Minneapolis VA Health Care System

The American College of Physicians (ACP) developed these rapid practice points addressing the efficacy, comparative effectiveness, and harms of respiratory syncytial virus (RSV) vaccines in adults aged 18 years or older who are not pregnant or immunocompromised. The ACP Population Health and Medical Science Committee developed the rapid practice points based on a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria. Adults aged 75 years or older should receive a protein subunit RSV vaccine. Adults aged 60 to 74 years who are at increased risk for severe RSV may consider receiving a protein subunit RSV vaccine.

Pediatric patients with high-risk medical diagnoses were more likely to receive recommended household TSE screening. Levels of household TSE screening were lowest among patients age 2 years and under and those who are underinsured. Increasing systematic screening for household TSE is essential to connect parents who smoke with resources to quit.

Background: Administrative data help managers monitor and manage health care enrollees’ health. Of the few available administrative measures of psychiatric illness severity, however, most either commingle sociodemographics and medical comorbidities or lack ordinal properties. Objective: To assess construct, concurrent, and predictive validity of a novel, 6-item, administrative measure of psychiatric severity, the Manifestations of Psychiatric Severity Index (MoPSI). Methods: A panel study of 960 gender-stratified, nationally representative, post-9/11 US Veterans with pending disability claims for posttraumatic stress disorder (PTSD). MoPSI scoring was based on the joint probability density (JPD) method and a JPD linear approximation. Results: The JPD MoPSI score and its linear approximated score had a correlation of 0.999. Relative to their counterparts, unmarried Veterans, Veterans with low income, and Veterans with serious mental illness or PTSD had higher MoPSI scores (Ps: <0.0001–0.03). Higher MoPSI scores predicted cigarette and street drug use and PTSD and depression/anxiety symptoms six months later, and disability award approximately 1 year later (Ps: 0.01–0.02). Conclusions: In this sample, the MoPSI had evidence of construct, concurrent, and predictive validity.

The Program for LUng cancer screening and TObacco cessation (PLUTO) trial was a sequential, multiple assignment, randomized trial to optimize the delivery of tobacco longitudinal care (TLC), a one-year telephone coaching and combination nicotine replacement therapy program. Our analyses tested the effects of the randomized response assessment timepoint. Participants who smoked daily and were eligible for lung cancer screening (N=636) were randomized to have their response to treatment assessed after 4 or 8 weeks of TLC. Participants' responses determined whether they could be randomized to more (TLC with prescription medication therapy management, MTM) or less (TLC delivered quarterly) intensive treatment for the remainder of the trial. We used chi-squares and generalized linear models to test whether assessment timing affected 7-day point prevalence abstinence at weeks 12, 26, 52, and 78. Participants who were assessed at week 4, rather than 8, were more likely to report abstinence at weeks 12 and 26 (ORs>1.48, p's<0.034). Among participants who were smoking at week 4, early assessment was associated with higher abstinence at weeks 12-52 (ORs>1.31, p's<0.019), and there was some evidence at weeks 12 and 52 that it was better to offer MTM earlier rather than later (ORs>1.27, p's<0.057). Earlier treatment response assessment may be beneficial, especially for those who are not responsive to initial treatment, but more research is needed to understand the mechanisms, generalizability, and robustness of the effect. The timing of response assessment in adaptive interventions may be an important, but often overlooked, factor for optimizing clinical treatment programs. In the context of tobacco longitudinal care delivered to participants who are eligible for lung cancer screening, there may be a benefit to assessing participant responses to tobacco cessation treatment earlier (after 4 weeks) rather than later (after 8 weeks), although the reasons for the benefit remain unclear.

More than 30 million people in the US take prescribed benzodiazepines, which, when taken long-term, carry risks of falls, cognitive decline, and dependence. A previous trial showed that a patient-focused self-management intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) can reduce long-term benzodiazepine dependence use and the risks that accompany it. To replicate the finding of the EMPOWER trial after converting the intervention from printed materials to electronic format. This 2-arm, individually randomized clinical trial with a 6-month follow-up was conducted at US Veterans Health Administration primary care clinics in 2 Veterans Affairs health care systems. Participants included 161 primary care patients taking benzodiazepines for 3 or more months and having access to a smartphone, tablet, or desktop computer. Recruitment occurred from June 1, 2022, to January 31, 2024. Participants were randomized to either the electronically delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow clinician recommendations regarding their benzodiazepine use (treatment as usual). Preregistered primary outcomes were complete benzodiazepine cessation and at least 25% dose reduction at 6-month follow-up, assessed using pharmacy data. Secondary outcomes were self-reported anxiety symptoms, sleep quality, and overall health and quality of life. Analysis was performed on an intent-to-treat basis. The 161 participants had a mean (SD) age of 61.9 (13.7) years and were mostly male (134 [83.2%]). Individuals assigned to the EMPOWER-ED group had a significantly greater likelihood of complete benzodiazepine cessation (odds ratio [OR], 5.31 [95% CI, 1.12-25.12]). There was no likelihood of at least a 25% dose reduction in the EMPOWER-ED group relative to the control group (OR, 2.51 [95% CI, 0.91-6.90]). No statistically significant difference was found between the 2 groups for the secondary outcomes. This randomized clinical trial found a large effect of a low-cost, self-administered electronic intervention for reducing benzodiazepine use among long-term users. Findings from this replicated clinical trial are encouraging given the prevalence of benzodiazepine dependence and the constraints on clinician time available to address it. Dissemination of this intervention-which is in the public domain-by health care and public health systems seems warranted. ClinicalTrials.gov Identifier: NCT04572750.

Abstract Background Successfully recruiting respondents to complete surveys is integral for ensuring representative samples and providing adequate power for analyses that researchers can extrapolate to the population of interest. However, obtaining survey responses for public health and health services research can be challenging, especially when working with populations with varied engagement with the providers of the institution conducting the study. Recruitment is even more challenging when selecting participants based on historical events, which they may not remember, such as a brief health screen. Many researchers implement the Tailored Design Method (TDM) to optimize response rates. Methods We surveyed a national sample of 9,775 US Iraq and Afghanistan war veterans who had been screened between 2007 and 2018 for post-deployment health concerns in the Veterans Health Administration (VHA). We implemented a modified TDM to recruit respondents through USPS mail and an online data collection platform (i.e., Qualtrics) between July 2020 and August 2021. Results Twenty-one percent (N = 2,025) responded. It took a median of 21 and 69 days to receive responses via electronic survey (i.e., Qualtrics) and USPS, respectively. Participants had varied levels of engagement with the VHA at the time of screening and survey. Respondents and non-respondents used equal amounts of neurology, physical medicine and rehabilitation, and mental health VHA services in the 6 months post-screens. At the time of the survey, 20.82% of respondents reported not having recently used VHA services. Respondents were more likely to be older, White, and female than non-respondents, although differences were small in magnitude. Compared to online respondents, paper respondents were more likely to be older, rural, and screened earlier, and less likely to live in the same state as the research team. Conclusions This manuscript describes TDM implementation techniques and modifications that comply with federal regulations, and factors associated with response rates and contact methods. Researchers in federal institutions seeking to optimize response rates may find our TDM adaptations useful when surveying populations drawn from historical cohorts or without regular interaction with the research institution.

ObjectiveTo assess the feasibility, acceptability, and treatment outcomes of a proactive motivational texting program with phone-based care coordination among people with chronic obstructive pulmonary disease who smoke (PCWS).DesignRandomized, unblinded pilot among PCWS, regardless of intention to quit smoking.MethodsConsenting participants were randomized 2:1 to the intervention vs a mailed offer of cessation services. Intervention consisted of a 12-week tapering-frequency motivational texting protocol, adapted from an existing clinically available protocol. Tailoring included COPD-specific messages and the option for phone-based care coordination, connecting participants to their choice of tobacco treatments. Primary outcomes were feasibility and treatment participation through 6 months. Results were analyzed using logistic regression, adjusted for imbalanced baseline characteristics deemed a priori likely to impact cessation behaviors.ResultsOf 697 invited, 125 enrolled and were randomized (83 intervention and 42 control) and 148 were ineligible, for an enrollment rate of 22.8% among eligible individuals. Primary reasons for ineligibility were: already quit or engaged in cessation efforts (n = 79), no text-capable phone (n = 50). Participants were older (mean age 68.4 years), predominantly male (82.3%) and white (78.2%). Most participants in the intervention arm completed the texting protocol (71/83, 85.5%) and responded to it at least once (63/83, 75.9%). Cessation outcomes were not statistically significant but favored the intervention. More participants in the intervention arm utilized any treatment (34.9% vs 21.9%, OR 2.37, 95%CI 0.94-6.40); 11 (13.2%) vs 1 (2.4%) (P = 0.053) completed a care coordination call. Acceptability of the texting protocol was high with 80.6% of participants finding the content relevant and 69.4% indicating they would recommend it. There were no identified harms. Study has completed all study procedures.ConclusionIn this randomized pilot of a proactive, motivational texting program for PCWS, we found evidence of feasibility, acceptability, and possible benefits for cessation outcomes. Such a program is low burden and may be suitable for both future research and broad use.