Interdisciplinary Centers, Units, and Projects

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Now showing 1 - 10 of 3459
  • Publication
    Polypharmacy: Patterns And Policy Propositions
    (2020-01-01) Do, Duy Hoang
    Sixty percent of U.S. adults report frequent use of prescription medications, a prevalence that is higher than ever before. Although medications are lifesaving when used properly, they can produce side effects ranging from minor problems like dizziness to severe events such as an increased risk of cancer. Polypharmacy – a phenomenon typically defined as concurrent use of multiple medications – may present unique risks for medication side effects, amplifying the effects of each of the medication in a set. Given the growing medication use across the country, this dissertation examined the causes of polypharmacy and the consequences of concurrent use of medications with side effects on population health and health care use. The first chapter provided background information on polypharmacy and medication side effects. The second chapter used the National Health and Nutrition Examination Survey (NHANES) to investigate whether and how the introduction of Medicare Part D, a large and sudden change to health care financing for Medicare beneficiaries, affected medication use for older adults. While Part D increased the use of lifesaving medications, it also increased polypharmacy. The third chapter used the NHANES to show that concurrent use of three or more medications with cognitive impairment side effects among U.S. older adults increased three-fold in the past two decades. Individuals who used three or more such medications experienced increased risks of cognitive deficits compared to non-users. The fourth chapter used the Medical Expenditure Panel Survey (MEPS) to document a growth of 36% in the concurrent use of at least three medications with mental health side effects among U.S. adults in the past two decades. Concurrent use of these medications was associated with an increase in psychiatric symptoms and the use/costs of mental health services. In the fifth chapter, I discussed how the processes of medicalization and pharmaceuticalization contributed to rising medication use and disparities in such use, which in turn had implications for population-level health disparities. Collectively, these findings shed light on patterns and disparities in population health associated with polypharmacy and speak directly to the role of broader social, economic, cultural, and institutional inequalities in generating and maintaining health disparities.
  • Publication
    Could a Public Health Insurance Option Lead to More Competitive Markets?
    (2019-12-10) Pauly, Mark V.
    Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?
  • Publication
    Affirmative Action Bans and Health Risk Behaviors
    (2019-07-19) Venkataramani, Atheendar S.; Cook, Erin; O'Brien, Rourke L.; Kawachi, Ichiro; Jena, Anupam B.; Tsai, Alexander C.
    College affirmative action bans were associated with higher rates of smoking and drinking in underrepresented minority 11th and 12th graders, and these students continued to smoke at higher rates into young adulthood. Policymakers should consider unintended public health consequences of proposals, such as affirmative action bans, that may limit socioeconomic opportunities.
  • Publication
    Substance Use Disorder in America: Research to Practice, and Back Again
    (2017-08-01) Miclette, Matthew; Cuan, Isabella; Meisel, Zachary F.
    These proceedings summarize the insights shared by nationally renowned panels of experts and overall themes discussed throughout a substance use disorder conference held at the University of Pennsylvania. The conference included experts from academia and public and private sectors, who came together to discuss the gaps in evidence-based substance use policy and practice, with particular emphasis on the opioid epidemic. The day concluded with an interactive session focused on the exchange of ideas and solutions to curb the opioid epidemic. Those ideas are included in these proceedings
  • Publication
    Lower Health Care Use Among Elderly Patients Residing with Another Adult
    (2019-06-11) Carlin, Caroline; David, Guy
  • Publication
    Transforming Mental Health Care Through Implementation of Evidence-Based Practices
    (2020-05-21) Glickman, Aaron; Weiner, Janet; Beidas, Rinad
    Changing clinical practice is hard, and changing practices within larger organizations is even harder. Increasingly, policymakers are looking to implementation science—the study of why some changes prove more durable than others—to understand the dynamics of successful transformation. In this brief, we summarize the results of an ongoing community-academicpartnership to increase the uptake of evidence-based practices in Philadelphia’s public behavioral health care system. Over five years, researchers found that widescale initiatives did successfully change the way care was delivered, albeit modestly and slowly. The evidence suggests that organizational factors, such as a proficient work culture, are more important than individual therapist factors, like openness in change, in influencing successful practice change. Furthermore, organizations must address staff turnover and burnout, and employees must feel supported in general in order for managers to expect them to change. In short, while practice transformation is possible—even in highly stressed and under-resourced public health settings—it requires focusing on underlying problems within organizations as well as championing new policies.
  • Publication
    Contributors to Post-Injury Mental Health In Urban Black Men With Serious Injuries
    (2019-06-05) Richmond, Therese S.; Wiebe, Douglas J.; Reilly, Patrick M.; Rich, John; Shults, Justine; Kassam-Adams, Nancy
  • Publication
    Opportunities for Precision Cancer: Reflections from the Gant Consortium
    (2018-09-20) Glickman, Aaron; Weiner, Janet
    There is substantial interest in targeted cancer therapies, spurred by recent biomedical research in genomics and oncology. Targeted cancer therapies, in which prevention and treatment of cancer are based on genomic and biologic analyses, hold promise for cancer care. However, the rising costs of such therapies may threaten that promise. In an effort to meet the future challenges of targeted cancer medicine head-on, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, cancer research and medicine, patient advocacy, and the pharmaceutical and insurance industry. The Gant Consortium sought answers to a central question: what approaches should stakeholders take to foster the economic viability and sustainability of targeted cancer drugs? The Consortium literature review was conducted from August through November 2016. The expert committee met regularly from October 2016 to May 2017 to identify points of contention and consensus, outline the issues at the core of sustainable targeted cancer medicine, and inform potential policy recommendations. The literature presented in this report does not include therapies developed afterwards, such as CAR-T. The views expressed in this White Paper reflect the discussions of the Gant Consortium but do not necessarily represent the views of either any individual member or of the Consortium as a whole.
  • Publication
    Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population
    (2018-10-23) Candon, Molly; Andreyeva, Elena; Rosenquist, Rebecka; Grande, David
    This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.
  • Publication
    Health Inequity in the United States: A Primer
    (2020-01-06) Escarce, José
    By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place. In this primer, we provide an overview of these distinctly American problems, and discuss programs and policies that might promote greater health equity in the population.