Biomedical subjects

Andrea J Apter

Publications and source records attributed to Andrea J Apter.

25 records · Page 2Linked to original sources

PubMed2004

Gaining insight into patients' beliefs using qualitative research methodologies.

PURPOSE OF THE REVIEW: Qualitative research is a rigorous inductive approach to data collection and data interpretation used to describe patients' perspectives and behaviors. Qualitative research can also be used to develop hypotheses to be tested with quantitative procedures. Combining qualitative and quantitative methodologies can provide more-comprehensive explanations for health actions and beliefs than can be derived from either approach alone. This review serves as a primer for those health care professionals who are unfamiliar with this alternative research paradigm. RECENT FINDINGS: We will explore the similarities and differences between quantitative and qualitative techniques and describe how focus groups allowed us an enhanced appreciation of the reasons for poor inhaled-corticosteroid adherence in low-income African-American patients with persistent asthma. SUMMARY: As populations become more diverse, providers are under increased pressure to effectively communicate and partner with their patients. Qualitative research offers the practitioner a roadmap for enhanced understanding of the unique experiences of patients, thus promoting quality patient-provider relationships.

Asthma↗

PubMed2003

Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics.

BACKGROUND: The safety of sulfonamide nonantibiotics is unclear in patients with prior allergic reactions to sulfonamide antibiotics. METHODS: We conducted a retrospective cohort study using the General Practice Research Database in the United Kingdom, examining the risk of allergic reactions within 30 days after the receipt of a sulfonamide nonantibiotic. Patients with evidence of prior hypersensitivity after the receipt of a sulfonamide antibiotic were compared with those without such evidence. Similar analyses were also performed with the use of penicillins instead of sulfonamides, to determine whether any risk was specific to sulfonamide cross-reactivity. RESULTS: Of 969 patients with an allergic reaction after a sulfonamide antibiotic, 96 (9.9 percent) had an allergic reaction after subsequently receiving a sulfonamide nonantibiotic. Of 19,257 who had no allergic reaction after a sulfonamide antibiotic, 315 (1.6 percent) had an allergic reaction after receiving a sulfonamide nonantibiotic (adjusted odds ratio, 2.8; 95 percent confidence interval, 2.1 to 3.7). However, the risk of allergic reactions was even greater after the receipt of a penicillin among patients with a prior hypersensitivity reaction to a sulfonamide antibiotic, as compared with patients with no such history (adjusted odds ratio, 3.9; 95 percent confidence interval, 3.5 to 4.3). Furthermore, among those with a prior hypersensitivity reaction after the receipt of a sulfonamide antibiotic, the risk of an allergic reaction after the subsequent receipt of a sulfonamide nonantibiotic was lower than the risk of an allergic reaction after the subsequent receipt of a penicillin (adjusted odds ratio, 0.7; 95 percent confidence interval, 0.5 to 0.9). Finally, the risk of an allergic reaction after the receipt of a sulfonamide nonantibiotic was lower among patients with a history of hypersensitivity to sulfonamide antibiotics than among patients with a history of hypersensitivity to penicillins (adjusted odds ratio, 0.6; 95 percent confidence interval, 0.5 to 0.8). CONCLUSIONS: There is an association between hypersensitivity after the receipt of sulfonamide antibiotics and a subsequent allergic reaction after the receipt of a sulfonamide nonantibiotic, but this association appears to be due to a predisposition to allergic reactions rather than to cross-reactivity with sulfonamide-based drugs.

Anti-Bacterial Agents↗

PubMed2003

Early exposure to allergen: is this the cat's meow, or are we barking up the wrong tree?

Several recent studies have suggested that exposure to cat and dog allergen in infancy is protective against the subsequent risk of allergic sensitization and asthma. The methodologic problems to be overcome in clinical research addressing these hypotheses are complex. Appreciation of these studies requires an assessment of the design and adequacy of variables measuring exposures, outcomes, and confounders. It includes understanding the role of effect modification. This article discusses some of the epidemiologic issues in interpreting these studies. Review of relevant epidemiology demonstrates that much research remains to be performed before these interesting hypotheses are proved or disproved.

Allergens↗

PubMed2003

Qualitative research-enhanced understanding of patients' beliefs: results of focus groups with low-income, urban, African American adults with asthma.

BACKGROUND: Qualitative research is an important research methodology for understanding the health beliefs and attitudes of patients. These beliefs and attitudes have been proposed as partial explanations for low adherence to medical therapy and the consequent high burden of morbidity from asthma among low-income urban minorities. OBJECTIVE: The purpose of this study was to explore barriers to adherence to inhaled corticosteroids (ICSs), health beliefs regarding asthma and its treatment, and opinions about providers and clinical research among low-income groups. METHODS: Three focus groups were conducted with 15 low-income, urban, African American adults with persistent asthma. These focus group sessions were audiotaped, transcribed verbatim, and coded by using qualitative analytic techniques. RESULTS: Health beliefs that influenced adherence included patients' reliance on their assessment of asthma control over that of the health provider and concern over the adverse effects of ICS therapy. Adherence was also adversely affected by social obligations and insurers' approval policies and restricted formularies. Although mistrust of the medical establishment was evident, members generally expressed a willingness to participate in nonpharmacologic clinical research and the belief that research was beneficial. However, they had strong preferences for where the research should be conducted. CONCLUSIONS: Although barriers exist to ICS adherence in patient populations, many of these can be addressed during patient-clinician interactions. Qualitative research is an important tool for formulating hypotheses for improving ICS adherence that can then be tested in the future by using quantitative research methods.

Administration, Inhalation↗

PubMed2003

Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white.

BACKGROUND: Sociobehavioral factors influence adherence to inhaled corticosteroid (ICS) in adults with asthma and warrant exploration as explanations of apparent racial disparities in adherence. OBJECTIVE: The purposes of this study were to identify barriers to adherence, potentially modifiable by healthcare providers, in a group of African Americans and non-African Americans and to test modifiable barriers as explanations of racial-ethnic differences in adherence. METHODS: We conducted a cohort study of 85 adults (mean age, 47 +/- 15 years; 61 [72%] female; 55 [65%] African American) with moderate or severe persistent asthma to determine modifiable sociobehavioral predictors of adherence. These were knowledge of the function of ICS, patient-perceived adequacy of communication with the provider, social support, attitude (perception of risks/benefits of ICS), depression, and self-efficacy. Adherence was calculated from electronic monitoring data as the mean of the number of doses recorded per 12 hours divided by the number prescribed, truncated at 100%. Past adherence, baseline severity of symptoms, and sociodemographics were treated as fixed confounders in ordinal logistic modeling. RESULTS: Adherence was 60% +/- 30%. In bivariate analyses, favorable attitude to ICS (P =.01) was associated with better adherence. Of immutable predictors, African American race-ethnicity (P =.001), lower educational achievement (P =.01), lower household income (P =.002), and more baseline symptoms (P =.003) were associated with poorer adherence. In multivariable analysis, controlling for immutable predictors, favorable attitude was associated with adherence. Favorable attitude was associated with greater adherence in African Americans and non-African Americans. Controlling for immutable factors, the race-adherence relationship was not mediated by the mutable factors, but economic factors (income and insurance) were mediators. CONCLUSION: Attitude is strongly related to adherence but does not mediate the effect of race-ethnicity.

Administration, Inhalation↗

PubMed2003

Clinical advances in adult asthma.

From October 2001 through September 2002, reports of clinical research on asthma in adults focused on the epidemiology of asthma, the investigation of pharmacologic and immunologic therapy in the context of new national guidelines, and discussions of medical economics. Epidemiologic findings include the observation that overall mortality has declined and hospitalizations have remained constant in the United States since 1995, although these rates are at least twice as high in Blacks. Socially and economically disadvantaged groups receive poorer health care for asthma. Young children who have fewer than 5 episodes of wheezing in conjunction with respiratory infections generally have a good prognosis and do not have compromised lung function as adults. Pharmacologic reports and the National Asthma Education and Prevention Program Update recommend low- to medium-dose inhaled steroids combined with a long-acting beta-agonist as the preferred therapy for moderate persistent asthma. The use of chlorofluorocarbon-free medications for asthma is increasing. Medications comprise the largest cost category for asthma.

Administration, Inhalation↗

PubMed2002

Stratifying medical and pharmaceutical administrative claims as a method to identify pediatric asthma patients in a Medicaid managed care organization.

Claims data are a problematic indicator of underlying clinical diagnosis. They are attractive because of their affordability, a criterion especially salient in resource-shy environments such as the Medicaid Managed Care Organization. This study tested the validity of administrative medical and pharmaceutical claims stratified by treatment modality to identify true pediatric asthma patients. Primary and secondary data were used. Secondary data consisted of 1997 medical and pharmaceutical claims. Primary data consisted of chart data collected through expert chart review. We stratified claims by treatment modality hypothesized to better identify true asthma patients. Claim patterns were analyzed for support of expectations. Expert chart review determined true asthma status on study sample. We found that claims are patterned in accordance with hypotheses about stratification groups. The combined use of both medical and pharmaceutical claims was more effective in identifying asthmatics than the use of either set of claims by itself. The Medicaid Managed Care Organization can begin to identify its asthma population using the stratification meth.

Asthma↗