Background: Proton pump inhibitors (PPIs) are among the most commonly used medications by patients due to its availability over the counter and frequent prescribing by physicians to treat and alleviate symptoms of gastroesophageal reflux disease. Recently, the FDA issued a warning with respect to the utilization of PPIs and risk of developing Clostridium difficile infections (CDI). The most commonly known medications to cause CDI are antibiotics. However, available studies suggest an association and increase in risk for CDI with PPI use as well. Objective: The purpose of this research is to review and summarize data currently available on the association between PPIs and CDI. Methods: To search for eligible studies, EBSCO engines were investigated using proton pump inhibitors or PPIs and Clostridium difficile or C. diff. as search terms. Meta analyses and systematic reviews published between 2000 and 2020 on adult patients were considered. Results: Eight meta-analyses and systematic reviews met the inclusion criteria. They included studies conducted in the US, Europe, Asia and Canada on inpatient and outpatient adults. The final result for all 8 studies showed a statistically significant association between PPIs and CDI ranging from mild to high risk. Conclusion: Currently available data suggest a positive association between PPIs and CDI.

We examined the effect of shared decision-making (SDM) on women’s adherence to breast and cervical cancer screenings and estimated the prevalence and adherence rate of screenings. The study used a descriptive cross-sectional design using the 2017 Health Information National Trends Survey (HINTS) data collected by the National Cancer Institute. Adherence was defined based on the guidelines from the American Cancer Society and the composite measure of shared decision-making was constructed using three items in the data. Multivariable logistic regression was performed to examine the association between the SDM and adherence, controlling for cancer beliefs and socio-demographic variables. The analysis included 742 responses. Weighted to represent the U.S. population, 68.1% adhered to both breast and cervical cancer screening guidelines. The composite measure of SDM was reliable (α = 0.85), and a higher SDM score was associated with women’s screening adherence (b = 0.17; p = 0.009). There were still women who did not receive cancer screenings as recommended. The results suggest that the use of the SDM approach for healthcare professionals’ communication with patients can improve screening adherence.

Medicare Part D beneficiaries tend not to switch plans despite the government’s efforts to engage beneficiaries in the plan switching process. Understanding current and alternative plan features is a necessary step to make informed plan switching decisions. This study explored beneficiaries’ plan switching using a mixed-methods approach, with a focus on the concept of information processing. We found large variation in beneficiary comprehension of plan information among both switchers and nonswitchers. Knowledge about alternative plans was especially poor, with only about half of switchers and 2 in 10 nonswitchers being well informed about plans other than their current plan. We also found that helpers had a prominent role in plan decision making—nearly twice as many switchers as nonswitchers worked with helpers for their plan selection. Our study suggests that easier access to helpers as well as helpers’ extensive involvement in the decision-making process promote informed plan switching decisions.

The individual mandate is one of the key features of the Affordable Care Act (ACA) and has contributed to a substantial decrease in the overall uninsured rate. We examined the relationship between the individual’s insurance status and his/her attitude towards risk and uncertainty among the nonelderly adults, without employer-sponsored insurance (ESI) sources and who are most likely to benefit from the ACA. A descriptive, cross-sectional study was conducted using the 2014 full-year consolidated data file from the Household Component of the Medical Expenditure Panel Survey-Household Component (MEPS-HC). This study included 4,848 individuals, aged 18–64 years, with incomes between 138–400 % of the Federal Poverty Level (FPL), and without access to public coverage or ESI. We examined the factors associated with the likelihood of being uninsured using a logit model. We found that the proportion of the uninsured among the low-income nonelderly adults without ESI (31.1%) was much higher than the one among the nonelderly adults (14.3%). The uninsured adults were likely to have lower demand for insurance and perceived value of insurance and were less likely to visit a doctor or to fill prescription drugs. More rigorous outreach efforts focusing on increasing perceived value of health insurance could contribute to an increased insurance coverage among low-income populations. Type: Original Research

The Affordable Care Act (ACA) established the health insurance marketplaces to provide people the opportunity to obtain healthcare coverage. Assisters have worked with people who may have difficulty understanding the new system and selecting the right plan. This study aims to describe the local availability of assister programs, and examine the factors influencing assister provision. The 2016 Small Area Health Insurance Estimates data and a database of assister programs constructed using healthcare.gov were analyzed at the county level. Bivariate analysis by assister provision was performed to determine the differences between the two groups, and the hierarchical generalized linear model was used to examine the factors predicting assister availability. The study analyzed 2260 counties nested within 35 states. Assister availability largely varied across counties and states. About half of the counties did not provide assisters at all, and the assister provision rate at state level ranged between 19 - 100%. Counties in metropolitan areas were more likely to provide assister programs than rural areas, and so were counties with higher adult uninsured rate or higher uninsured rate among the people with incomes between 138 - 400% of federal poverty level (FPL). Despite the important role of in-person assistance in plan enrollment, no previous study has examined the local variability of assister program. Our study found a large geographical variation in assister availability, raising concerns about the disparity in access to assister service.