BACKGROUND: The extent of outpatient adverse drug events (ADEs) remains unclear. Trigger tools are used as a screening method to identify care episodes that may be ADEs, but their value in a population with high chronic-illness burden remains unclear. METHODS: The authors used six abnormal laboratory triggers for detecting ADEs among adults in outpatient care. Eligible patients were included if they were >18 years, sought primary or urgent care between November 2008 and November 2009 and were prescribed at least one medication. The authors then used the clinical / administrative database to identity patients with these triggers. Two physicians conducted in-depth chart review of any medical records with identified triggers. RESULTS: The authors reviewed 1342 triggers representing 622 unique episodes among 516 patients. The trigger tool identified 91 (15%) ADEs. Of the 91 ADEs included in the analysis, 49 (54%) occurred during medication monitoring, 41 (45%) during patient self-administration, and one could not be determined. 96% of abnormal international normalised ratio triggers were ADEs, followed by 12% of abnormal blood urea nitrogen triggers, 9% of abnormal alanine aminotransferase triggers, 8% of abnormal serum creatinine triggers and 3% of aspartate aminotransferase triggers. CONCLUSIONS: The findings imply that other tools such as text triggers or more complex automated screening rules, which combine data hierarchically are needed to effectively screen for ADEs in chronically ill adults seen in primary care.

This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil refinery and near other industrial and mobile sources of pollution. The Richmond health survey aimed to assess local concerns and perceptions of neighborhood conditions, health problems, mobile and stationary hazards, access to health care, and other issues affecting residents of Richmond. Although respondents thought their neighborhoods were good places to live, they expressed concerns about neighborhood stressors and particular sources of pollution, and identified elevated asthma rates for children and long-time Richmond residents. The Richmond health survey offers a holistic, community-centered perspective to understanding local environmental health issues, and can inform future environmental health research and organizing efforts for community-university collaboratives.

Although the benefits of community-based participatory research (CBPR) for community and university partners have been well documented, these have mostly focused on disseminating research findings. However, how CBPR can function as a useful community organizing tool remains understudied. We present the CBPR process of an environmental health survey conducted by a team of community organizers and academic researchers in Richmond, CA, to describe how survey research can be aligned with community organizing principles and methods. Through a case study of our Richmond health survey that documented and quantified neighborhood concerns and health problems, we describe and analyze three steps through which community organizing and CBPR align: community-driven hypothesis generation and testing, how community surveyors are trained and study participants are recruited, and how results are applied and disseminated to policy advocacy and community action. Our case study of surveying for environmental health justice demonstrates how CBPR can be used for community organizing by: (1) building community capacity in research methods, literacy, and numeracy through training community residents as surveyors and data analysis advisors; (2) supporting organizing goals with community-driven hypothesis generation and hypothesis testing; (3) using research findings to determine future issues to prioritize; and (4) developing strategic initiatives accordingly. We recommend ensuring adequate, funded time for CBPR partners to apply their research findings toward community organizing goals and strategic planning for future community organizing and research.

Background

Limited health literacy (HL) contributes to poor health outcomes and disparities, and direct measurement is often time-intensive. Self-reported HL questions have not been validated among Spanish-speaking and diverse English-speaking populations.

Objective

To evaluate three self-reported questions: 1 "How confident are you filling out medical forms?"; 2 "How often do you have problems learning about your medical condition because of difficulty understanding written information?"; and 3 "How often do you have someone help you read hospital materials?" Answers were based on a 5-point Likert scale.

Design

This was a validation study nested within a trial of diabetes self-management support in the San Francisco Department of Public Health.

Participants

English and Spanish-speaking adults with type 2 diabetes receiving primary care.

Methods

Using the Test of Functional Health Literacy in Adults (s-TOFHLA) in English and Spanish as the reference, we classified HL as inadequate, marginal, or adequate. We calculated the C-index and test characteristics of the three questions and summative scale compared to the s-TOFHLA and assessed variations in performance by language, race/ethnicity, age, and education.

Key results

Of 296 participants, 48% were Spanish-speaking; 9% were White, non-Hispanic; 47% had inadequate HL and 12% had marginal HL. Overall, 57% reported being confident with forms "somewhat" or less. The "confident with forms" question performed best for detecting inadequate (C-index = 0.82, (0.77-0.87)) and inadequate plus marginal HL (C index = 0.81, (0.76-0.86); p<0.01 for differences from other questions), and performed comparably to the summative scale. The "confident with forms" question and scale also performed best across language, race/ethnicity, educational attainment, and age.

Conclusions

A single self-reported HL question about confidence with forms and a summative scale of three questions discriminated between Spanish and English speakers with adequate HL and those with inadequate and/or inadequate plus marginal HL. The "confident with forms" question or the summative scale may be useful for estimating HL in clinical research involving Spanish-speaking and English-speaking, chronically-ill, diverse populations.

Due to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consideration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women. We report data from a qualitative interview study (n=30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs. Women in the study lived in a range of SRO built environments, from publicly-funded, newly built SROs to privately-owned, dilapidated buildings, which presented a rich opportunity for ethnographic comparison. Applying Rhodes et al.’s framework of socio-structural vulnerability, we explore how SROs can operate as “mental health risk environments” in which macro-structural factors (housing policies shaping the built environment) interact with meso-level factors (social relations within SROs) and micro-level, behavioral coping strategies to impact women’s mental health. The degree to which SRO built environments were “trauma-sensitive” at the macro level significantly influenced women’s mental health at meso- and micro- levels. Women who were living in SROs which exacerbated fear and anxiety attempted, with limited success, to deploy strategies on the meso- and micro- level to manage their mental health symptoms. Study findings underscore the importance of housing polices which consider substance use in the context of current and cumulative trauma experiences in order to improve quality of life and mental health for unstably housed women.