BACKGROUND: The extent of outpatient adverse drug events (ADEs) remains unclear. Trigger tools are used as a screening method to identify care episodes that may be ADEs, but their value in a population with high chronic-illness burden remains unclear. METHODS: The authors used six abnormal laboratory triggers for detecting ADEs among adults in outpatient care. Eligible patients were included if they were >18 years, sought primary or urgent care between November 2008 and November 2009 and were prescribed at least one medication. The authors then used the clinical / administrative database to identity patients with these triggers. Two physicians conducted in-depth chart review of any medical records with identified triggers. RESULTS: The authors reviewed 1342 triggers representing 622 unique episodes among 516 patients. The trigger tool identified 91 (15%) ADEs. Of the 91 ADEs included in the analysis, 49 (54%) occurred during medication monitoring, 41 (45%) during patient self-administration, and one could not be determined. 96% of abnormal international normalised ratio triggers were ADEs, followed by 12% of abnormal blood urea nitrogen triggers, 9% of abnormal alanine aminotransferase triggers, 8% of abnormal serum creatinine triggers and 3% of aspartate aminotransferase triggers. CONCLUSIONS: The findings imply that other tools such as text triggers or more complex automated screening rules, which combine data hierarchically are needed to effectively screen for ADEs in chronically ill adults seen in primary care.

[West J Emerg Med. 2013;14(5):448–449.]

Background

Interpersonal care (IPC) is increasingly emphasized as health care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos.

Objective

To examine the associations between provider Spanish fluency and Spanish-speaking patients' ratings of IPC and between patient-provider language concordance and patient engagement in diabetes self-care activities.

Design

Cross-sectional survey combined with chart reviews.

Setting/participants

Two hundred fifty Latino adults with diabetes receiving care at safety-net community health centers in two rural California counties.

Main measures

Using a validated questionnaire, we assessed patient ratings of IPC in three areas: communication, decision-making, and interpersonal style. Patient-provider language concordance was measured by physician self-reported fluency in Spanish. We measured participation in diabetes self-care activities by patient self-report. The survey response rate was 68%.

Key results

Patients with language-concordant providers had more favorable IPC ratings (20% to 41% of language-discordant patients had optimal scores for IPC scales vs. 35% to 69% of language-concordant patients, p < 0.05), except with respect to discrimination. Patients with language-concordant providers reported higher levels of participation in diabetic foot care (1.4 days vs. 0.7 days per week, p value 0.01) compared to patients with language discordance. There was no association between language concordance and participation in other self-care activities.

Conclusion

This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.

Objective

To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue.

Design

Qualitative study using a community-partnered participatory research framework.

Setting

Community forum breakout discussion.

Discussants

Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district.

Main outcome measures

Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.

Results

Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality.

Conclusions

Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.