In the second installment of a 2-part interview, Jacinda Abdul-Mutakabbir, PharmD, MPH, offers some novel findings around UTI treatment failure associated with levels of education and insurance payers.
In the course of her study looking at antibiotic treatment selection and failure by race and ethnicity for uncomplicated urinary tract infection, Jacinda Abdul-Mutakabbir, PharmD, MPH, assistant professor of clinical pharmacy and antimicrobial resistance researcher at UC San Diego, discovered an unusual finding: They saw less treatment failure with their Black and Hispanic patients who were treated with cephalosporins.
This got her thinking about other potential findings and reasons for these outcomes. She knew they collected participants’ insurance. They then discovered that there was a correlation between people with higher levels of education and higher treatment failure rates.
Abdul-Mutakabbir posited a theory that this might be due to patients with private insurance advocating for non-formulary therapies that they might be seeing in advertising, for example.
“Say you saw a commercial and you think that this therapy may be the best one for you, you go to your provider, you advocate for that,” she said. “And while you know this may have been a therapy that you heard about—that may have been good—it may not have been the best one for your infection.”
Conversely, a patient who is on restricted insurance plans may have limited treatment options; therefore, the roles of insurance payers in treatment outcomes may play a role in success or failure.
“I don't even think I thought about insurance payers as an arm in healthcare. It was this study that really pushed me, but then it made me think about that bridge that our industry partners can serve for that because, while they conduct these real-world studies, they collaborate with academicians, and they can interface with insurance companies.”
Additionally, providers need to stop making assumptions about clinical guidance they give to patients, especially those they perceive as being highly educated.
“I think that a lot of times when we have this conversation around tailoring education, it is to those individuals that may have compromised health literacy, but now we have to change our hypothesis, and it's like, no, we need to have education for everyone,” Abdul-Mutakabbir said. “We need to make sure we're presenting this information in the best way for everyone that can receive it.”
Her work in this area has made her think differently in the approach to clinical care and the factors associated with treatment failure.
This is the second installment of a 2-part interview. In the first episode, Abdul-Mutakabbir discusses another study around UTIs and social determinants of health.
She also had a study published in Current Infectious Disease Reports on area-based deprivation indices and healthcare-associated infections.
“I hope that this data spurs [clinicians] to be more intentional about the therapies that they do give, and then, honestly, we need more research to really figure out those mechanistic reasons why treatments fail…Why is it that these antibiotics don't work? What are those social factors that may be happening? Because sometimes, they may have been [prescribed] the best therapy for that patient, but maybe they didn't know that they had to take it for that entire duration. Is it the education when we're getting these medications? Is it the fact that while we're prescribing these medications, folks may not be actually picking them up from the pharmacy?”
She stresses the need for qualitative data and feedback from patients to better understand their clinical care.
“We really have to bring that perspective of the patient into the conversation…We need to have their actual comments,” Abdul-Mutakabbir said.
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