over a 3-year period. DESIGN: Retrospective analysis of administrative claims data. SETTING: Older Kansas Medicaid community dwellers and institutionalized beneficiaries. PARTICIPANTS: A 15% random sample (N = 6,256) of recipients aged 60 and older. MEASUREMENTS: Prescription medication use was tracked for three sequential 1-year periods for eight therapeutic classes accounting for the greatest Medicaid drug expenditures, categorizing individual medications as newer or older agents based on generic availability and other clinical distinctions. Outcome measures were utilization per person-year, price per prescription, market share as percentage of prescriptions, and market share as percentage of expenditures for prescriptions within each class. RESULTS: Use increased for all classes, driven by the adoption of newer agents. Mean prescription prices rose in nearly all classes primarily because of the higher prices of the newer agents. Newer drugs accounted for more than 50% of prescriptions in four of eight classes and constituted a disproportionately greater share of expenditures than their prescription share among several classes: antidepressants (>95%), antipsychotics (>92%), antiulcer agents (>63%), antiinflammatory drugs (>60%), and opiates (>45%). CONCLUSION: Newer drug products for a variety of treatment indications consume a majority of pharmaceutical expenditures through widespread adoption and higher prices. Although these agents may offer some therapeutic advantages, further research is needed to determine in what circumstances, and for which patients, the advantages of new pharmaceuticals outweigh their higher costs.

Aged↗
PubMed2006

Domestic violence and contraceptive adoption in Uttar Pradesh, India.

This study examines the association between domestic violence and the subsequent adoption of modern contraception in North India. Matched data on married couples who were not practicing contraception are analyzed from companion surveys of married husbands and wives in five districts of Uttar Pradesh. By means of hazard modeling, a significant negative association was found between a husband's reporting of using physical domestic violence against his wife and the couple's adoption of a modern method of contraception. Community norms that were more tolerant of domestic violence were, in contrast, not a significant predictor of subsequent method adoption. The results highlight the need to address the issue of support for women experiencing domestic violence within existing family planning services and to sensitize service providers to the specific needs of women experiencing such violence.

Adult↗