Browsing by Author "Kim-Romo, Dawn Nicole"
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Item Spanish-speaking patients’ satisfaction with clinical pharmacists’ communication skills and demonstration of cultural sensitivity(2012-05) Kim-Romo, Dawn Nicole; Brown, Carolyn M., Ph. D.; Barner, Jamie C.; Rivera, Jose O.The primary purpose of this study was to assess Spanish-speaking patients’ satisfaction with their clinical pharmacists’ communication skills and demonstration of cultural sensitivity and to determine their association with Spanish-speaking patients’ socio-demographic, clinical, and communication factors, as well as pharmacists’ Spanish proficiency, cultural rapport, knowledge of complementary and alternative medicines, and race/ethnicity. A self-administered survey was designed to assess the study objectives, and a convenience sample of 93 adult (≥18 years) Spanish speakers with limited English proficiency was obtained from five CommUnityCare Health Centers in Austin, Texas. Satisfaction with communication skills and satisfaction with cultural sensitivity were measured as a 6-item construct and a 4-item construct, respectively, where Spanish-speaking patients rated their satisfaction using a 4-point Likert scale (1=extremely dissatisfied, 2=dissatisfied, 3=satisfied, 4=extremely satisfied). The participants’ mean age was 52.0±14.3 years, where respondents primarily were female (65.9%), utilized publicly-funded insurance (100%), received less than a high school education (86.9%), and reported a “fair” health status (64.8%). Spanish-speaking participants reported overall satisfaction with their clinical pharmacists’ communication skills (3.6±0.5) and demonstration of cultural sensitivity (3.6±0.5). Study participants also indicated items within the cultural rapport subscale were generally important characteristics to Spanish speakers (3.5±0.5). The cultural rapport subscale instructed participants to rate the importance of pharmacists’ specific characteristics (i.e., speaks Spanish, is Latino, provides written information in Spanish, is respectful, is kind, is friendly, and understandings the importance of family opinion in healthcare decisions) on a 4-point Likert scale, where 1=not at all important, 2=somewhat important, 3=important, 4=very important. Multiple linear regression analyses showed that cultural rapport was the only significant predictor of Spanish speakers’ satisfaction with their clinical pharmacists’ communication skills (p<0.01) and demonstration of cultural sensitivity (p<0.001). The results of this study may be instrumental in understanding the communication-related and cultural sensitivity-related needs of Spanish speakers in relation to pharmacists’ cultural rapport and may help initiate future initiatives and interventions involving pharmacists and Spanish-speaking patients with limited English proficiency.Item The treatment of unipolar major depression with psychotic features using combination therapy versus monotherapy : a study of adherence, persistence, health care utilization and expenditures, and medication-related adverse events(2015-08) Kim-Romo, Dawn Nicole; Rascati, Karen L.; Ford, Kentya C.; Richards, Erika K.; Wilson, James P.; Beretvas, Susan N.The purpose of the study was to assess medication adherence, medication persistence, suicide ideation/attempts, health care utilization and costs, and medication adverse events in Texas Medicaid patients with psychotic depression who utilized antidepressant monotherapy (AD cohort) or antidepressant plus second-generation antipsychotic therapy (AD/SGA cohort). Using prescription and medical records from September 2007 to December 2012, beneficiaries were included if they were aged 18-63 years, had no confounding psychiatric disorders, had a 6-month pre-index period with no antidepressants plus a 12-month post-index period, and had a diagnosis for unipolar major depressive disorder with psychotic features (ICD-9-CM 296.24 or 296.34). The index date was the first claim date for an antidepressant. All participants had at least two antidepressant claims, and those in the AD/SGA cohort also had at least two SGA claims. Study covariates included: age, race/ethnicity, gender, residence, Charlson Comorbidity Index score, tobacco use and/or dependence, and antidepressant persistence. A total of 926 participants met study criteria (AD cohort n=510; AD/SGA n=416). Overall, the mean age (±SD), Charlson Comorbidity Index score, and antidepressant persistence rate was 40.5 (±13.2) years, 0.6 (±1.3), and 172.3 (±130.4) days, respectively. The final sample included 66.8% females, 25.2% Caucasians, 34.9% African Americans, 36.7% Hispanics, 79.5% urban dwellers, and 19.7% with known tobacco use/dependence. The AD/SGA cohort had a 53% significantly higher likelihood of being adherent to antidepressant therapy, compared to the AD cohort (p=0.006). Similarly, the AD/SGA cohort had a 23% significantly lower hazard of antidepressant nonpersistence (based on persistence with a 45-day gap) (p=0.001). Alternatively, the AD cohort had a significantly lower rate of psychotic depression-related outpatient/emergency department visits (p<0.001), as well as significantly lower psychotic depression-related costs (medication, medical, and total) and all-cause medication costs (p<0.001). There were no differences in suicide ideation/attempts or rates of incident dyslipidemia or diabetes mellitus between cohorts. Evidence of incident extrapyramidal symptoms were rare (n=12). In conclusion, the AD/SGA cohort had better outcomes associated with antidepressant adherence and persistence, and the AD cohort had lower rates of health care utilization and costs. These real-world estimates should help increase the understanding of appropriate treatment for psychotic depression.