Objective To examine the persistence with rapid-acting insulin (RAI) and its association with clinical outcomes among elderly patients with type 2 diabetes (T2D). Methods This observational, retrospective cohort study analyzed RAI persistence and its association with change in A1C and risk of severe hypoglycemia among elderly (≥65 years) Medicare beneficiaries with T2D who added RAI to their basal insulin regimen. Results Among T2D patients with >1 RAI prescriptions (n=3,927), only 21% were persistent. Baseline factors positively associated with RAI persistence (Adjusted Odds Ratio [95% CI]) were: age ≥75 vs 65–74 years: 1.20 [1.01–1.43]; use of ≥3 oral antidiabetes drugs: 1.63 [1.16–2.28]; cognitive impairment: 1.34 [1.03–1.73]; and A1C >9.0%: 1.58 [1.15–2.17]. Elderly T2D patients having emergency department visits (0.73 [0.59–0.91]) and higher RAI out-of-pocket costs (≥$75 vs $0 to <$6.40: 0.56 [0.44–0.70]) were less likely to be persistent. Persistent RAI users had a significantly higher reduction in A1C (beta coefficient [standard error]: −0.24 [0.10] and lower odds of severe hypoglycemia (Adjusted Odds Ratio [95% CI]): 0.73 [0.53–0.99]. Conclusion Among elderly T2D patients, persistence with RAI added to basal insulin was associated with improved glycemic control, with lower risk of severe hypoglycemia. Despite treatment effectiveness, RAI persistence was poor and might be improved by reducing RAI out-of-pocket costs.

A447and optimise the reporting of such evaluations. To our knowledge, there are no such published guidelines in Spain. Methods: This guidance was designed with the main aim of providing authors with recommendations, in the form of a checklist, to optimise design and reporting of EE and BIA to be submitted to the Catalan Health System (CatSalut) within its harmonization program for pharmaceutical innovation. Results: For a given evaluation, two separate guidelines with corresponding checklists assess its methodology, quality, and reporting based on several dimensions. ConClusions: The steps outlined in this first guidance in Spain, although not compulsory, will provide useful practical tips for how to go about designing and reporting of an EE or a BIA for pharmaceuticals in Catalonia (Spain).

Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient's sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5–97.5%) and high trust (95.4–99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed.

Background Vaccine preventable diseases are making a comeback in the US. However, research is lacking on illness representations of vaccine preventable diseases and their application in improving childhood immunization. Objective We utilized the common sense model of self-regulation to examine illness representations of pertussis and their associations with child's receipt of any vaccine, up-to-date vaccination status, and mothers' intentions to follow the recommended vaccination schedule in the future. Methods We developed vaccine worry and vaccine hassles scales to assess mothers' worries and hassles for child vaccination, and used an open ended question to assess mother's illness representations of pertussis. We surveyed mothers with children <3 years old (N = 160) in the Appalachian state of West Virginia, which only allows medical vaccine exemptions. Results Some children (5.0%) had received no vaccination, 15.0% were not up-to-date with the recommended vaccination schedule, and 13.8% mothers reported no intention to follow the recommended schedule in future (future intention). Illness representations included identity (17.8%), timeline (61.8%), consequences (58.6%), cause (35.0%), and cure/control (56.7%). Higher vaccine worry was associated with child receiving no vaccine. Not using daycare, higher vaccine worry, and difficulty breathing (identity) were associated with child not being up-to-date. Higher vaccine worry, cough (identity), and belief that vaccines are ineffective (cure/control) were associated with no future intention. Conclusions Vaccination interventions need to address mothers' worry regarding vaccine safety. 'Common Sense' beliefs regarding vaccines need to be reconciled with scientific data about vaccine safety and effectiveness, even among those with high socio-economic status in a strict vaccination state.

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