AJPM focus最新文献

{"title":"Expanding Pharmacists’ Prescribing Authority and Medication Uptake: Evidence From Pre-Exposure Prophylaxis","authors":"Bita Fayaz-Farkhad PhD","doi":"10.1016/j.focus.2025.100415","DOIUrl":"10.1016/j.focus.2025.100415","url":null,"abstract":"<div><h3>Introduction</h3><div>Considering the crisis in access to care in the U.S., pharmacies are expected to significantly expand access to a variety of preventive care, including HIV care. As of August 2024, 10 states allow pharmacists to initiate pre-exposure prophylaxis, a medicine taken to prevent HIV, independently. This study analyzed how the expansion of pharmacists’ authority to independently initiate pre-exposure prophylaxis affected pre-exposure prophylaxis prescription rates per 100,000 county residents.</div></div><div><h3>Methods</h3><div>Hand-collected data on pharmacists’ prescribing authority from 2015 to 2023 were linked to county-level pre-exposure prophylaxis prescription rates. Using these data, the impact of the laws was estimated through a difference-in-differences approach. The analysis first calculated changes in pre-exposure prophylaxis prescription rates before and after the expansions and then compared these changes between counties in states that expanded pharmacists’ scope of practice (treatment group) and counties in states that did not (control group).</div></div><div><h3>Results</h3><div>Expanding pharmacists’ prescribing authority increased pre-exposure prophylaxis prescription rates by 11.6%. The largest effects were observed in states that allowed pharmacists to prescribe pre-exposure prophylaxis without any mandatory training, a requirement that may otherwise burden pharmacists. Effects were most prominent in nonrural counties and counties with high insurance coverage and lower proportions of Black and Latinx populations.</div></div><div><h3>Conclusions</h3><div>These results suggest that expanding pharmacists’ prescribing authority will not improve disparities in pre-exposure prophylaxis use if the laws fail to address structural barriers, such as staffing constraints or a lack of capacity.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Moves Health Care From Reactive Risk Transfer to a Proactive Risk Avoidance System","authors":"Duane F. Wisk DO, MPH ,&nbsp;Stefan Gravenstein MD, MPH ,&nbsp;Denis P.H. Mihale MD, MBA ,&nbsp;Manijeh Berenji MD, MPH","doi":"10.1016/j.focus.2025.100411","DOIUrl":"10.1016/j.focus.2025.100411","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board and Journal Information","authors":"","doi":"10.1016/S2773-0654(25)00156-7","DOIUrl":"10.1016/S2773-0654(25)00156-7","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100468"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of SARS-CoV-2 Serology Test Result and COVID-19 Vaccination in Adults: A Multisite Cohort Study","authors":"Jason M. Glanz PhD ,&nbsp;Darryl E. Palmer-Toy MD, PhD ,&nbsp;Komal J. Narwaney PhD ,&nbsp;Jennifer C. Barrow MSPH ,&nbsp;Katia J. Bruxvoort PhD ,&nbsp;Courtney R. Kraus MSPH ,&nbsp;Jason A. Lyons MA ,&nbsp;Ingrid A. Binswanger MD, MPH","doi":"10.1016/j.focus.2025.100423","DOIUrl":"10.1016/j.focus.2025.100423","url":null,"abstract":"<div><h3>Introduction</h3><div>Although the utility of SARS-CoV-2 serology testing is limited, individuals may have used serology test results to inform COVID-19 vaccination decisions during the pandemic. Serology test results may have changed individuals’ perceived susceptibility to SARS-CoV2 infection, leading to risk compensation behavior. Understanding how serology results as a measure of perceived susceptibility influence COVID-19 vaccination decisions could inform future interventions to increase adult vaccine acceptance. This study examined the association between SARS-CoV-2 serology (antibody) test results and COVID-19 vaccination uptake.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults who received ≥1 serology test between January 1, 2021, and February 28, 2023. The date of the first serology test represented Day 0, and vaccination uptake was followed for 30 days. Individuals could have multiple serology tests, and person-time follow-up was enumerated across tests. The main exposure was the SARS-CoV-2 serology test result. Receipt of COVID-19 vaccination (BNT162b2 or mRNA-1273) was analyzed using Cox proportional hazards regression, controlling for age, sex, race/ethnicity, tobacco use, and comorbidities.</div></div><div><h3>Results</h3><div>Within a cohort of 28,610 adults, there were 28,820 serology test results. Approximately 38% (<em>n</em>=10,802) of the cohort had at least 1 positive serology result. Among negative tests, the COVID-19 vaccination rate was 1,489 per 1,000 person-years of follow-up; among positive tests, the rate was 829 vaccinations per 1,000 person-years. A negative serology test result was positively associated with COVID-19 vaccination (adjusted hazard ratio=1.58; 95% CI=1.45, 1.72).</div></div><div><h3>Conclusions</h3><div>SARS-CoV-2 serology results appear to influence vaccination behavior. Future interventions could target perceived illness susceptibility to increase vaccine acceptance.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Lung Cancer Screening: Demographic and Socioeconomic Influences","authors":"Elie Mulhem MD ,&nbsp;Elkhansa Sidahmed PhD ,&nbsp;Yuying Xing PhD ,&nbsp;Hany Eraqi MD ,&nbsp;Holly MacIntyre DO ,&nbsp;Ramin Homayouni PhD","doi":"10.1016/j.focus.2025.100428","DOIUrl":"10.1016/j.focus.2025.100428","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung cancer is the leading cause of cancer mortality in the U.S. Low-dose computed tomography is recommended for lung cancer screening in high-risk patients. The U.S. Preventive Services Task Force updated its recommendation for lung cancer screening in March 2021 to expand eligibility. This study aims to assess lung cancer screening rates and identify factors influencing lung cancer screening uptake under the new recommendations in Southeast Michigan.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on lung cancer screening–eligible patients from April 2021 to December 2023. Patients’ demographics, clinical, and socioeconomic factors were extracted from electronic medical records. Multivariable logistic regression was used to identify factors associated with lung cancer screening uptake.</div></div><div><h3>Results</h3><div>Of the 42,769 eligible patients, only 9,249 (22%) completed lung cancer screening at least once during the study period. Lung cancer screening rate increased from &lt;10% in the first year to nearly 35% by the end of the study period. Higher uptake was observed in patients aged 60–80 years, females, former smokers, and Asian patients. Lung cancer screening was significantly less likely among patients of Middle Eastern or Arab ethnicity, patients of Black race, Medicaid beneficiaries, and those who lived in deprived ZIP codes.</div></div><div><h3>Conclusions</h3><div>Since U.S. Preventive Services Task Force expanded eligibility criteria, lung cancer screening rates remain suboptimal, with disparities across demographic and socioeconomic groups. Tailored, equitable interventions are critical to increasing screening uptake among high-risk and minority populations.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 6","pages":"Article 100428"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediabetes Awareness Barriers and Enablers: National Health and Nutrition Examination Survey 2011–2020","authors":"Li Wang PhD ,&nbsp;Xingran Weng DrPH ,&nbsp;Jennifer L. Kraschnewski MD, MPH ,&nbsp;Ariana R. Pichardo-Lowden MD, MEd, MS","doi":"10.1016/j.focus.2025.100378","DOIUrl":"10.1016/j.focus.2025.100378","url":null,"abstract":"<div><h3>Introduction</h3><div>Prediabetes is prevalent and commonly progresses to diabetes when unaddressed. Prediabetes progression is preventable, yet prediabetes unawareness jeopardizes timely intervention. This study examines barriers and enablers of prediabetes awareness, and describes its influence on diet and physical activity.</div></div><div><h3>Methods</h3><div>We used the United States National Health and Nutrition Examination Survey 2011-2020 data to identify participants with prediabetes. Weighted logistic regression identified factors associated with prediabetes awareness. Weighted logistic and linear regression tested the effects of prediabetes awareness on lifestyle choices such as sugar, carbohydrate and calorie consumption, and physical activity.</div></div><div><h3>Results</h3><div>Of the 2,749 adult participants identified as having prediabetes, 84% were unaware of their condition. Having had a glucose testing in the previous three years before participating in the survey was the strongest independent contributor of prediabetes awareness (AOR: 3.97, 95% CI: 2.76-5.71, P&lt;0.0001). Prediabetes awareness was associated with weight loss intent (AOR: 1.63, 95% CI: 1.13-2.33, p&lt;0.01), but not with healthy lifestyle choices. Healthcare professionals’ advice was associated with increased exercise (AOR: 1.75, 95% CI: 1.31-2.33, p&lt;0.01), however, not with a change in diet.</div></div><div><h3>Conclusions</h3><div>Most participants were unaware of their prediabetes condition, regardless of social determinants of health and demographic factors. This suggests the need to promote prediabetes awareness across populations. Proactively evaluating and discussing results may help narrow the unawareness chasm. Lifestyle choices not being associated with prediabetes awareness suggests that mere awareness and medical advice are not enough for patients to embrace healthy behaviors.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100378"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board and Journal Information","authors":"","doi":"10.1016/S2773-0654(25)00134-8","DOIUrl":"10.1016/S2773-0654(25)00134-8","url":null,"abstract":"","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duration of Breastfeeding in Infancy and Levels of Central Adiposity and Systemic Inflammation in Early Middle Adulthood","authors":"Thomas W. McDade PhD ,&nbsp;Jessica A. Polos PhD ,&nbsp;Kiarri N. Kershaw PhD ,&nbsp;Taylor W. Hargrove PhD ,&nbsp;Stephanie M. Koning PhD","doi":"10.1016/j.focus.2025.100375","DOIUrl":"10.1016/j.focus.2025.100375","url":null,"abstract":"<div><h3>Introduction</h3><div>Overweight, obesity, and systemic inflammation contribute to chronic degenerative diseases that are major public health burdens associated with aging. This longitudinal cohort study investigates whether the duration of breastfeeding in infancy predicts waist circumference and chronic systemic inflammation in early middle adulthood.</div></div><div><h3>Methods</h3><div>Survey-weighted regression models were implemented with data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of adults (aged 33–44 years) with information on breastfeeding history as well as measures of waist circumference, C-reactive protein, and interleukin 6. Analyses focused on 3,417 and 3,570 participants with C-reactive protein and interleukin 6 measurements, respectively. Fixed-effects regression models were also used to analyze between-sibling differences in breastfeeding duration, waist circumference, and C-reactive protein/interleukin 6. C-reactive protein and interleukin 6 were quantified in serum with highly sensitive particle-enhanced nephelometric and electrochemiluminescent immunoassays, respectively.</div></div><div><h3>Results</h3><div>Longer duration of breastfeeding was associated with significantly lower waist circumference and lower C-reactive protein. Results were similar for interleukin 6 but statistically weaker. For individuals who were breastfed for 6–12 months and those not at all, marginal mean waist circumference was 94.8 cm (95% CI=92.5, 97.1) and 101.7 cm (95% CI=100.2, 103.2), respectively. Marginal mean C-reactive protein was 1.59 mg/L (95% CI=1.38, 1.84) versus 2.10 mg/L (95% CI=1.97, 2.24). Waist circumference mediated 57.3%–93.8% of the associations between breastfeeding duration and C-reactive protein, depending on duration category. Breastfeeding duration was negatively associated with waist circumference and inflammation in sibling comparisons, but estimates were imprecise and not statistically significant.</div></div><div><h3>Conclusions</h3><div>The convergence of obesogenic environments and low uptake of breastfeeding for cohorts born after the historical nadir of breastfeeding in the U.S. may contribute to epidemics of overweight/obesity and chronic inflammation that presage risk for chronic degenerative diseases of aging.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100375"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multi-Institutional Evaluation of Billing for Tobacco-Cessation Services: Opportunities to Improve Quality and Enhance Revenue Capture","authors":"Edward Anselm MD ,&nbsp;Derek J. Baughman MD ,&nbsp;Marcus Rauhut MS ,&nbsp;Taylor Martin DO, MPH ,&nbsp;Ishan Mahajan ,&nbsp;Allison B. McCoy PhD","doi":"10.1016/j.focus.2025.100379","DOIUrl":"10.1016/j.focus.2025.100379","url":null,"abstract":"<div><div>A recent paper identified significant gaps in billing for tobacco-cessation services for a multihospital health system. Underbilling can reflect poor billing practices, low rates of tobacco-cessation counseling, or a combination of both. The study design was applied to 2 academic medical centers. Deidentified data from the electronic medical records systems were used to identify adult tobacco users and their insurance coverage for patients who had visits to primary care clinics. The proportion of office visits where cessation services were billed was calculated. An economic evaluation of the missed counseling opportunities was based on insurance type and a fee-for-service-payment model. Billing of cessation services is consistently below 2% across the medical centers studied, suggesting substantial opportunities to improve quality and increase revenue. The prevalence of tobacco use in the patient populations studied was significantly lower than reported for that state by the Centers for Disease Control and Prevention.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Breast Cancer Screening Between Medicare Beneficiaries With and Without Food Insecurity","authors":"Yeunkyung Kim PhD ,&nbsp;Jihye Kim PhD ,&nbsp;Sungchul Park PhD ,&nbsp;Colleen Heflin PhD ,&nbsp;Hyunjee Kim PhD ,&nbsp;Yue Li PhD","doi":"10.1016/j.focus.2025.100386","DOIUrl":"10.1016/j.focus.2025.100386","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the importance of food insecurity, there remains limited data on recent trends in disparities between individuals with and without food insecurity in the receipt of breast cancer screening. The authors examined national trends in breast cancer screening rates between female Medicare beneficiaries with and without food insecurity as well as determined whether access to breast cancer screening was disrupted by the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>The authors performed repeated cross-sectional analyses on 2018–2021 data of Medicare Current Beneficiary Survey Public Use Files. Study sample included 4,459 (in 2018); 4,565 (in 2019); 4,334 (in 2020); and 3,966 (in 2021) noninstitutionalized female Medicare beneficiaries. After applying survey weights, this corresponds to 119,746,358 total beneficiary-years over the 2018–2021 period. The authors fitted a logistic regression model to assess the differences in the receipt of breast cancer screening between female Medicare beneficiaries with and without food insecurity over time.</div></div><div><h3>Results</h3><div>The rate of breast cancer screening between female beneficiaries with and without food insecurity was not statistically different from 2018 to 2020. However, in 2021, female beneficiaries with food insecurity had a rate that was 8.1 percentage points (95% CI= −15.2, −1.0) lower than that of female beneficiaries without food insecurity.</div></div><div><h3>Conclusions</h3><div>These findings suggest the importance for identifying female Medicare beneficiaries who are at increased risk of food insecurity and missed breast cancer screening in clinical settings during and after the COVID-19 pandemic.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 5","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}