Communicating about NSAIDs Risk: Racial/Ethnic Disparities Mike Schoen, PhD Division of CME UAB School of Medicine

Introduction Background – recent transplant from N. Indiana; school psychology training; university administration; outreach programs Background – recent transplant from N. Indiana; school psychology training; university administration; outreach programs Behavior is important and influenced by many variables; including the environment which can be powerful (e.g., prisons and other institutions) Behavior is important and influenced by many variables; including the environment which can be powerful (e.g., prisons and other institutions)

UAB factoids Established in 1930’s as University Alabama extension center Established in 1930’s as University Alabama extension center Largest employer in Birmingham & state Largest employer in Birmingham & state More than 18,00 students; 31% minorities and 60% women More than 18,00 students; 31% minorities and 60% women Ranked 4 th nationally for diversity of student population Ranked 4 th nationally for diversity of student population

UAB CERTs (DSM) Educational activities Work-in-Progress Forums Work-in-Progress Forums Epidemiology Book Chapter reviews Epidemiology Book Chapter reviews Visiting Professor and Special Seminar Series Visiting Professor and Special Seminar Series Post-Doctoral Fellowships Post-Doctoral Fellowships Other products (e.g., websites) Other products (e.g., websites)

Patient-Doctor communication Medical interview or encounter is a core clinical skill Medical interview or encounter is a core clinical skill 120,000 – 160,000 career interviews performed by physician 120,000 – 160,000 career interviews performed by physician Quality of patient care related to quality of P-P communication Quality of patient care related to quality of P-P communication Doctors think, feel and behave too Doctors think, feel and behave too

Racial/Ethnic Disparities in NSAIDs Risk Awareness, Communication Rachel Fry, Midge Ray, et. al. Arthritis Care and Research December 2007

Background: NSAIDs Commonly prescribed medication class to treat inflammatory, arthritic, and musculoskeletal conditions Commonly prescribed medication class to treat inflammatory, arthritic, and musculoskeletal conditions Frequently lead to adverse effects (AEs) Frequently lead to adverse effects (AEs) Hospitalizations, deaths, $ Hospitalizations, deaths, $ Racial disparities exist, but what about with NSAIDs risk and communication? Racial disparities exist, but what about with NSAIDs risk and communication?

Study design and methods 48 physician practices in Alabama 48 physician practices in Alabama Established patients Established patients 65 years or older 65 years or older Currently taking Rx NSAIDs Currently taking Rx NSAIDs N = 404 participants(73% participation rate) N = 404 participants(73% participation rate) Gift card for completing 1 hour phone interview Gift card for completing 1 hour phone interview

Interview questions OTC NSAIDs risk awareness (Y or N) OTC NSAIDs risk awareness (Y or N) Rx NSAIDs risk awareness (Y or N) Rx NSAIDs risk awareness (Y or N) Doctor-patient communications about Doctor-patient communications about risk (Y or N) Risk avoiding behaviorby taking GI prophylaxis (Y on N) Risk avoiding behaviorby taking GI prophylaxis (Y on N) Demographics, health, education, insurance status Demographics, health, education, insurance status

Major findings 32% African-American patients; 68% white 32% African-American patients; 68% white AA patients almost twice as likely to report diabetes AA patients almost twice as likely to report diabetes Significant SES differences; AA patients more likely to report income <$20,000 Significant SES differences; AA patients more likely to report income <$20,000

NSAIDs risk and awareness findings AA patients less likely to report risk associated with OTC NSAIDs (13/29) AA patients less likely to report risk associated with OTC NSAIDs (13/29) AA patients less likely to report risk associated with Rx NSAIDs (31/50) AA patients less likely to report risk associated with Rx NSAIDs (31/50) AA patients less likely to report communication with physician about risk (38/52) AA patients less likely to report communication with physician about risk (38/52) AA less likely to take GI prophylaxis (31/50) AA less likely to take GI prophylaxis (31/50)

Limitations of study Cross-sectional Cross-sectional All data patient self-report All data patient self-report Response format limited to Y/N Response format limited to Y/N Telephone interviews lengthy (fatigue?) Telephone interviews lengthy (fatigue?) Specific NSAIDs info and dose info? Specific NSAIDs info and dose info? NSAIDs use not corroborated NSAIDs use not corroborated Single sample not generalizable Single sample not generalizable

Summary Gaps or disparities may exist despite study limitations Gaps or disparities may exist despite study limitations Gaps might be targeted by new CME Gaps might be targeted by new CME Physicians overwhelmed with little time, competing demands Physicians overwhelmed with little time, competing demands Can behavioral science help? Can behavioral science help?