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Biomedical subjects

Steven R Erickson

Publications and source records attributed to Steven R Erickson.

At least 19 recordsLinked to original sources
PubMed2006

Self-reported adherence in patients with asthma.

BACKGROUND: Not all patients with asthma adhere to their prescribed drug regimens. The Behavioral Model of Health Services Utilization, organized as predisposing, enabling, and need variables, may be useful in identifying variables related to adherent medication-taking behavior. OBJECTIVE: To examine the relationship between predisposing, enabling, and need variables and self-reported adherence with asthma controller drugs. METHODS: A secondary analysis was conducted from a cross-sectional study using survey and claims data obtained from adults with asthma enrolled in a managed care organization. Independent variables included predisposing (age, gender, race, years with asthma, number of comorbidities, health beliefs), enabling (income, number of metered-dose inhaler [MDI] instructors, inhaler technique, perceived physician access), and need (patient-perceived severity, symptom-derived severity, health-related quality of life). Adherence was measured using a 4 item questionnaire scored as the mean of the responses, with 5 denoting highest adherence. Multivariate regression analysis was used to identify variables with statistically significant relationships to self-reported adherence. Stepwise backward elimination was used, with the final model consisting of variables considered significant at p less than 0.05. RESULTS: The 573 respondents (1270 packets sent; 45% response rate) were primarily white (89.5%) and female (71.0%), with an average age of 40.5 +/- 12.4 years (mean +/- SD) and average asthma duration of 18.3 +/- 14.2 years. The mean adherence scale score was 3.7 +/- 1.1, with 84.6% indicating some level of nonadherence (score <5). The final model had an adjusted R(2) of 0.26 and included 6 independent variables. Better adherence was associated with stronger beliefs in the benefits of treatment and trigger avoidance, greater perceived asthma severity, longer asthma duration, more MDI instructors, and higher scores on the Short-Form 36 mental component summary. CONCLUSIONS: Complex beliefs, perceptions, and experiences constitute the variables associated with adherent medication-taking behavior. Future longitudinal studies should include these variables to determine the predictive strength of the model.

Adolescent↗
PubMed2005

Adherence to medications by patients after acute coronary syndromes.

BACKGROUND: Nonadherence to medication may lead to poor medical outcomes. OBJECTIVE: To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics. METHODS: Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value < or = 0.05 was considered significant for all analyses. RESULTS: Two hundred eight patients were interviewed. Mean +/- SD age was 64.9 +/- 13.0 years, with 60.6% male, 95.7% white, 57.3% with a college education, 87.9% living with > or =1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 +/- 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R(2) = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables. CONCLUSIONS: After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

Acute Disease↗
PubMed2005

Perceived work performance of patients who experienced an acute coronary syndrome event.

The objectives of this study were to describe the perceived work performance of patients previously diagnosed with acute coronary syndrome (ACS) and to determine the relationship between patient-specific variables and perceived work performance. This cross-sectional study utilized a mailed survey to all patients discharged from a university affiliated hospital with the diagnosis of ACS during a 3-year period. Perceived work performance was measured using the Work Performance Scale (WPS). Independent variables included health status (SF-8, PCS-8, MCS-8 and EQ-5D visual analog scale), cardiac functional status (Duke activity status index), symptom count, comorbidity index, patient-perceived cardiac disease severity, medication count and compliance, job satisfaction, current employment duration, patient demographics and ACS type. Step-wise multivariate linear regression models determined the independent variables with significant association (p < 0.05) to WPS. Of 1,217 patients surveyed, 490 (40%) responded, including 158 currently working (study sample). The regression model with the highest explanatory ability (r(2) = 0.29) included number of symptoms, age, perceived cardiac severity and PCS-8, with more symptoms, higher perceived severity, higher age and lower PCS-8 scores associated with lower WPS. Currently employed ACS patients report a high level of work performance. Symptom burden, perceived disease severity, age and physical function appear to be associated with perceived work performance.

Acute Disease↗
PubMed2005

Depressive symptoms and treatment after acute coronary syndrome.

BACKGROUND: There is limited data regarding the effects of depression treatment adequacy on the mental component of health-related quality of life in a post-acute coronary syndrome population. METHODS: All patients diagnosed with an acute coronary syndrome and discharged from a university-affiliated hospital during a 3-year period were mailed a survey that included the SF-8, EQ-5D and other self-reported measures of disease and treatment (e.g. physical functioning, comorbidity, medication compliance and perceived cardiac severity). Patients were categorized based on self-report of depressive symptoms and antidepressant medication. Adjusted mean mental health-related quality of life scores were determined by least square mean analysis controlling for independent variables. RESULTS: Of 1217 eligible patients, 490 (40.3%) responded. Respondents averaged 65.2 (+/-11.3) years of age, 71% male, 92% Caucasian, 64% with MI history, 17% had their most recent cardiac event within 6 months. No depressive symptoms and no depression treatment (without depression) were reported by 59.8%, 27.6% reported untreated depressive symptoms (untreated), 8.6% reported depressive symptoms and antidepressant medication (undertreated), and 4.1% reported no symptoms and antidepressant medication (adequately treated). Adjusted mean SF-8 Mental Component Summary scores were 52.8, 52.5, 42.8 and 40.2 for patients without depression, adequately treated, untreated and undertreated, respectively (p<0.0001 for all pairwise comparisons except for patients without depression vs. adequately treated and untreated vs. undertreated). CONCLUSIONS: Depressive symptoms are common in patients diagnosed with acute coronary syndrome and appear to be related to lower mental health-related quality of life. These observations stress the importance of diagnosis and treatment of depression in this population.

Aged↗
PubMed2005

Gender and perceived severity of cardiac disease: evidence that women are "tougher".

PURPOSE: Patients' beliefs about their disease may affect their willingness to engage in preventive health behaviors. We sought to determine whether men and women with acute coronary syndrome differ in their perceptions of the severity of cardiac-related illness while controlling for the clinical severity of their condition. METHODS: All patients with acute coronary syndrome discharged from a university hospital during a 3-year period were mailed a questionnaire, and medical records were abstracted. The questionnaire assessed perceived severity of cardiac-related illness (5-point scale from "very mild" to "very severe"), symptom frequency, type of acute coronary syndrome event, number of medications, Duke Activity Status Index (DASI), time since most recent cardiac event, Charlson Comorbidity Index, and demographic information. A logistic regression model was constructed with perceived severity of heart disease as the dependent variable. Gender was the key independent variable while controlling for the other patient and disease variables. RESULTS: The 490 respondents (1217 surveys sent, 40.3% response rate) included 348 men and 142 women who were similar with regard to race and type of acute coronary syndrome event experienced. Women were older, less educated, had a lower DASI score, had more symptoms, and were taking more medications. However, they perceived their cardiac disease as being no more severe than the men. The significant predictors in the regression model of perceived severity included gender, DASI, number of symptoms, type of acute coronary syndrome event, and comorbidity. Female gender was associated with lower perceived severity (odds ratio 0.30-0.80). CONCLUSIONS: Women rate their cardiac disease as less severe than do men when controlling for other measures of cardiac disease severity.

Acute Disease↗
PubMed2005

Validation of the EQ-5D in patients with a history of acute coronary syndrome.

OBJECTIVE: To analyze the construct validity of the EQ-5D in patients with acute coronary syndromes (ACS). METHODS: All ACS-diagnosed patients discharged from a university-affiliated hospital during a 3-year period were mailed a questionnaire that included the EQ-5D and the SF-8. The EQ-5D includes a visual analogue scale (EQ VAS) to measure self-reported current health-status (0-100) and a five-item descriptive system measuring mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Also included were disease severity measures [Duke Activity Status Index (DASI), cardiac symptom count (SC), patient-perceived cardiac disease severity], comorbidity measures (Charlson comorbidity index, total medication count), and other demographic and disease-related items. RESULTS: Of 1217 patients, 490 (40.3%) responded. Patients averaged 65.2 (SD 11.3) years of age; 71.0% male; 91.9% Caucasian; 64.3% history of MI. Only 0.2%-0.4% of EQ-5D items and 8% of the EQ VAS were left unanswered by respondents. The nine most common health states were identified based on the five EQ-5D item scores. Levels of responses to EQ-5D items and the EQ VAS score were significantly better for patients with very mild/mild perceived disease severity compared to severe/very severe, for patients with lower comorbidity, for patients with lower symptom responses, and for patients with a higher cardiac-related functioning. EQ VAS score and SF-8 subscale score correlation coefficients ranged from 0.527 to 0.798 (all p < 0.0001). Significant differences were observed between the response level of individual EQ-5D items and scores of comparable SF-8 subscales. CONCLUSIONS: This study demonstrated the construct validity of the EQ-5D in a population-based sample of patients with a history of ACS.

Acute Disease↗
PubMed2004

Smoking cessation: a pilot study of the effects on health-related quality of life and perceived work performance one week into the attempt.

BACKGROUND: Most patients attempting to quit smoking experience symptoms that may influence functioning and sense of well-being. OBJECTIVE: To conduct a pilot study to assess the acute effects of smoking cessation on health-related quality of life (HRQoL) and perceived work performance. METHODS: Questionnaires were mailed to patients of a smoking-cessation program just prior to quit date and one week after they quit. The questionnaires included the Smoking Cessation Quality of Life Questionnaire and the Work Performance Scale (WPS). Other data included patient demographics, smoking duration, Fagerstro m Test for Nicotine Dependence scale, and smoking status. Student's t-tests were used for pre-post comparisons as well as comparison between higher addiction and lower addiction groups, with p </= 0.05 used for determination of statistical significance. RESULTS: Thirty-four respondents (higher addiction = 12, lower addiction = 22) averaged 48.6 +/- 12.0 (mean +/- SD) years of age and were primarily white (97.1%) and female (72.2%). From baseline to one week post-quit, there was significant worsening of anxiety (71.5 +/- 25.1 to 61.1 +/- 26.0; p = 0.04) and cognitive functioning (72.2 +/- 20.4 to 61.3 +/- 23.9; p = 0.02) scores and improved general health (65.2 +/- 18.4 to 70.5 +/- 16.9; p = 0.01). HRQoL scores for the lower addiction group were higher than those for the higher addiction group, significantly for sleep, cognitive functioning, anxiety, role emotional and mental health. Both groups experienced significant improvement in self-control. The lower addiction group had a significant decline in sleep, cognitive function, and anxiety, while only one domain changed significantly for the higher addiction group. There were no significant differences in WPS analyses. CONCLUSIONS: This pilot study found that, generally, HRQoL changes one week into a smoking cessation attempt. Smokers with higher addiction have lower HRQoL when they begin their cessation attempt, while smokers with lower addiction have greater change in HRQoL.

Female↗
PubMed2004

The concordance of self-report with other measures of medication adherence: a summary of the literature.

OBJECTIVE: The objective of this study was to evaluate the concordance of self-report measures of medication adherence (interview, diary, or questionnaire) with nonself-report measures of adherence (administrative claims, pill count or canister weight, plasma drug concentration, electronic monitors, or clinical opinion). METHODS: A literature search was conducted to identify published reports in which self-report and nonself-report measures of adherence were used within the same study. The concordance of measures within each study was categorized as high, moderate, or low based on a comparison of the adherence estimates. RESULTS: Eight-six comparisons of self-report to nonself-report measures of adherence were identified. Thirty-seven of the 86 comparisons (43%) were categorized as highly concordant. However, concordance varied substantially by type of self-report measure and nonself-report measure. Self-report measures, in general, were highly concordant with electronic measures in only 17% of comparisons, whereas they were highly concordant with other types of nonself-report measures in 58% of comparisons (chi-square = 14.30, P <0.01). When comparing self-report measures, interviews had significantly lower concordance with nonself-report measures as compared with questionnaires or diaries (chi-square = 8.47, P = 0.01). In 15 comparisons of interviews with electronic measures, none of the comparisons were highly concordant, whereas questionnaires and diaries had moderate-to-high concordance with electronic measures in 12 of 16 comparisons (75%). CONCLUSIONS: The concordance of self-report and other measures of medication adherence varies widely based on the type of measures used. Questionnaires and diaries tend to have moderate-to-high concordance with other measures of medication adherence. However, interview-based self-reports are not concordant with electronic measures. Questionnaire and diary methods could be preferable to interviews for self-reported medication adherence.

Data Collection↗
PubMed2004

Suboptimal statin adherence and discontinuation in primary and secondary prevention populations.

OBJECTIVES: To compare statin nonadherence and discontinuation rates of primary and secondary prevention populations and to identify factors that may affect those suboptimal medication-taking behaviors. DESIGN: Retrospective cohort utilizing pharmacy claims and administrative databases. SETTING: A midwestern U.S. university-affiliated hospital and managed care organization (MCO). PATIENTS: Non-Medicaid MCO enrollees, 18 years old and older, who filled 2 or more statin prescriptions from January 1998 to November 2001; 2258 secondary and 2544 primary prevention patients were identified. MEASUREMENTS: Nonadherence was assessed by the percent of days without medication (gap) over days of active statin use, a measurement known as cumulative multiple refill-interval gap (CMG). Discontinuation was identified by cessation of statin refills prior to the end of available pharmacy claims data. RESULTS: On average, the primary and secondary groups went without medication 20.4% and 21.5% of the time, respectively (P=.149). Primary prevention patients were more likely to discontinue statin therapy relative to the secondary prevention cohort (relative risk [RR], 1.24; 95% confidence interval [CI], 1.08 to 1.43). Several factors influenced nonadherence and discontinuation. Fifty percent of patients whose average monthly statin copayment was < US dollars 10 discontinued by the end of follow-up (3.9 years), whereas 50% of those who paid >US dollars 10 but US dollars 20 discontinued by 2.2 and 1.0 years, respectively (RR, 1.39 and 4.30 relative to <US dollars 10 copay, respectively). CONCLUSIONS: Statin nonadherence and discontinuation was suboptimal and similar across prevention categories. Incremental efforts, including those that decrease out-of-pocket pharmaceutical expenditures, should focus on improving adherence in high-risk populations most likely to benefit from statin use.

Cohort Studies↗
PubMed2004

Variation in the distribution of patient-reported outcomes based on different definitions of defining asthma severity.

OBJECTIVES: The purpose of this study was to observe the variation in the distribution of health-related quality of life and work performance scale scores based on using different methods of determining asthma severity. METHODOLOGY: Five methods of determining asthma severity were used, including three patient-derived measures (patient perceived severity or PPS; overall symptom-derived severity or OSS; and nocturnal symptom-severity or NSS); and 2 methods using retrospective pharmacy claims (reliever/oral steroid use or ROSU and multi-drug use or MDU). Three levels of severity were examined: mild, moderate, and severe, requiring condensing some severity categories of several methods. Data were obtained from a cross-sectional mail survey of 603 adults with asthma in a US managed care organization linked to pharmaceutical/medical claims data. Patient-reported outcomes included the Physical Component Summary Score (PCS) and the Mental Component Summary Score (MCS) of the SF-36, the summary score (AQLQ) of the Asthma Quality of Life Questionnaire, and the Work Performance Scale score (WPS) of the perceived work performance scale of the Functional Status Questionnaire. Analysis of variance (ANOVA) was used to examine each method's ability to distinguish between severity levels. Descriptive statistics were used to observe differences in scale scores between methods. RESULTS: Within each method, significant severity effects (except MDU) were found for PCS, AQLQ, and WPS. In post-hoc analyses, mild-moderate and mild-severe comparisons were consistently significant (p < 0.05). In the cross-method analyses, method effects were found at all levels of severity for most scale scores with ranges increasing with increases in severity level. Within-method results were consistent with previous studies demonstrating a significant relationship between severity, health-related quality of life (HRQL) and work performance (WP). However, HRQL and WP scale scores varied by the method used to define severity. CONCLUSION: This variation should be considered when performing cross-study comparisons of burden of illness and treatment effects.

Adult↗
PubMed2004

Work-related outcomes after a myocardial infarction.

STUDY OBJECTIVE: To evaluate work-related outcomes of patients at 7 months after a myocardial infarction and to identify patient, disease, and intervention characteristics associated with these outcomes. DESIGN: Cross-sectional survey analysis. SETTING: Large Midwestern academic health system. PATIENTS: Eighty-nine patients with the discharge diagnosis of acute myocardial infarction during a 1-year index period. INTERVENTION: Work performance questionnaire administered by telephone, and medical record review. MEASUREMENTS AND MAIN RESULTS: Seven months after discharge, 232 patients were interviewed by telephone to determine work status before and after myocardial infarction, work-related outcomes (absenteeism and perceived work performance, assessed by the Work Performance Scale [WPS] of the Functional Status Questionnaire), and health-related quality of life. Univariate analyses were used to determine the association between individual characteristics and work-related outcomes. Of the 89 patients who had worked before the index myocardial infarction, 21 (23.6%) did not return to work. Variables associated with the outcome of not returning to work were past myocardial infarction (before the index myocardial infarction), coronary artery bypass graft surgery, heart failure, positive stress test, and low score on the Physical Component Summary (PCS-12) scale of the Short Form-12. Patients who did not return to work also tended to have more comorbidities and take more prescribed drugs than those who returned to work. Median WPS scores were higher for patients who had higher ejection fractions at discharge, had not experienced a myocardial infarction before the index event, underwent a percutaneous revascularization intervention at the time of hospitalization, and had not recently been absent from work. Workers reporting absences had lower PCS-12 scores than their counterparts or reported a rehospitalization before the survey. CONCLUSION: Preexisting cardiac disease and poorer physical functioning were consistently related to worse work-related outcomes. This small study demonstrates the need for a larger, broader study that includes health beliefs, treatment, and other job and patient factors that may influence work-related outcomes.

Absenteeism↗
PubMed2004

Relationship between symptoms and health-related quality of life in patients treated for hypertension.

STUDY OBJECTIVE: To determine the relationship between symptoms and health-related quality of life (HRQOL) in patients receiving drug therapy for hypertension. DESIGN: Cross-sectional survey. SETTING: Outpatient general medicine and university-based hypertension clinics. PATIENTS: All patients prescribed one or more antihypertensive drugs seen during a 6-month period in the clinics. INTERVENTION: Data were obtained from a mailed questionnaire and medical records. MEASUREMENTS AND MAIN RESULTS: Symptoms were measured by a symptom count and total symptom distress. Two scores derived from the Short Form-36 (SF-36)--the Physical Component Summary (PCS) and the Mental Component Summary (MCS)--were used to assess HRQOL. Responses were received from 125 of 220 patients (56.8%). Mean +/- SD values were 8.8 +/- 7.8 for symptom count, 31.6 +/- 46.2 for total symptom distress, 48.7 +/- 9.3 for PCS, and 51.6 +/- 10.1 for MCS. Higher symptom counts and symptom distress scores were strongly associated with lower HRQOL scores in multivariate models, with standardized coefficients from -0.62 to -0.41. These were greater in magnitude than any other predictor, including demographic information (age, sex, race, education level, income), disease variables (blood pressure, years of hypertension), and drug treatment (number of antihypertensive drugs and duration of regimen). Model-adjusted R2 values were 0.22-0.41. CONCLUSION: Symptoms have a greater impact on HRQOL than patient characteristics, blood pressure, or drug-related factors. Among patients receiving drug therapy for hypertension, detailed review of symptoms may yield important information for assessing and improving HRQOL.

Aged↗
PubMed2003

Methods of measuring asthma severity and influence on patient assignment.

BACKGROUND: There is a need for nonclinical measures in studies where objective clinical data used to determine asthma severity, such as spirometry and peak expiratory flow rate meter readings, are not available. OBJECTIVE: To determine whether different methods of defining asthma severity provide different distributions of patients across the categories of mild, moderate, and severe asthma. METHODS: Data were obtained from a mail survey and the database of a managed care organization located in Michigan. Seven methods of asthma severity that used either patient self-report or claims data were evaluated and divided into 3 categories: patient-perceived severity (1 method), symptom-derived severity (4 methods), and medication-derived severity (2 methods). To further evaluate the extent of the degree of agreement among the 7 severity methods, percent agreement and Cohen K scores were calculated. RESULTS: Surveys were sent to 1,139 persons, and 603 responses were usable. Substantial differences exist in the number of patients in each severity level for different methods of determining asthma severity. The proportion of persons identified as having mild, moderate, and severe asthma ranged from 48% to 82%, 16% to 38%, and 2% to 33%, respectively. The percent agreement and Cohen kappa scores were generally low among the 7 methods. CONCLUSIONS: Due to variations caused by the method of measuring asthma severity, comparability among studies using different methods of classifying asthma severity is limited. Although a uniform evaluation of asthma severity is needed, the results of this study do not identify one preferable method. Rather, investigators should know the limitations of the methods used.

Adolescent↗
PubMed2003

Lecture versus Web tutorial for pharmacy students' learning of MDI technique.

OBJECTIVE: To compare pharmacy students' acquired knowledge and ability to assess metered-dose inhaler (MDI) technique after a traditional lecture versus a Web-based MDI technique tutorial. METHODS: All 42 third-year PharmD students completed a baseline MDI technique knowledge test and were then randomized into 1 of 3 groups. The Web group completed the tutorial on the college dispensing laboratory computers; the lecture group participated in the MDI technique excerpt of the asthma therapeutics lecture; and the control group participated in a 15-minute discussion of participants' hobbies. Afterward, participants in each group completed an identical MDI technique knowledge posttest. Students then observed a standardized mock patient perform MDI technique, documenting steps that were conducted incorrectly. MDI technique knowledge test and MDI technique evaluation test scores were compared between groups using repeated measures ANOVA. RESULTS: There was no significant difference in the baseline MDI technique knowledge test scores between groups. The post-MDI technique knowledge test scores for the Web and lecture groups did not differ significantly (p = 0.38), and both were significantly different from the control group (p < 0.001). MDI technique knowledge scores increased significantly for the Web and lecture groups from pre- to post-assessment, but did not change for the control group. A 2-way repeated measures ANOVA analysis demonstrated no significant interaction of subject and group characteristics. The MDI technique evaluation scores for the Web and lecture groups were not significantly different (p = 0.50), and both were significantly different from the control group (p </= 0.001). CONCLUSIONS: The Web-based MDI technique tutorial was as effective as the standard lecture format in pharmacy students acquiring knowledge of MDI technique and in evaluating a mock-patient exhibiting incorrect MDI technique. Further testing is required to assess the longitudinal effect of the program.

Curriculum↗
PubMed2002

A cross-sectional analysis of work-related outcomes in adults with asthma.

BACKGROUND: Asthma is a disease with physical symptoms that can impair a person's functioning to the point of interfering with school, work, and social activities. OBJECTIVE: Describe how disease (asthma) and patient characteristics affect perceived work performance and absenteeism. METHODS: Using a cross-sectional study design, 369 adults with asthma from a managed care organization responded to a mailed questionnaire which included a perceived work performance scale (WPS) and an item assessing absenteeism. Analysis consisted of psychometric testing of the scale (internal consistency and construct validity); trend observation of influence of perceived and symptom-derived severity on WPS and absenteeism distribution; and regression analysis to examine the relationship between patient/disease characteristics and the work-related outcomes. RESULTS: The mean WPS score was 88.0 +/- 16.2 (of a possible 100), with a Cronbach's alpha of 0.79. Most respondents (84.7%) did not miss any work in the previous 4 weeks. WPS scores declined and the percentage of respondent absenteeism increased as perceived and symptom-derived severity worsened. The regression model for WPS produced an adjusted R2 of 0.32 and included the number of other illnesses, health beliefs, race, income, and perceived and symptom-derived asthma severity. The regression model for absenteeism included number of other illnesses, race, health beliefs, and symptom-derived severity. Perceived work performance and absenteeism are outcomes measures that are distinctive and complementary. CONCLUSIONS: Disease severity, race, income, and health beliefs also contribute and should be considered in health services research related to asthma.

Absenteeism↗
PubMed2002

Influence of sociodemographics on the health-related quality of life of pediatric patients with asthma and their caregivers.

The relationship between socioeconomic variables and the health-related quality of life (HQL) of children with asthma and their caregivers was examined. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ) were administered to 99 pediatric asthmatic patients and caregivers in two specialty clinics. Sociodemographic data was obtained from medical records and additional questions. The relationship between sociodemographic variables and HQL was determined using multiple linear regression. The mean patient age was 12.6+/-2.1 years, more were male and from a minority race. The mean age of caregivers was 41.2+/-8.5 years; most were female and were fom a minority race. Patients tended to rate their asthma severity as mild to moderate, while caregivers tended to rate patients in the moderate to severe category. Based on prescribed medications, most patients had mild to moderate asthma. Household income was consistently associated with patient-perceived HQL. Less consistent associations were seen with other variables. Household income and the caregiver's perception of asthma severity were associated with all caregiver HQL domains. It was concluded that household income was most consistently associated with the HQL of asthmatic pediatric patients and their caregivers.

Adolescent↗
PubMed2002

Health-related quality of life in patients 7 months after a myocardial infarction: factors affecting the Short Form-12.

We assessed patients' health-related quality of life after myocardial infarction and identified related variables. Clinical data were obtained retrospectively from medical records of consecutive patients admitted to a Midwestern university-affiliated medical center with diagnosis of myocardial infarction from July 1999-July 2000. Telephone interviews 7 months after discharge were made to administer the Short Form-12 (SF-12) and obtain patient, disease, drug, and intervention data. Complete information was obtained from 200 patients (mean age 63.4 +/- 13.1 yrs, 68% men). The mean Physical Component Summary (PCS)-12 score was 40.6 +/- 12.0, and the mean Mental Component Summary (MCS)-12 score was 52.1 +/- 10.0. Based on univariate analyses, low PCS-12 scores were associated with women; non-Q-wave infarctions; greater number of illnesses; history of myocardial infarction, chronic heart failure (CHF), transient ischemic attack (TIA), renal disease, peripheral vascular disease, or percutaneous coronary intervention (PCI); rehospitalization during the interim period; and unscheduled PCI since index myocardial infarction. Low MCS-12 scores were associated with age below 65 years, low overall self-reported drug therapy compliance, low self-reported compliance with angiotensin-converting enzyme inhibitor and lipid-lowering therapy, no history of coronary artery bypass graft, and no stress test since index myocardial infarction. A multivariate regression model for PCS-12 kept the following variables: greater number of illnesses, history of CHF or TIA, and rehospitalization since index myocardial infarction. The MCS-12 model contained age below 65 years, low overall compliance, and low compliance with lipid-lowering therapy. Further work is necessary to determine noncardiovascular predictors of quality of life and whether interventions for these patients will result in improved quality of life.

Adult↗