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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 8993 Research Studies Displayed
Levis B, Benedetti A, Ioannidis JPA
Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.
The authors compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. They found that PHQ-9 ≥10 substantially overestimated depression prevalence, as there was too much heterogeneity to correct statistically in individual studies.
Citation: Levis B, Benedetti A, Ioannidis JPA . Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. J Clin Epidemiol 2020 Jun;122:115-28.e1. doi: 10.1016/j.jclinepi.2020.02.002..
Keywords: Depression, Mental Health, Diagnostic Safety and Quality, Diagnosis
Anderson KE, Saloner B, Eckstein J
Quality of buprenorphine care for insured adults with opioid use disorder.
This retrospective cohort study evaluated the quality of treatment for insured adults with opioid use disorder (OUD) in the United States. A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older from the OptumLabs Data Warehouse database with an OUD diagnosis in 2018 were analyzed. The treatment analyzed was use of buprenorphine. Only 1 in 10 eligible individuals with OUD initiated buprenorphine within 365 days of diagnosis with 2850 individuals (6.3%) initiating buprenorphine within 14 days of diagnosis. Of the 4600 individuals who received buprenorphine, half were maintained in care with 180 days or more of covered treatment. Treatment quality was generally lower for individuals with MA compared with commercial coverage as well as Hispanic and Black adults compared with White adults.
Citation: Anderson KE, Saloner B, Eckstein J . Quality of buprenorphine care for insured adults with opioid use disorder. Med Care 2021 May;59(5):393-401. doi: 10.1097/mlr.0000000000001530..
Keywords: Opioids, Medication, Substance Abuse, Quality of Care
Ragavan MI, Query LA, Bair-Merritt M
Expert perspectives on intimate partner violence power and control in pediatric healthcare settings.
Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. In this study, the investigators explored the perspectives of pediatric IPV experts about 1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; 2) how controlling behaviors impact healthcare access and quality; and 3) recommendations for the pediatric healthcare team.
Citation: Ragavan MI, Query LA, Bair-Merritt M . Expert perspectives on intimate partner violence power and control in pediatric healthcare settings. Acad Pediatr 2021 Apr 1;21(3):548-56. doi: 10.1016/j.acap.2020.02.021..
Keywords: Children/Adolescents, Domestic Violence
Moriya AS, Xu L
AHRQ Author: Moriya AS
The complex relationships among race/ethnicity, social determinants, and opioid utilization.
The objective of this study was to examine individual- and community-level factors associated with racial/ethnic differences in individuals' opioid prescription use. The investigators found that the average annual rate of any outpatient opioid prescription use was higher for non-Hispanic whites than for non-Hispanic blacks and Hispanics. The smaller difference between non-Hispanic blacks and whites was not explained by the differences in the risk factors, while almost all the difference between Hispanics and non-Hispanic whites could be explained by the differences in the means of the risk factors.
Citation: Moriya AS, Xu L . The complex relationships among race/ethnicity, social determinants, and opioid utilization. Health Serv Res 2021 Apr;56(2):310-22. doi: 10.1111/1475-6773.13619..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial / Ethnic Minorities, Social Determinants of Health, Opioids, Medication, Disparities
Michelson KA, Dart AH, Bachur RG
Measuring complications of serious pediatric emergencies using ICD-10.
The purpose of this study was to create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD-10-CM/PCS), and to assess whether complication rates are similar to those measured with ICD-9-CM/PCS. The investigators concluded that for most conditions, incidences and complication rates were similar before and after the transition to ICD-10-CM/PCS codes, suggesting their system identified complications of conditions in administrative data similarly using ICD-9-CM/PCS and ICD-10-CM/PCS codes.
Citation: Michelson KA, Dart AH, Bachur RG . Measuring complications of serious pediatric emergencies using ICD-10. Health Serv Res 2021 Apr;56(2):225-34. doi: 10.1111/1475-6773.13615..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Adverse Events
Mellor JM, McInerney M, Sabik LM
Misclassification of Medicaid participation by dual eligibles: evidence from the Medicare Current Beneficiary Survey.
Previous studies show that survey-based reports of Medicaid participation are measured with error, but no prior study has examined measurement error in an important segment of the Medicaid population-low-income adults enrolled in Medicare. Using the Medicare Current Beneficiary Survey, the investigators examined whether respondent self-reports of Medicaid enrollment matched administrative records and present several key findings.
Citation: Mellor JM, McInerney M, Sabik LM . Misclassification of Medicaid participation by dual eligibles: evidence from the Medicare Current Beneficiary Survey. Med Care Res Rev 2021 Apr;78(2):113-24. doi: 10.1177/1077558719858839..
Keywords: Medicaid, Managed Care, Health Insurance
Makarem N, Alcántara C, Williams N
Effect of sleep disturbances on blood pressure.
This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Recommendations include efforts to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.
Citation: Makarem N, Alcántara C, Williams N . Effect of sleep disturbances on blood pressure. Hypertension 2021 Apr;77(4):1036-46. doi: 10.1161/hypertensionaha.120.14479..
Keywords: Sleep Apnea, Sleep, Blood Pressure, Hypertension
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
Citation: Jacobs PD, Kronick R . The effects of coding intensity in Medicare Advantage on plan benefits and finances. Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Managed Care, Health Insurance, Healthcare Costs, Policy
Hill SC, Zuvekas SH
AHRQ Author: Hill SC, Zuvekas SH
Patient-centered medical homes and pediatric preventive counseling.
The authors sought to measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities. Using MEPS data, they found that PCMHs were associated with substantially greater receipt of pediatric preventive counseling. They recommended that evaluations of PCMHs account for the quality-related activities of comparison practices.
Citation: Hill SC, Zuvekas SH . Patient-centered medical homes and pediatric preventive counseling. Acad Pediatr 2021 Apr 1;21(3):488-96. doi: 10.1016/j.acap.2020.07.001..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Patient-Centered Healthcare, Prevention
Gurka MJ, Siddiqi SU, Filipp SL
Attention deficit hyperactivity disorder medications and BMI trajectories: the role of medication type, sex and age.
Investigators estimated the proximal change in BMI associated with start of medication and to assess whether medication-specific departures in BMI varied by age and sex in patients with attention deficit hyperactivity disorder (ADHD). Longitudinal electronic health records from children aged 4-19 years with an ADHD diagnosis at one healthcare system were analyzed. They found that all medications had larger impacts at younger ages; decreased BMI was observed with stimulants, while antidepressants and antipsychotics led to BMI increases as did alpha-agonists, significantly varying by sex and age. They recommended future research to study further the interactions of these medications on long-term impacts on obesity.
Citation: Gurka MJ, Siddiqi SU, Filipp SL . Attention deficit hyperactivity disorder medications and BMI trajectories: the role of medication type, sex and age. Pediatr Obes 2021 Apr;16(4):e12738. doi: 10.1111/ijpo.12738..
Keywords: Children/Adolescents, Attention Deficit Hyperactivity Disorder (ADHD), Mental Health, Medication, Obesity
Griffith KN, Feyman Y, Auty SG
County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access.
Researchers created a dataset to provide a new level of precision that may be leveraged by scholars, policymakers, or data journalists who are interested in studying the opioid epidemic. Other researchers may use this dataset to identify patterns in opioid distribution over time and characteristics of counties or states which were disproportionately impacted by the epidemic. These data may also be joined with other sources to facilitate studies on the relationships between opioid pill volume and a wide variety of health, economic, and social outcomes.
Citation: Griffith KN, Feyman Y, Auty SG . County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access. Data Brief 2021 Apr;35:106779. doi: 10.1016/j.dib.2021.106779.
Keywords: Opioids, Medication, Substance Abuse
Glenn BA, Nonzee NJ, Hamilton AS
Cancer surveillance and preventive services in a diverse sample of breast and colorectal cancer survivors.
This study assessed engagement in surveillance for recurrence, cancer screening, and other recommended preventive health services among breast and colorectal cancer survivors with early-onset disease (age 50 years and younger) who were diagnosed in California. Findings showed that, although the majority of survivors received appropriate surveillance for recurrence, engagement in other preventive health services varied substantially. Implications included efforts to address gaps in the use of recommended cancer screening and preventive health services among cancer survivors.
Citation: Glenn BA, Nonzee NJ, Hamilton AS . Cancer surveillance and preventive services in a diverse sample of breast and colorectal cancer survivors. J Cancer Surviv 2021 Apr;15(2):213-23. doi: 10.1007/s11764-020-00925-4..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Prevention, Screening
Ellison J, Griffith K, Thursby M
The impact of driving time to family planning facilities on preventive service use in Ohio.
This study examined the impact of driving time to family planning facilities for preventive service use in Ohio due to newly enacted restrictions in public funding for organizations that provide or refer patients to abortion care, often resulting in clinic closures. Data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System was assessed for female respondents aged 18-45 years with household incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP codes to compute driving times to the nearest family planning clinic. Each additional 10 minutes of driving time was associated with an 8.9 percentage point increase in the likelihood of avoided care owing to cost, a 10.4 percentage point decrease in the likelihood of a mammogram during the past 12 months, and a 12.5 percentage point decrease in the likelihood of ever receiving a clinical breast examination. Results were similar for driving distance increases.
Citation: Ellison J, Griffith K, Thursby M . The impact of driving time to family planning facilities on preventive service use in Ohio. Am J Prev Med 2021 Apr;60(4):542-45. doi: 10.1016/j.amepre.2020.11.009..
Keywords: Access to Care, Women, Prevention, Screening, Mammogram
Classen DC, Munier W, Verzier N
AHRQ Author: Munier W, Eldridge N, Brady J, Helwig A, Battles J
Measuring patient safety: the Medicare Patient Safety Monitoring System (past, present, and future).
This review article discusses the development, strengths and limitations, and future of the Medicare Patient Safety Monitoring System (MPSMS), which was created more than 10 years ago. MPSMS is a chart review-based national patient safety surveillance system that provides rates of 21 specific hospital inpatient adverse event measures, which are divided into 4 clinical domains (general, hospital-acquired infections, post-procedure adverse events, and adverse drug events). The 2014 MPSMS national sample was drawn from 1109 hospitals and includes approximately 20,000 medical records of patients admitted to the hospital for at least 1 of 4 conditions: congestive heart failure, acute myocardial infarction, pneumonia, and major surgical procedures as defined by the Centers for Medicare and Medicaid Services Surgical Care Improvement Project. The MSPMS is now undergoing a major transformation to capture additional types of adverse events, and is being renamed the Quality and Safety Review System (QSRS). Data will be electronically imported and will be updated and evolved over time to incorporate expanded standardized data available from electronic health records.
Citation: Classen DC, Munier W, Verzier N . Measuring patient safety: the Medicare Patient Safety Monitoring System (past, present, and future). J Patient Saf 2021 Apr 1;17(3):e234-3240. doi: 10.1097/pts.0000000000000322..
Keywords: Patient Safety, Medicare, Medical Errors, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT)
Byrnes ME, Brown CS, De Roo A
Elective surgical delays due to COVID-19: the patient lived experience.
This study looked at the effects of the COVID-19 pandemic on scheduling of elective cardiac and vascular surgery. The authors interviewed 47 individuals who experienced a postponement of surgery due to coronavirus. Patients described 3 key issues around their postponement: 1) surgery as part of a “return to normal”; 2) postponement took a toll on their physical health and mental wellbeing; and 3) many patients in their study said they would “rather die from a heart attack” than be exposed to the coronavirus.
Citation: Byrnes ME, Brown CS, De Roo A . Elective surgical delays due to COVID-19: the patient lived experience. Med Care 2021 Apr;59(4):288-94. doi: 10.1097/mlr.0000000000001503..
Keywords: Infectious Diseases, Surgery, Public Health, Patient Experience
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM . What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS. Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Organization and Administration: Organizational Change, Rural Health
Ahmedov M, Pourat N, Liu H
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of experiences with ambulatory healthcare for Asians and non-Hispanic Whites in the United States.
This paper discusses the results of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinical and Group (CG-CAHPS) Adult Visit Survey 1.0 which includes data on care experiences to compare specific aspects of care of Asians and Whites. Most surveys were administered by mail with a sample comprised of 64% female, 89% White, 2% Asian, 39% 65 years or older, and 32% were high school graduates or less. Asians reported worse access, lower scores on office staff courtesy and helpfulness and rating their doctors, and were less likely to recommend their doctors to family/friends than did Whites.
AHRQ-funded; HS016980; HS016978.
Citation: Ahmedov M, Pourat N, Liu H . Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of experiences with ambulatory healthcare for Asians and non-Hispanic Whites in the United States. J Patient Rep Outcomes 2021 Mar 24;5(1):29. doi: 10.1186/s41687-021-00303-3..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Racial / Ethnic Minorities, Patient Experience, Quality of Care, Outpatient Care
Afshar M, Sharma B, Bhalla S
External validation of an opioid misuse machine learning classifier in hospitalized adult patients.
This study looks at new methods to make opioid misuse screening in hospitals less resource-intensive, which causes it to occur rarely. The objective of this study is to externally validate the author’s previously published and open-source machine learning classifier by implementing it a different hospital to identify cases of opioid misuse. An observational cohort of 56,227 adult hospitalizations from October 2017 to December 2019 was used during a hospital-wide substance use screening program with manual screening. A manually completed Drug Abuse Screening Test served as the reference standard to validate a convolutional neural network (CNN) classified with coded word embedding features to capture electronic health record (EHR) clinical notes. Manual screening was completed in 67.8% of patients with 1.1% identified with opioid misuse. The opioid misuse classifier had good discrimination during external validation and may help overcome manual screening barriers.
Citation: Afshar M, Sharma B, Bhalla S . External validation of an opioid misuse machine learning classifier in hospitalized adult patients. Addict Sci Clin Pract 2021 Mar 17;16(1):19. doi: 10.1186/s13722-021-00229-7..
Keywords: Opioids, Medication, Substance Abuse, Screening, Hospitalization
Dy CJ, Salter A, Barker A
Increased utilization of total joint arthroplasty after Medicaid expansion.
This study examined prior analyses that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) was to be expected after Medicaid expansion in 2014. Using 2012-2015 data from the HCUP Database, 9 expansion states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York, and Vermont) were compared to 2 states that did not expand Medicaid (Florida and Missouri). After adjusting for community characteristics, THA and TKA increased 15% in 2014 and 23% in 2015 within expansion states compared to 2013. In non-expansion states, compared to 2013, there were significant decreases of 18% in 2014 and 11% in 2015.
Citation: Dy CJ, Salter A, Barker A . Increased utilization of total joint arthroplasty after Medicaid expansion. J Bone Joint Surg Am 2021 Mar 17;103(6):524-31. doi: 10.2106/jbjs.20.00303..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Orthopedics, Surgery, Healthcare Utilization, Access to Care
Schoenfeld EM, Poronsky KE, Westafer LM
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Both ultrasound and CT scan can be used for diagnosis of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone), but the majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. The investigators developed a decision aid to facilitate SDM in this scenario. The objective of this study was to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization.
Citation: Schoenfeld EM, Poronsky KE, Westafer LM . Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial. Trials 2021 Mar 10;22(1):201. doi: 10.1186/s13063-021-05140-9..
Keywords: Emergency Department, Decision Making, Kidney Disease and Health, Imaging, Diagnostic Safety and Quality, Diagnosis
Cole ES, DiDomenico E, Green S
The who, the what, and the how: a description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America.
This study looked at the problems of treatment access for opioid use disorder (OUD) in rural areas within the United States. Providers must complete 8-24 hours of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine. The authors executed 5 AHRQ-funded dissemination and implementation grants to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports. Obtaining the DATA 2000 waiver was found to be just one component of meaningful treatment using MOUD, and there are other significant barriers that providers face daily. The researchers’ initiatives and common lessons learned across their grants are summarized and recommendations are offered how primary care providers can be better supported to expand access to MOUD across rural America.
Citation: Cole ES, DiDomenico E, Green S . The who, the what, and the how: a description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America. Subst Abus 2021;42(2):123-29. doi: 10.1080/08897077.2021.1891492..
Keywords: Opioids, Medication, Primary Care, Rural Health, Substance Abuse, Access to Care
Ye S, Hiura G, Fleck E
Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness.
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. The objective of this study was to determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. The investigators found that lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
AHRQ-funded; HS024262; HS025198.
Citation: Ye S, Hiura G, Fleck E . Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness. J Gen Intern Med 2021 Mar;36(3):722-29. doi: 10.1007/s11606-020-06340-w..
Keywords: Infectious Diseases, Hospital Discharge, Hospital Readmissions, Hospitals, Public Health, Hospitalization, Risk
Williams D, Holmes GM, Song PH
For rural hospitals that merged, inpatient charges decreased and outpatient charges increased: a pre-/post-comparison of rural hospitals that merged and rural hospitals that did not merge between 2005 and 2015.
The purpose of this study was to determine whether inpatient and outpatient charges changed at rural hospitals after a merger. The investigators found that merging was strongly associated with a decrease in inpatient charges and somewhat associated with an increase in outpatient charges for rural hospitals. They indicated that future work could build upon their results to determine whether acquirers reduce or eliminate certain services at rural hospitals after a merger, and ultimately how changes in service delivery could impact patients in those rural communities.
Citation: Williams D, Holmes GM, Song PH . For rural hospitals that merged, inpatient charges decreased and outpatient charges increased: a pre-/post-comparison of rural hospitals that merged and rural hospitals that did not merge between 2005 and 2015. J Rural Health 2021 Mar;37(2):308-17. doi: 10.1111/jrh.12461..
Keywords: Rural Health, Hospitals, Healthcare Costs
Wang J, Ying M, Temkin-Greener H
Utilization and functional outcomes among Medicare home health recipients varied across living situations.
Home health (HH) is a major type of home-based skilled care available to Medicare beneficiaries. In this study, the investigators examined the association between living situation and utilization and functional outcomes among Medicare HH recipients. The investigators concluded that, in the study population, patients living with others at home had the highest risk of hospitalization and ED visits, whereas assisted living (AL) residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits.
Citation: Wang J, Ying M, Temkin-Greener H . Utilization and functional outcomes among Medicare home health recipients varied across living situations. J Am Geriatr Soc 2021 Mar;69(3):704-10. doi: 10.1111/jgs.16949..
Keywords: Home Healthcare, Medicare, Outcomes
Szymczak JE, Keller SC, Linder JA
"I never get better without an antibiotic": antibiotic appeals and how to respond.
In this paper, the investigators present various scenarios in which patients who do not meet guideline criteria for antibiotic prescribing, appeal to clinicians for antibiotics. The authors discuss the issue of antiobiotic appeals and provide examples of responses for clinicians. They suggest that clinicians should acquire a stock of responses to these appeals grounded in the latest evidence about antibiotics.
AHRQ-funded; 233201500020I; HS026506; HS025782.
Citation: Szymczak JE, Keller SC, Linder JA . "I never get better without an antibiotic": antibiotic appeals and how to respond. Mayo Clin Proc 2021 Mar;96(3):543-46. doi: 10.1016/j.mayocp.2020.09.031..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinician-Patient Communication, Communications, Practice Patterns