UMD Theses and Dissertations

Permanent URI for this collectionhttp://hdl.handle.net/1903/3

New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.

More information is available at Theses and Dissertations at University of Maryland Libraries.

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    ASSESSING THE IMPACT OF POLYPHARMACY ON THE ELDERLY USING NATIONALLY REPRESENTATIVE SURVEY DATA
    (2023) Eschenlauer, Adam; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: Polypharmacy is a growing issue that affects individuals of all ages yet is most prevalent among patients aged 65 and older with chronic comorbidities. Although integral to most treatment plans, pharmaceutical intervention may negatively impact one’s health when five or more medications are taken daily. Given the concurrent rise in elderly population and polypharmacy prevalence, it is vital that we better understand the impact that concomitant medication use has on this vulnerable segment of population.Purpose: This research examines the factors leading to polypharmacy among the elderly population and explores its various impacts on healthcare utilization. Data and Methods: This study uses Medical Expenditure Panel Survey (MEPS) Data. Fixed-Effects regression analyses examine relationships between predictive factors and polypharmacy, polypharmacy and expenditures, and polypharmacy and utilization. Classification models assess the ability of machine learning to correctly predict utilization within the sample population. Key Results: Aside from clinical indicators, demographic and socio-economic factors play a role in determining polypharmacy status. Polypharmacy risk is higher for women (1.088, p < 0.001), high income individuals (1.107, p < 0.01), and those covered by Medicaid (1.110, p < 0.001). Conversely, married individuals (0.930, p < 0.001) and non-Hispanic Blacks (0.864, p < 0.001) have reduced risks of polypharmacy. We find polypharmacy to be associated with higher total (p < 0.001), inpatient (p < 0.01), outpatient (p < 0.01), and prescription medical expenditures (p < 0.001) when holding other predictors constant. We find the risk of hospitalization to be higher for polypharmacy patients (RR: 1.592, p < 0.001) than nonpolypharmacy patients after controlling for multimorbidity and medication class. Lastly, machine learning algorithms classify admissions with an overall accuracy of 84.9%; however, a low true positive rate (TPR) of 41.7% and high true negative rate (TNR) of 96.5% indicate best performance is achieved in predicting non-admissions. Conclusion: Polypharmacy is associated with several non-clinical factors and has a statistically significant impact on medical expenditures and admissions. Though imperfect, predictive analysis methods improve our ability to identify patients at risk for admissions and present a potential opportunity for future applications aimed at reducing utilization and costs.
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    The effect of a citrus tastant on pill swallowing
    (2010) Albert, Amy Beth; Sonies, Barbara C; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    If using a sweetened citrus tastant (i.e., a chemical that stimulates the taste buds and produces a sense of taste) to coat a pill could make swallowing pills easier, this could have a considerable positive impact on the ability to swallow pills in healthy adults and on those with identified swallowing difficulties who need to take a variety of oral medications. In this study, it was predicted that pills would be cleared from the pharynx more quickly and efficiently if a pill was coated with a tastant. Thus, the following study examined the effect of a pleasant citrus tastant on pill swallowing in healthy individuals (7 male; 17 female) aged 19-49 years (M = 27.83 years). Durational measures of swallowing were obtained from real-time ultrasound images of the oropharyngeal swallow. It was hypothesized that swallow durations would be shortest for citrus-coated tablets, followed by water swallows and then plain pills. Although results from statistical analyses did not support a quicker oropharyngeal swallow for one stimulus over another, rationale for lack of significant findings, such as a ceiling effect for healthy pill swallowing, are provided.