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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 28 Research Studies DisplayedCarrel M, Clore GS, Kim S
Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018.
The purpose of this study was to determine how the differential exposure to Hurricane Harvey in August 2017 was associated with changes in utilization of Veterans Health Administration health care. Findings suggested that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. The patients most exposed to the disaster had the greatest delay or nonreceipt of care.
AHRQ-funded; HS027472.
Citation: Carrel M, Clore GS, Kim S .
Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018.
JAMA Netw Open 2021 Dec;4(12):e2138535. doi: 10.1001/jamanetworkopen.2021.38535..
Keywords: Healthcare Utilization, Emergency Department
Ching JH, Owens DK, Trafton JA
Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration.
This study used simulation of a Veterans Health Administration cohort to identify the opioid use disorder (OUD) treatment durations necessary for the elevated mortality risks during treatment transitions balanced by reductions in mortality while receiving medication-assisted treatment (MAT) with methadone or buprenorphine. A simulated cohort of 10,000 individuals with OUD was created by using parameters obtained through calibration and published meta-analyses of studies from North America, Europe, and Australia. Methadone treatment for 4 months or longer or buprenorphine for 2 months or longer resulted in 54 and 65 fewer deaths relative to not receiving MAT for the same duration. The authors estimated shorter treatment durations necessary to achieve net mortality benefits of 2 months or longer for methadone and 1 month or longer for buprenorphine. Necessary treatment increased more with smaller mortality reductions on treatment with larger relative risks during treatment transitions.
AHRQ-funded; HS027935; HS026128.
Citation: Ching JH, Owens DK, Trafton JA .
Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration.
Addiction 2021 Dec;116(12):3494-503. doi: 10.1111/add.15574.
AHRQ-funded; HS027935; HS026128..
AHRQ-funded; HS027935; HS026128..
Keywords: Opioids, Substance Abuse, Behavioral Health, Mortality
Schuttner L, Haraldsson B, Maynard C
Factors associated with low-value cancer screenings in the Veterans Health Administration.
Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. The objective of this study was to understand rates and factors associated with outpatient low-value cancer screenings.
AHRQ-funded; HS026369.
Citation: Schuttner L, Haraldsson B, Maynard C .
Factors associated with low-value cancer screenings in the Veterans Health Administration.
JAMA Netw Open 2021 Oct;4(10):e2130581. doi: 10.1001/jamanetworkopen.2021.30581..
Keywords: Screening, Cancer
Saffo S, Kaplan DE, Mahmud N
Impact of SGLT2 inhibitors in comparison with DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) may have favourable neurohumoral and metabolic effects in patients with chronic liver disease. However, studies examining SGLT2i in this population have been limited to patients with non-alcoholic fatty liver disease and have focused on surrogate biomarkers. The aim of this study was to evaluate whether SGLT2i could reduce the incidence of ascites and death over a period of 36 months in patients with cirrhosis and diabetes mellitus.
AHRQ-funded; HS022882; HS025164.
Citation: Saffo S, Kaplan DE, Mahmud N .
Impact of SGLT2 inhibitors in comparison with DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin.
Diabetes Obes Metab 2021 Oct;23(10):2402-08. doi: 10.1111/dom.14488..
Keywords: Diabetes
Baughman AW, Triantafylidis LK, O'Neil N
Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility.
This study described a quality improvement (QI) approach to improve medication reconciliation in a skilled nursing facility (SNF) setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). Findings showed that SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.
AHRQ-funded; HS023757.
Citation: Baughman AW, Triantafylidis LK, O'Neil N .
Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility.
Jt Comm J Qual Patient Saf 2021 Oct;47(10):646-53. doi: 10.1016/j.jcjq.2021.06.001..
Keywords: Medication, Quality Improvement, Quality of Care
Wayne MT, Seelye S, Molling D
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. The purpose of this study was to examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. The investigators concluded that this cohort study found that time-to-antibiotics for sepsis has declined over time. However, there remained significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment.
AHRQ-funded; HS026725.
Citation: Wayne MT, Seelye S, Molling D .
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
JAMA Netw Open 2021 Sep 4(9):e2123950. doi: 10.1001/jamanetworkopen.2021.23950..
Keywords: Sepsis
Sico JJ, Kundu S, So-Armah K
Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study.
Background HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. In this study the investigators examined depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study. The investigators concluded that depression is associated with an increased risk of stroke among HIV-positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV-specific factors.
AHRQ-funded; HS023464.
Citation: Sico JJ, Kundu S, So-Armah K .
Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study.
J Am Heart Assoc 2021 Jul 6;10(13):e017637. doi: 10.1161/jaha.119.017637..
Keywords: Depression, Behavioral Health, Risk, Human Immunodeficiency Virus (HIV), Stroke, Cardiovascular Conditions
Caram MEV, Burns J, Kumbier K
Factors influencing treatment of veterans with advanced prostate cancer.
This study examined factors influencing treatment of veterans with metastatic castration-resistant prostate cancer (CRPC). Clinician and nonclinical factors associated with the first-line treatment for CPRC using data from the Veterans Health Administration was used. Almost 5000 patients who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017 were identified. Increasing age was associated with receipt of abiraterone or enzalutamide versus docetaxel. Greater preexisting comorbidity was associated with enzalutamide versus abiraterone. Patients with higher PSA values at the start of treatment were more likely to receive docetaxel than the other three treatments. African American men were more likely to receive ketoconazole.
AHRQ-funded; HS025707.
Citation: Caram MEV, Burns J, Kumbier K .
Factors influencing treatment of veterans with advanced prostate cancer.
Cancer 2021 Jul 1;127(13):2311-18. doi: 10.1002/cncr.33485..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Treatments
Rogal S, Youk A, Agbalajobi O
Medication treatment of active opioid use disorder in veterans with cirrhosis.
Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. In this study, the investigators aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. The investigators found that few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
AHRQ-funded; HS019461.
Citation: Rogal S, Youk A, Agbalajobi O .
Medication treatment of active opioid use disorder in veterans with cirrhosis.
Am J Gastroenterol 2021 Jul;116(7):1406-13. doi: 10.14309/ajg.0000000000001228..
Keywords: Opioids, Substance Abuse, Medication
Clair K, Ijadi-Maghsoodi R, Nazinyan M
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
This paper looks at veterans’ perspectives on adaptations made to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic. Adaptations to services are described within a large residential rehabilitation program for under-resourced veterans; reports veterans’ experiences; and outlines successes and challenges encountered. Data was collected from two focus groups with nine veterans in the program. The groups highlighted experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation.
AHRQ-funded; HS026407.
Citation: Clair K, Ijadi-Maghsoodi R, Nazinyan M .
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
Community Ment Health J 2021 Jul;57(5):801-07. doi: 10.1007/s10597-021-00810-z..
Keywords: Substance Abuse, Rehabilitation, COVID-19, Healthcare Delivery, Access to Care, Patient Experience
Spalluto LB, Lewis JA, Stolldorf D
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. In this study, the investigators evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening.
AHRQ-funded; HS026395.
Citation: Spalluto LB, Lewis JA, Stolldorf D .
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
J Am Coll Radiol 2021 Jun;18(6):809-19. doi: 10.1016/j.jacr.2020.12.010..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Implementation, Organizational Change
Danan ER, White KM, Wilt TJ
Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans.
This study looked at differences in attitudes about recommendations and evidence on prostate cancer screening among White and Black male veterans. The authors provided a draft educational pamphlet about the benefits and harms of Prostate Specific Antigen (PSA) screening to 44 men, ages 55-81 at a midwestern VA medical center in 2013 and 2015. The groups were divided into four White and two Black focus groups. Three universal themes were low baseline familiarity with prostate cancer, surprise and resistance to the guidelines not to test routinely, and negative emotions in response to ambiguity. Discussions in the White groups highlighted the potential benefits of screening, minimized the harms, and emphasized personal choice in screening decisions. Discussions in Black groups devoted almost no time to benefits, considered harms significant, and emphasized personal and collective responsibility for cancer prevention through diet, exercise, and alternative medicine. Discussion in Black groups also emphasized the history of racism and discrimination in healthcare and medical research.
AHRQ-funded; HS026379.
Citation: Danan ER, White KM, Wilt TJ .
Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans.
Am J Mens Health 2021 May-Jun;15(3):15579883211022110. doi: 10.1177/15579883211022110..
Keywords: Cancer: Prostate Cancer, Cancer, Screening, Prevention, Racial and Ethnic Minorities, Evidence-Based Practice, Health Promotion, Education: Patient and Caregiver
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shenoy R, Childers CP .
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Donnelly JP, Wang XQ, Iwashyna TJ
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
This study describes reasons for readmission, use of intensive care unit (ICU) interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.
AHRQ-funded; HS026725.
Citation: Donnelly JP, Wang XQ, Iwashyna TJ .
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
JAMA 2021 Jan 19;325(3):304-06. doi: 10.1001/jama.2020.21465.
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Keywords: Respiratory Conditions, COVID-19, Hospital Readmissions, Hospital Discharge, Mortality, Outcomes
Lewis JA, Senft N, Chen H
Evidence-based smoking cessation treatment: a comparison by healthcare system.
The authors surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated Veterans Health Administration (VHA) in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment at least once in the past 12 months. They found that VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers.
AHRQ-funded; HS026122.
Citation: Lewis JA, Senft N, Chen H .
Evidence-based smoking cessation treatment: a comparison by healthcare system.
BMC Health Serv Res 2021 Jan 7;21(1):33. doi: 10.1186/s12913-020-06016-5..
Keywords: Health Systems, Tobacco Use: Smoking Cessation, Tobacco Use, Evidence-Based Practice, Substance Abuse
Ahuja V, Sohn MW, Birge JR
Geographic variation in rosiglitazone use surrounding FDA warnings in the Department of Veterans Affairs.
The purpose of this study was to document variation in the use of rosiglitazone and other glucose- lowering drugs across 21 Veterans Integrated Service Networks. It found that aggregate rosiglitazone use increased monotonically from 7.7 percent, in the quarter it was added to the VA formulary, to a peak of 15.3 percent in the quarter when the FDA issued the safety alert.
AHRQ-funded; HS018542.
Citation: Ahuja V, Sohn MW, Birge JR .
Geographic variation in rosiglitazone use surrounding FDA warnings in the Department of Veterans Affairs.
J Manag Care Spec Pharm 2015 Dec;21(12):1214-34. doi: 10.18553/jmcp.2015.21.12.1214.
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Keywords: Adverse Drug Events (ADE), Medication: Safety, Medication, Practice Patterns
LaFleur J, Hoop R, Korner E
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
The researchers determined whether selected patient characteristics predicted discontinued therapy for reasons other than lack of efficcacy (non-LOE) using national databases of U.S. veterans. They found that predictors of greatest magnitude included comorbidities of myocardial infarction/congestive heart failure, renal disease, platelets 100/mm or more, Black race, albumin 3.5 mg/dl or more, sleep aid use, and poor persistence with antidepressants and antihypertensive agents.
AHRQ-funded; HS018582.
Citation: LaFleur J, Hoop R, Korner E .
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
Gastroenterol Nurs 2015 Nov-Dec;38(6):417-28. doi: 10.1097/sga.0000000000000214.
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Keywords: Chronic Conditions, Hepatitis, Medication, Patient Adherence/Compliance
Heslin KC, Gable A, Dobalian A
AHRQ Author: Heslin KC
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
The researchers examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 substance use disorder treatment facilities. Approximately 31 percent of facilities had special programs exclusively for women. Although the VA had the lowest prevalence of programs for women, at 19.1 percent, it offered a significantly higher average number of key services for women.
AHRQ-authored.
Citation: Heslin KC, Gable A, Dobalian A .
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
Womens Health Issues 2015 Nov-Dec;25(6):666-72. doi: 10.1016/j.whi.2015.07.005.
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Keywords: Substance Abuse, Women, Healthcare Delivery
Price LE, Shea K, Gephart S
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
This article described the developments in research associated with the VHA's transition into the world of Big Data analytics through Corporate Data Warehouse (CDW) utilization. The authors found that the most commonly-occurring research topics are pharmacy/medications, systems issues, and weight management/obesity. They concluded that, despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.
AHRQ-funded; HS022908.
Citation: Price LE, Shea K, Gephart S .
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
Nurs Adm Q 2015 Oct-Dec;39(4):311-8. doi: 10.1097/naq.0000000000000118.
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Keywords: Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing
LaFleur J, DuVall SL, Wilson T
Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans.
This study evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans. It found that most bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs.
AHRQ-funded; HS018582.
Citation: LaFleur J, DuVall SL, Wilson T .
Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans.
Bone 2015 Sep;78:174-85. doi: 10.1016/j.bone.2015.04.022..
Keywords: Osteoporosis, Medication, Elderly, Injuries and Wounds
Ricci KA, Griffin AR, Heslin KC
AHRQ Author: Heslin KC
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
This study was conducted to identify factors that most heavily influenced the decisions to evacuate the Manhattan Veterans Administration Medical Center before Hurricane Irene in 2011 and Hurricane Sandy in 2012. The researchers conducted semi-structured interviews with 11 senior leaders on the processes and factors that influenced their evacuation decisions.
AHRQ-authored
Citation: Ricci KA, Griffin AR, Heslin KC .
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/s1049023x15000229..
Keywords: Emergency Preparedness, Decision Making, Hospitals
Ripley DC, Kwong PL, Vogel WB
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
This study examined the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke. It found that even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with inhospital mortality.
AHRQ-funded; HS018540.
Citation: Ripley DC, Kwong PL, Vogel WB .
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
Med Care 2015 Jun;53(6):501-9. doi: 10.1097/mlr.0000000000000366..
Keywords: Stroke, Mortality, Access to Care
Storzbach D, O'Neil ME, Roost SM
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
The purpose of this paper was to compare neuropsychological test performance of veterans with and without mild traumatic brain injury (MTBI), blast exposure, and posttraumatic stress disorder (PTSD) symptoms. The authors found that, although some mild neurocognitive effects were associated with blast exposure, these neurocognitive effects might be better explained by PTSD symptom severity rather than blast exposure or MTBI history alone.
AHRQ-funded; HS022981; HS019456.
Citation: Storzbach D, O'Neil ME, Roost SM .
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
J Int Neuropsychol Soc 2015 May;21(5):353-63. doi: 10.1017/s1355617715000326.
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Keywords: Brain Injury, Behavioral Health, Neurological Disorders
Jump RL, Heath B, Crnich CJ
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
The reseasrchers conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. They found that the average score on 5 questions assessing knowledge was 3.6 out of 5.0, thus supporting a need for education regarding the care of older adults with infections.
AHRQ-funded; HS023866.
Citation: Jump RL, Heath B, Crnich CJ .
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
Am J Infect Control 2015 Mar;43(3):298-300. doi: 10.1016/j.ajic.2014.11.017.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Long-Term Care, Medication
Hansen RA, Voils CI, Farley JF
Prescriber continuity and medication adherence for complex patients.
The purpose of this study was to examine the relationship between number of prescribers, number of conditions, and refill adherence to oral medications among 7,933 veterans who were identified with 1 to 4 cardiometabolic conditions: diabetes, hypertension, dyslipidemia, and/or heart failure. It found that for veterans taking antihypertensive or lipid-lowering medications, having more prescribers involved in care modestly decreased the likelihood of being adherent.
AHRQ-funded; HS019445.
Citation: Hansen RA, Voils CI, Farley JF .
Prescriber continuity and medication adherence for complex patients.
Ann Pharmacother 2015 Mar;49(3):293-302. doi: 10.1177/1060028014563266..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions