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            "title": "Identifying modifiable barriers to medication error reporting in the nursing home setting",
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            "abstractNote": "OBJECTIVES\n\nTo have health care professionals in nursing homes identify organizational-level and individual-level modifiable barriers to medication error reporting.\n\n\nDESIGN\n\nNominal group technique sessions to identify potential barriers, followed by development and administration of a 20-item cross-sectional mailed survey.\n\n\nPARTICIPANTS AND SETTING\n\nRepresentatives of 4 professions (physicians, pharmacists, advanced practitioners, and nurses) from 4 independently owned, nonprofit nursing homes that had an average bed size of 150, were affiliated with an academic medical center, and were located in urban and suburban areas.\n\n\nMEASUREMENTS\n\nBarriers identified in the nominal group technique sessions were used to design a 20-item survey. Survey respondents used 5-point Likert scales to score factors in terms of their likelihood of posing a barrier (\"very unlikely\" to \"very likely\") and their modifiability (\"not modifiable\" to \"very modifiable\"). Immediate action factors were identified as factors with mean scores of <3.0 on the likelihood and modifiability scales, and represent barriers that should be addressed to increase medication error reporting frequency.\n\n\nRESULTS\n\nIn 4 nominal group technique sessions, 28 professionals identified factors to include in the survey. The survey was mailed to all 154 professionals in the 4 nursing homes, and 104 (67.5%) responded. Response rates by facility ranged from 55.8% to 92.9%, and rates by profession ranged from 52.0% for physicians to 100.0% for pharmacists. Most respondents (75.0%) were women. Respondents had worked for a mean of 9.8 years in nursing homes and 5.4 years in their current facility. Of 20 survey items, 14 (70%) had scores that categorized them as immediate action factors, 9 (64%) of which were organizational barriers. Of these factors, the 3 considered most modifiable were (1) lack of a readily available medication error reporting system or forms, (2) lack of information on how to report a medication error, and (3) lack of feedback to the reporter or rest of the facility on medication errors that have been reported.\n\n\nCONCLUSIONS\n\nThe study results provide a broad-based perspective of the barriers to medication error reporting in the nursing home setting. Efforts to improve medication error reporting frequency should focus on organizational-level rather than individual-level interventions.",
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                    "creatorType": "author",
                    "firstName": "Marvella E",
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                    "firstName": "Suzanne L",
                    "lastName": "Havstad"
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                    "firstName": "Shawna D",
                    "lastName": "Davis"
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            "abstractNote": "BACKGROUND\n\nIncidence rates for many types of cancer are higher among African American men than in the general population, yet African American men are less likely to participate in cancer screening trials. This paper describes the outcomes of a randomized trial (the AAMEN Project) designed to recruit African American men aged 55-74 years to a prostate, lung and colorectal cancer screening trial.\n\n\nMETHODS\n\nThe recruitment interventions address four types of barriers to clinical trial participation: sociocultural barriers, economic barriers, individual barriers and barriers inherent in study design. Subjects were randomized to a control group or one of three increasingly intensive intervention arms, which used different combinations of mail, phone and in person church-based recruitment.\n\n\nRESULTS\n\nOf the 39,432 African American men residing in the geographically defined study population (southeastern Michigan and northern Ohio), 17,770 men (45%) could be contacted, and 12,400 (31% of 39,432) were found to be eligible to participate. No statistically significant differences in age, education or income level were found among participants in the four study arms. A significantly greater enrollment yield (3.9%) was seen in the most intensive, church-based intervention arm, compared to the enrollment yields in the other two intervention arms (2.5 and 2.8%) or the control group (2.9%) (P < 0.01).\n\n\nCONCLUSIONS\n\nThe intervention that involved the highest rate of face-to-face contact with the study participants produced the highest enrollment yield, but several strategies that were thought could improve yield had no effect. These findings, which are consistent with current literature on population-based recruitment, should facilitate the development of future recruitment efforts involving older African American men.",
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            "pages": "343-351",
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            "abstractNote": "Older people are systematically excluded from many clinical research studies. In this review, we examine the reasons for this state of affairs and summarise the current knowledge of strategies to increase the rate of participation of older people in clinical studies. Older people want to participate in clinical research and are driven by a mixture of altruism and self-interest. They are often excluded by overt age cut-offs or covert exclusions based on co-morbidity and frailty. Other barriers to participation include communication and cognitive difficulties, transport difficulties, low income and self-imposed agism. Possible strategies to improve recruitment of older people to clinical studies include abolishing age limits, reducing exclusion criteria, and allowing sufficient study time (to recruit and deal with older patients) and money (for reimbursement of their participation costs) in study protocols. Involving older people and their attending health professionals in the design of study protocols may also be helpful. Providing transportation, easy physical access to research institutions and use of personalised and face-to-face recruitment also pay dividends. A variety of recruitment methods have been found to be effective, but tailoring the strategy to the condition and population under study is necessary. Together, these strategies should improve the representation of older people in clinical research and ensure that the evidence base is relevant and useful to all those caring for older people.",
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            "abstractNote": "Older adults continue to be underrepresented in clinical research despite their burgeoning population in the United States and worldwide. Physicians often propose treatment plans for older adults based on data from studies involving primarily younger, more-functional, healthier participants. Major barriers to recruitment of older adults in aging research relate to their substantial health problems, social and cultural barriers, and potentially impaired capacity to provide informed consent. Institutionalized older adults offer another layer of complexity that requires cooperation from the institutions to participate in research activities. This paper provides study recruitment and retention techniques and strategies to address concerns and overcome barriers to older adult participation in clinical research. Key approaches include early in-depth planning; minimizing exclusion criteria; securing cooperation from all interested parties; using advisory boards, timely screening, identification, and approach of eligible patients; carefully reviewing the benefit:risk ratio to be sure it is appropriate; and employing strategies to ensure successful retention across the continuum of care. Targeting specific strategies to the condition, site, and population of interest and anticipating potential problems and promptly employing predeveloped contingency plans are keys to effective recruitment and retention.",
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            "title": "Functional health and dental service use among older adults",
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                    "creatorType": "author",
                    "firstName": "T A",
                    "lastName": "Dolan"
                },
                {
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            "abstractNote": "BACKGROUND\n\nAlthough socioeconomic barriers to receiving adequate dental care have been well documented, physical frailty as a risk factor for not visiting the dentist has not been fully explored. This study prospectively examines the relationship between functional health and dental service use, taking into account sociodemographic characteristics, general and dental health status, and prior dental utilization behavior.\n\n\nMETHODS\n\nData from a randomized trial of a comprehensive geriatric assessment and prevention program in community-dwelling adults age 75+ years living in Santa Monica, CA, collected between 1988 and 1993, were analyzed. A series of discrete-time proportional hazards models were used to assess the effects of functional status, sociodemographic characteristics, and general health and dental health measures on dental service use.\n\n\nRESULTS\n\nFunctional status was negatively associated with dental service use, and the conditional probability of a first visit to the dentist after baseline decreased over time. When additional measures of general health, dental health, and socioeconomic status were introduced, the effect of functional status was mitigated but remained significant. In the most fully specified model, which took dental visitation behavior prior to the beginning of the study into account, the effect of functional limitation remained significant.\n\n\nCONCLUSIONS\n\nEven in this relatively well-educated group of older persons with higher than average dental service use, impaired functional status was associated with lower levels of dental service use over time.",
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            "title": "Access to dental care among older adults in the United States",
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                    "creatorType": "author",
                    "firstName": "Teresa A",
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                {
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            "abstractNote": "Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.",
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            "abstractNote": "Oral health is integral to an older adult's general health and quality of life, and basic oral health services are an essential component of primary health care. The elderly should receive special consideration in terms of their oral health care needs since they: 1) may have unique problems accessing the health care delivery system; 2) experience different patterns and prevalence rates of oral diseases; and 3) may have characteristics that affect the amount and types of dental treatment and the method by which it is performed. Older adults are maintaining their natural teeth into their later years, and epidemiologic trends suggest the increasing need for dental services by older adults. Yet dental utilization rates are lower for older adults than for younger age groups, and barriers to care include the cost of dental care, the lack of perceived need for care, transportation problems, and fear. Oral diseases and impairments are most commonly experienced by those segments of society least able to obtain dental care. Economically and socially disadvantaged older adults and the physically impaired are more likely to experience tooth loss and edentulism, untreated dental decay and periodontal diseases. Adults over the age of 65 years have the lowest proportion of dental expenses reimbursed by private dental insurance (10 percent), and the highest percentage of out-of-pocket dental expenses (79 percent), as compared to all other age groups. Of the two largest public programs, Medicare does not pay for most dental services, and Medicaid (Title XIX), does not offer dental benefits for adults in most states. Although the majority of older adults live independently in the community, there is a growing number of elders with special needs that require long term care either at home or in an institution. These frail and functionally dependent elders have significant dental needs, and experience greater barriers to receiving dental care as compared to the independent elderly. Additional research is needed to accurately characterize the oral health status and needs of the growing number of homebound and institutionalized elders. This will be of growing importance with the emergence of the vast array of home health care services available to older adults, and the changing emphasis on home care often seen as the preferred and lower cost alternative to nursing home care.",
            "publicationTitle": "Journal of Dental Education",
            "publisher": "",
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            "date": "Dec 1993",
            "volume": "57",
            "issue": "12",
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            "pages": "876-887",
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                    "creatorType": "author",
                    "firstName": "Richard J",
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                    "creatorType": "author",
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