Communicating about NSAIDs Risk: Racial/Ethnic Disparities - Slide Presentation

Slide Presentation from the AHRQ 2008 Annual Conference

By Mike Schoen, Ph.D.

On September September 9, 2008, Mike Schoen, Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (260 KB).

Slide 1

Communicating About Nonsteroidal Antiinflammatory Drugs (NSAIDs) Risk: Racial/Ethnic Disparities

Mike Schoen, Ph.D.
Division of CME [Continuing Medical Education]
University of Alabama at Birmingham (UAB) School of Medicine

Slide 2

Introduction

• Background—recent transplant from N. Indiana; school psychology training; university administration; outreach programs.
• Behavior is important and influenced by many variables; including the environment which can be powerful (e.g., prisons and other institutions).

Slide 3

UAB Factoids

• Established in 1930's as University Alabama extension center.
• Largest employer in Birmingham & State.
• More than 18,000 students; 31% minorities and 60% women.
• Ranked 4th nationally for diversity of student population.

Slide 4

UAB Centers for Education and Research on Therapeutics (CERTs) (DSM): Educational Activities

• Work-in-Progress Forums.
• Epidemiology Book Chapter reviews.
• Visiting Professor and Special Seminar Series.
• Post-Doctoral Fellowships.
• Other products (e.g., Web sites).

Slide 5

Patient-Doctor Communication

• Medical interview or encounter is a core clinical skill.
• 120,000-160,000 career interviews performed by physician.
• Quality of patient care related to quality of patient-physician (P-P) communication.
• Doctors think, feel, and behave too.

Slide 6

Racial/Ethnic Disparities in NSAIDs Risk Awareness, Communication

Rachel Fry, Midge Ray, et al.
Arthritis Care and Research
December 2007

Slide 7

Background: NSAIDs

• Commonly prescribed medication class to treat inflammatory, arthritic, and musculoskeletal conditions.
• Frequently lead to adverse effects (AEs).
• Hospitalizations, deaths, $.
• Racial disparities exist, but what about with NSAIDs risk and communication?

Slide 8

Study Design and Methods

• 48 physician practices in Alabama.
• Established patients.
• 65 years or older.
• Currently taking Rx NSAIDs.
• N = 404 participants (73% participation rate).
• Gift card for completing 1 hour phone interview.

Slide 9

Interview Questions

• Over-the-counter (OTC) NSAIDs risk awareness (Y or N).
• Rx NSAIDs risk awareness (Y or N).
• Doctor-patient communications about risk (Y or N).
• Risk avoiding behavior by taking gastrointestinal (GI) prophylaxis (Y on N).
• Demographics, health, education, insurance status.

Slide 10

Major Findings

• 32% African-American (AA) patients; 68% white.
• AA patients almost twice as likely to report diabetes.
• Significant SES differences; AA patients more likely to report income <$20,000.

Slide 11

NSAIDs Risk and Awareness Findings

• AA patients less likely to report risk associated with OTC NSAIDs (13/29).
• AA patients less likely to report risk associated with Rx NSAIDs (31/50).
• AA patients less likely to report communication with physician about risk (38/52).
• AA less likely to take GI prophylaxis (31/50).

Slide 12

Limitations of Study

• Cross-sectional.
• All data patient self-report.
• Response format limited to Y/N.
• Telephone interviews lengthy (fatigue?).
• Specific NSAIDs info and dose info?
• NSAIDs use not corroborated.
• Single sample not generalizable.

Slide 13

Summary

• Gaps or disparities may exist despite study limitations.
• Gaps might be targeted by new CME.
• Physicians overwhelmed with little time, competing demands.
• Can behavioral science help?