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Peng G, Yan F, Sun R, Zhang Y, Zhao R, Zhang G, Qiao P, Ma Y, Han L. Self-management behavior strategy based on behavioral economics in patients with hypertension: a scoping review. Transl Behav Med 2024; 14:405-416. [PMID: 38776869 DOI: 10.1093/tbm/ibae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Hypertensive patients often do not make the most favorable choices and behaviors for managing disease. Behavioral economics strategies offer new ideas for guiding patients toward health behavior. The scoping review aimed to summarize behavioral economics strategies designed to improve hypertension self-management behaviors. A literature search was conducted in September 2022 using the following electronic databases: Embase, Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, CNKI, Wan Fang Database for Chinese Periodicals, and CBM-SinoMed. We screened the literature for experimental studies written in Chinese or English reporting on BE strategies designed to improve self-management behavior in hypertension. We searched 17 820 records and included 18 articles in the final scoping review. We performed qualitative synthesis by the categories of choice architecture. The most common BE strategies were those targeting decision information and decision assistance, such as changing the presentation of information, making information visible, and providing reminders for actions. Most strategies targeted BP, diet, medication adherence, and physical activity behavior. Ten out of 18 studies reported statistically significant improvement in self-management behavior. Further research on BE strategies should focus on addressing the challenges, including changing the decision structure, encompassing a more comprehensive range of target behaviors, and examining the long-term effects of BE strategies.
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Affiliation(s)
- Guotian Peng
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fanghong Yan
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ruiyi Sun
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yanan Zhang
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Rongrong Zhao
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Guoli Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Pengyu Qiao
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Lin Han
- Nursing Management, Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
- Department of Internal Medicine, The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
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Baklouti M, Mejdoub Y, Tombohindy MG, Ketata N, Jdidi J, Triki F, Yaich S, Abid L. Impact of Therapeutic Education on the Management of High Blood Pressure: A Quasi-experimental Survey From Southern Tunisia. Crit Pathw Cardiol 2024; 23:30-35. [PMID: 37831463 DOI: 10.1097/hpc.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. METHODS This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021-March 2022). RESULTS In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70-80] vs. 80 [75-80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). CONCLUSIONS Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.
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Affiliation(s)
- Mouna Baklouti
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Yosra Mejdoub
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | | | - Nouha Ketata
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jihen Jdidi
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Faten Triki
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Sourour Yaich
- From the Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Leila Abid
- Cardiology Department Hedi Chaker University Hospital, University of Sfax, Tunisia
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Ye J, Sanuade OA, Hirschhorn LR, Walunas TL, Smith JD, Birkett MA, Baldridge AS, Ojji DB, Huffman MD. Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review. Prev Med 2024; 180:107880. [PMID: 38301908 PMCID: PMC10919242 DOI: 10.1016/j.ypmed.2024.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION CRD42021291368. PROTOCOL REGISTRATION PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Abigail S Baldridge
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Washington University in St. Louis, St. Louis, MO, USA; The George Institute for Global Health, Sydney, Australia
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Hayek MA, Giannouchos T, Lawley M, Kum HC. Economic Evaluation of Blood Pressure Monitoring Techniques in Patients With Hypertension: A Systematic Review. JAMA Netw Open 2023; 6:e2344372. [PMID: 37988078 PMCID: PMC10663963 DOI: 10.1001/jamanetworkopen.2023.44372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Blood pressure monitoring is critical to the timely diagnosis and treatment of hypertension. At-home self-monitoring techniques are highly effective in managing high blood pressure; however, evidence regarding the cost-effectiveness of at-home self-monitoring compared with traditional monitoring in clinical settings remains unclear. Objective To identify and synthesize published research examining the cost-effectiveness of at-home blood pressure self-monitoring relative to monitoring in a clinical setting among patients with hypertension. Evidence Review A systematic literature search of 5 databases (PubMed, MEDLINE, Embase, EconLit, and CINAHL) followed by a backward citation search was conducted in September 2022. Full-text, peer-reviewed articles in English including patients with high blood pressure (systolic blood pressure ≥130 mm Hg and diastolic blood pressure ≥80 mm Hg) at baseline were included. Data from studies comparing at-home self-monitoring with clinical-setting monitoring alternatives were extracted, and the outcomes of interest included incremental cost-effectiveness and cost-utility ratios. Non-peer-reviewed studies or studies with pregnant women and children were excluded. To ensure accuracy and reliability, 2 authors independently evaluated all articles for eligibility and extracted relevant data from the selected articles. Findings Of 1607 articles identified from 5 databases, 16 studies met the inclusion criteria. Most studies were conducted in the US (6 [40%]) and in the UK (6 [40%]), and almost all studies (14 [90%]) used a health care insurance system perspective to determine costs. Nearly half the studies used quality-adjusted life-years gained and cost per 1-mm Hg reduction in blood pressure as outcomes. Overall, at-home blood pressure monitoring (HBPM) was found to be more cost-effective than monitoring in a clinical setting, particularly over a minimum 10-year time horizon. Among studies comparing HBPM alone vs 24-hour ambulatory blood pressure monitoring (ABPM) or HBPM combined with additional support or team-based care, the latter were found to be more cost-effective. Conclusions and Relevance In this systematic review, at-home blood pressure self-monitoring, particularly using automatic 24-hour continuous blood pressure measurements or combined with additional support or team-based care, demonstrated the potential to be cost-effective long-term compared with care in the physical clinical setting and could thus be prioritized for patients with hypertension from a cost-effectiveness standpoint.
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Affiliation(s)
- Michelle A. Hayek
- Population Informatics Lab, Department of Industrial and Systems Engineering, Texas A&M University, College Station
| | - Theodoros Giannouchos
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station
| | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, College Station
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Bhattarai S, Bajracharya S, Shrestha A, Skovlund E, Åsvold BO, Mjolstad BP, Sen A. Facilitators and barriers to hypertension management in urban Nepal: findings from a qualitative study. Open Heart 2023; 10:e002394. [PMID: 37899127 PMCID: PMC10618998 DOI: 10.1136/openhrt-2023-002394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal. METHODS We used a qualitative methodology informed by Kaufman's socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted. RESULTS We found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor's access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure. CONCLUSION The study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.
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Affiliation(s)
- Sanju Bhattarai
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Archana Shrestha
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Bente Prytz Mjolstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
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Yuan W, Zhang Y, Ma L. Comparative Different Interventions to Improve Medication Adherence in Patients with Hypertension: A Network Meta-analysis. J Cardiovasc Nurs 2023:00005082-990000000-00104. [PMID: 37406171 DOI: 10.1097/jcn.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients. OBJECTIVE The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension. METHODS We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions. RESULTS Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension. CONCLUSIONS Health intervention is recommended to improve medication adherence in patients with hypertension. CLINICAL IMPLICATIONS Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.
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Shiraly R, Khani Jeihooni A, Bakhshizadeh Shirazi R. Perception of risk of hypertension related complications and adherence to antihypertensive drugs: a primary healthcare based cross-sectional study. BMC PRIMARY CARE 2022; 23:303. [PMID: 36443657 PMCID: PMC9706951 DOI: 10.1186/s12875-022-01918-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood pressure control is suboptimal in more than half of treated hypertensive patients. The purpose of this study was to assess perceived risk of high blood pressure sequelae and adherence to medications in known cases of hypertension. METHODS A cross-sectional study was designed using a sample of 600 hypertensive patients who were randomly selected from 32 primary healthcare centers in Shiraz, Iran. A structured interviewer-administered questionnaire was used to collect data. Participants were asked about their basic demographic information, smoking history, access to healthcare services, duration of antihypertensive therapy, number of drugs taken concurrently and their perceived risk of hypertension-related complications. The outcome of interest was adherence to antihypertensive medications measured by the Persian version of the Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis was used to identify independent factors associated with better adherence. RESULTS Nearly half (48.8%) of participants had uncontrolled hypertension. Just over one fifth (22.3%) of all the patients reported high adherence to antihypertensive medications. Independent factors associated with better adherence to antihypertensive medications were higher educational level (OR: 1.71, CI 95%: 1.06-2.75), being a never smoker (OR: 1.62, CI 95%: 1.06-2.46), having easy access to healthcare services (OR: 1.91, CI 95%: 1.10-3.35), lower mean treatment duration (OR: 0.96, CI 95%: 0.92-0.99), and having higher perceived risk of hypertension-related complications (OR:2.34, CI 95%: 1.52-3.60). CONCLUSION High perceived risk of hypertension-related complications is significantly associated with adherence to antihypertensive therapy. Our findings suggest that primary care physicians should regularly emphasize on negative consequences of uncontrolled/poorly controlled blood pressure while visiting hypertensive patients.
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Affiliation(s)
- Ramin Shiraly
- Department of Community Medicine, School of Medicine, Health Behavior Science Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Shams M, Pariani A, Raeisi A, Maleki M, Shariatinia S, Jamalizadeh A, Poorkarami A, Ostovar A. The Iranian National Blood Pressure Measurement Campaign: What Do the Process and Output Evaluation say? ARCHIVES OF IRANIAN MEDICINE 2022; 25:718-724. [PMID: 37543895 PMCID: PMC10685855 DOI: 10.34172/aim.2022.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/29/2021] [Indexed: 08/08/2023]
Abstract
BACKGROUND The Iranian National Blood Pressure Measurement Campaign (INBPMC) was conducted all over the country to raise awareness in different groups of people regarding the importance of blood pressure and persuading them to manage their blood pressure. The present research aimed at assessing the process and output of this campaign. METHODS For process evaluation, 31 universities/faculties were selected. Experts from the Ministry of Health and Medical Education assessed the documentation of the campaign implementation using the designed checklist. The output was assessed by including 8274 people and through a telephone survey using the designed instructions. RESULTS The response rate of the telephone interviews was 82.74% (8274 people). It was found that 79% of the selected groups were aware of the INBPMC. Among them, 64% remembered the messages, 99% of the participants who remembered the messages agreed with those messages, and 89% of the participants who agree with the messages went for a measurement of their blood pressure. In the telephone interviews, 30% of the participants stated that they were diagnosed with hypertension, 97% of these participants received the required consultations for subsequent care, and 86% of them went to the health service centers to receive care. The process evaluation of the INBPMC indicated that the universities of medical sciences obtained 97% of the score of the checklist. CONCLUSION The INBPMC was successful and accomplished its objectives.
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Affiliation(s)
- Mohsen Shams
- School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
- Iranian Social Marketing Association, Health Technology Incubation Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Abbas Pariani
- Department of Non-Communicable Diseases Management, Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza Raeisi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mostafa Maleki
- Iranian Social Marketing Association, Health Technology Incubation Center, Yasuj University of Medical Sciences, Yasuj, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Shariatinia
- Iranian Social Marketing Association, Health Technology Incubation Center, Yasuj University of Medical Sciences, Yasuj, Iran
- School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Jamalizadeh
- Health Deputy, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ye J, Orji IA, Baldridge AS, Ojo TM, Shedul G, Ugwuneji EN, Egenti NB, Aluka-Omitiran K, Okoli RCB, Eze H, Nwankwo A, Hirschhorn LR, Chopra A, Ale BM, Shedul GL, Tripathi P, Kandula NR, Huffman MD, Ojji DB. Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program. JAMA Netw Open 2022; 5:e2230025. [PMID: 36066896 PMCID: PMC9449788 DOI: 10.1001/jamanetworkopen.2022.30025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered. EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURES The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTS In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCE The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.
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Affiliation(s)
- Jiancheng Ye
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B. Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Aashima Chopra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Priya Tripathi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Washington University in St Louis, St Louis, Missouri
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
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Drake C, Lewinski AA, Rader A, Schexnayder J, Bosworth HB, Goldstein KM, Gierisch J, White-Clark C, McCant F, Zullig LL. Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations. Curr Hypertens Rep 2022; 24:267-284. [PMID: 35536464 PMCID: PMC9087161 DOI: 10.1007/s11906-022-01193-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an intervention called Team-supported, Electronic health record-leveraged, Active Management (TEAM). By doing so, we highlight the role of population health managers, practitioners who use population level data and to proactively engage at-risk patients, in improving blood pressure control. RECENT FINDINGS Within a population health paradigm, we discuss telehealth-delivered approaches to equitably improve hypertension care delivery. Additionally, we explore implementation considerations and complementary features of team-based, telehealth-delivered, population health management. By leveraging the unique role and expertise of a population health manager as core member of team-based telehealth, health systems can implement a cost-effective and scalable intervention that addresses multi-level barriers to hypertension care delivery. We describe the literature of telehealth-based population health management for patients with hypertension. Using the TEAM intervention as a case study, we then present implementation considerations and intervention adaptations to integrate a population health manager within the health care team and effectively manage hypertension for a defined patient population. We emphasize practical considerations to inform implementation, scaling, and sustainability. We highlight future research directions to advance the field and support translational efforts in diverse clinical and community contexts.
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Affiliation(s)
- Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA.
| | - Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Abigail Rader
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Julie Schexnayder
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Gierisch
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney White-Clark
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Felicia McCant
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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11
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A Systematic Review of Internet-Based Interventions for the Prevention and Self-Management of Cardiovascular Diseases among People of African Descent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148872. [PMID: 35886719 PMCID: PMC9319273 DOI: 10.3390/ijerph19148872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease (CVD) risk factors, morbidity, and mortality among people of African descent (PAD) appear to be higher than in the general population. While it has been found that lifestyle changes can prevent around 90% of CVDs, implementing an effective lifestyle programme is expensive and time-consuming. It has been demonstrated that Internet-based interventions (IbIs) can effectively and inexpensively encourage lifestyle modifications to prevent and manage chronic diseases. Although a number of studies have examined the effectiveness of IbIs in the general population, no comprehensive study of the usefulness and acceptability of IbIs among PAD has been conducted. This is the knowledge gap that this study aimed to address. We searched MEDLINE, EMBASE, CINAHL, and Web of Science to identify eligible studies published from inception to February 2022. Thirteen articles met our criteria for inclusion. Our textual narrative synthesis produced inconsistent results; nonetheless, high acceptability of IbIs and a considerable improvement in clinical and behavioural outcomes associated with CVDs were reported in several trials. The findings of this review are constrained by clinical, methodological and statistical variability among the studies. To have a good grasp on the effect of IbIs on behaviour change in PAD at risk of CVDs, large-scale longitudinal studies with long-term follow-up are required.
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Treadwell JR, Rouse B, Reston J, Fontanarosa J, Patel N, Mull NK. Consumer Devices for Patient-Generated Health Data Using Blood Pressure Monitors for Managing Hypertension: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33261. [PMID: 35499862 PMCID: PMC9112087 DOI: 10.2196/33261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes. Objective We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes. Methods An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results. Results We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non–BP monitor groups. Adherence to using consumer BP monitors ranged from 38% to 89%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts). Conclusions Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers.
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Affiliation(s)
| | | | | | | | - Neha Patel
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nikhil K Mull
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, United States
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Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database Syst Rev 2021; 9:CD011556. [PMID: 34693994 PMCID: PMC8543670 DOI: 10.1002/14651858.cd011556.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care is an important setting in which to treat tobacco addiction. However, the rates at which providers address smoking cessation and the success of that support vary. Strategies can be implemented to improve and increase the delivery of smoking cessation support (e.g. through provider training), and to increase the amount and breadth of support given to people who smoke (e.g. through additional counseling or tailored printed materials). OBJECTIVES To assess the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings. To assess whether any effect that these interventions have on smoking cessation may be due to increased implementation by healthcare providers. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries to 10 September 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs (cRCTs) carried out in primary care, including non-pregnant adults. Studies investigated a strategy or strategies to improve the implementation or success of smoking cessation treatment in primary care. These strategies could include interventions designed to increase or enhance the quality of existing support, or smoking cessation interventions offered in addition to standard care (adjunctive interventions). Intervention strategies had to be tested in addition to and in comparison with standard care, or in addition to other active intervention strategies if the effect of an individual strategy could be isolated. Standard care typically incorporates physician-delivered brief behavioral support, and an offer of smoking cessation medication, but differs across studies. Studies had to measure smoking abstinence at six months' follow-up or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our primary outcome - smoking abstinence - was measured using the most rigorous intention-to-treat definition available. We also extracted outcome data for quit attempts, and the following markers of healthcare provider performance: asking about smoking status; advising on cessation; assessment of participant readiness to quit; assisting with cessation; arranging follow-up for smoking participants. Where more than one study investigated the same strategy or set of strategies, and measured the same outcome, we conducted meta-analyses using Mantel-Haenszel random-effects methods to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS We included 81 RCTs and cRCTs, involving 112,159 participants. Fourteen were rated at low risk of bias, 44 at high risk, and the remainder at unclear risk. We identified moderate-certainty evidence, limited by inconsistency, that the provision of adjunctive counseling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost-free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. There was also moderate-certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow-up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants). There was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies we judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty. We downgraded the evidence due to imprecision, inconsistency and risk of bias across these comparisons. There was some indication that provider training increased the delivery of smoking cessation support, along with the provision of adjunctive counseling and cost-free medications. However, our secondary outcomes were not measured consistently, and in many cases analyses were subject to substantial statistical heterogeneity, imprecision, or both, making it difficult to draw conclusions. Thirty-four studies investigated multicomponent interventions to improve smoking cessation rates. There was substantial variation in the combinations of strategies tested, and the resulting individual study effect estimates, precluding meta-analyses in most cases. Meta-analyses provided some evidence that adjunctive counseling combined with either cost-free medications or provider training enhanced quit rates when compared with standard care alone. However, analyses were limited by small numbers of events, high statistical heterogeneity, and studies at high risk of bias. Analyses looking at the effects of combining provider training with flow sheets to aid physician decision-making, and with outreach facilitation, found no clear evidence that these combinations increased quit rates; however, analyses were limited by imprecision, and there was some indication that these approaches did improve some forms of provider implementation. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing adjunctive counseling by an allied health professional, cost-free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. There is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, we rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. Further studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting. Such studies should be cluster-randomized to account for the implications of implementation in this particular setting. Due to substantial variation between studies in this review, identifying optimal characteristics of multicomponent interventions to improve the delivery of smoking cessation treatment was challenging. Future research could use component network meta-analysis to investigate this further.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gillian Pritchard
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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Shahin W, Kennedy GA, Stupans I. The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract (Granada) 2021; 19:2300. [PMID: 34221197 PMCID: PMC8234709 DOI: 10.18549/pharmpract.2021.2.2300] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Medication adherence is a primary determinant of treatment success in
hypertensive patients. One of the challenges for healthcare providers that
has received little attention is the impact of patients’ social
supports on medication adherence. Objective: This review evaluates the impact of patients’ social supports on
medication adherence in hypertensive patients. Methods: A systematic review methodology was used. Pubmed, CINAHL, Embase, and
PsycINFO databases were searched systematically for relevant articles. The
outcome measure in the studies was medication adherence in hypertension. Results: From 1155 articles, 238 were retained for further assessment, and finally, 14
met the inclusion criteria. Statistically significant positive associations
between medication adherence and social support were found in nine studies
(p<0.05). Conclusions: This review evaluated the impact of social support on medication adherence
and highlighted gaps in the literature regarding the impact of social
support on adherence. Family members or peer support may promote better
adherence in some patient groups. This review suggests that healthcare
providers may need to consider whether patients have appropriate social
supports in place which will assist them adhering to and benefiting from
treatment recommendations.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Gerard A Kennedy
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
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Abstract
In this updated Self-care of Hypertension Inventory Version 3.0 (SC-HI v3.0), items were added to better reflect the Theory of Self-care of Chronic Illness and revised based on recent research. The reorganized and expanded SC-HI now reflects the theoretical concepts of self-care maintenance, monitoring, and management. OBJECTIVE To evaluate the psychometric properties of the SC-HI v3.0, we conducted exploratory factor analyses. Here, we report on its reliability and construct validity. METHODS A sample of 200 adults with chronic hypertension completed a sociodemographic survey and the SC-HI v3.0. Exploratory factor analyses were conducted on item sets using principal factor method for analyzing the correlation matrix. Reliability was calculated using common factor coefficient of determinacy for multidimensional scales, for which values greater than 0.80 are considered adequate. RESULTS The sample was 83.4% non-Hispanic White; 56% were women, with a mean age of 62.2 ± 12.5 years. The self-care maintenance scale (mean, 75.9 ± 13.6) had adequate reliability (ρ = 0.81, 0.80) for a 2-dimensional model of self-care maintenance identified as autonomous and consultative behaviors. The new self-care monitoring scale (mean score, 58.5 ± 21.99) had a single-factor solution with very good reliability (ρ = 0.94). The self-care management scale (mean score, 64.5 ± 19.5) had a single-factor solution, with moderate to strong factor loadings (0.22-0.68) and acceptable reliability (ρ = 0.84). CONCLUSIONS Initial testing suggests that the SC-HI v3.0 is a sound measure of the essential elements of self-care for adults with chronic hypertension. With the new self-care monitoring scale, the SC-HI v3.0 is a valid reflection of the theory on which it is based.
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16
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Marseille BR, Commodore-Mensah Y, Davidson PM, Baker D, D'Aoust R, Baptiste DL. Improving hypertension knowledge, medication adherence, and blood pressure control: A feasibility study. J Clin Nurs 2021; 30:2960-2967. [PMID: 33872425 DOI: 10.1111/jocn.15803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension. BACKGROUND Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension. DESIGN Pre-test and post-test feasibility study. METHODS A convenience sample of forty-four participants who identified as Haitian immigrants was enrolled in this evidence-based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill-Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes. RESULTS Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six-week follow-up period. CONCLUSION The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in-depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities. RELEVANCE TO CLINICAL PRACTICE Advanced practice nurses are uniquely qualified to implement evidence-based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence-based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.
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Affiliation(s)
- Beatrice Remy Marseille
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | - Yvonne Commodore-Mensah
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,School of Public Health, Johns Hopkins Bloomberg, Baltimore, MD, USA
| | | | - Deborah Baker
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA.,The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rita D'Aoust
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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17
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Bryant KB, Sheppard JP, Ruiz-Negrón N, Kronish IM, Fontil V, King JB, Pletcher MJ, Bibbins-Domingo K, Moran AE, McManus RJ, Bellows BK. Impact of Self-Monitoring of Blood Pressure on Processes of Hypertension Care and Long-Term Blood Pressure Control. J Am Heart Assoc 2020; 9:e016174. [PMID: 32696695 PMCID: PMC7792261 DOI: 10.1161/jaha.120.016174] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Self-monitoring of blood pressure (SMBP) improves blood pressure (BP) outcomes at 12-months, but information is lacking on how SMBP affects hypertension care processes and longer-term BP outcomes. Methods and Results We pooled individual participant data from 4 randomized clinical trials of SMBP in the United Kingdom (combined n=2590) with varying intensities of support. Multivariable random effects regression was used to estimate the probability of antihypertensive intensification at 12 months for usual care versus SMBP. Using these data, we simulated 5-year BP control rates using a validated mathematical model. Trial participants were mostly older adults (mean age 66.6 years, SD 9.5), male (53.9%), and predominantly white (95.6%); mean baseline BP was 151.8/85.0 mm Hg. Compared with usual care, the likelihood of antihypertensive intensification increased with both SMBP with feedback to patient or provider alone (odds ratio 1.8, 95% CI 1.2-2.6) and with telemonitoring or self-management (3.3, 2.5-4.2). Over 5 years, we estimated 33.4% BP control (<140/90 mm Hg) with usual care (95% uncertainty interval 27.7%-39.4%). One year of SMBP with feedback to patient or provider alone achieved 33.9% (28.3%-40.3%) BP control and SMBP with telemonitoring or self-management 39.0% (33.1%-45.2%) over 5 years. If SMBP interventions and associated BP control processes were extended to 5 years, BP control increased to 52.4% (45.4%-59.8 %) and 72.1% (66.5%-77.6%), respectively. Conclusions One year of SMBP plus telemonitoring or self-management increases the likelihood of antihypertensive intensification and could improve BP control rates at 5 years; continuing SMBP for 5 years could further improve BP control.
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Affiliation(s)
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
| | | | | | - Valy Fontil
- University of California at San Francisco CA
| | | | | | | | | | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences University of Oxford United Kingdom
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18
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Delavar F, Pashaeypoor S, Negarandeh R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:336-342. [PMID: 31451361 DOI: 10.1016/j.pec.2019.08.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/11/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control. METHOD This randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively. RESULTS At baseline, there were no significant between-group differences regarding participants' demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05). CONCLUSION Self-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure. PRACTICE IMPLICATION To promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required.
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Affiliation(s)
- Farzaneh Delavar
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahzad Pashaeypoor
- Dept. of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Johnson HM, Sullivan-Vedder L, Kim K, McBride PE, Smith MA, LaMantia JN, Fink JT, Knutson Sinaise MR, Zeller LM, Lauver DR. Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial. Contemp Clin Trials 2019; 78:88-100. [PMID: 30677485 PMCID: PMC6387836 DOI: 10.1016/j.cct.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Lisa Sullivan-Vedder
- Aurora Health Care Department of Family Medicine, Family Care Center, 1020 N 12(th) Street, Milwaukee, WI 53233, USA.
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/420 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-4675, USA.
| | - Patrick E McBride
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA.
| | - Maureen A Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726, USA; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715-1896, USA.
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Jennifer T Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee College of Health Sciences, NWQ Building B, Suite #6455, 2025 E. Newport Avenue, Milwaukee, WI 53211-2906, USA.
| | - Megan R Knutson Sinaise
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Laura M Zeller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Diane R Lauver
- School of Nursing, University of Wisconsin, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA.
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Elbashir M, Awaisu A, El Hajj MS, Rainkie DC. Measurement of health literacy in patients with cardiovascular diseases: A systematic review. Res Social Adm Pharm 2019; 15:1395-1405. [PMID: 30709731 DOI: 10.1016/j.sapharm.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. OBJECTIVE To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. METHODS Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. RESULTS Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. CONCLUSIONS The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.
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Affiliation(s)
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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21
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Shelby RA, Dorfman CS, Bosworth HB, Keefe F, Sutton L, Owen L, Corsino L, Erkanli A, Reed SD, Arthur SS, Somers T, Barrett N, Huettel S, Gonzalez JM, Kimmick G. Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET). Contemp Clin Trials 2019; 76:120-131. [PMID: 30472215 PMCID: PMC6346744 DOI: 10.1016/j.cct.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes. Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.
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Affiliation(s)
- Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Leonor Corsino
- Division of Endocrinology, Duke University, Durham, NC, United States.
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States.
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Sarah S Arthur
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Nadine Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University, Durham, NC, United States.
| | - Scott Huettel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, United States.
| | - Gretchen Kimmick
- Division of Medical Oncology, Duke University, Durham, NC, United States.
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Still CH, Jones LM, Moss KO, Variath M, Wright KD. African American Older Adults' Perceived Use of Technology for Hypertension Self-Management. Res Gerontol Nurs 2018; 11:249-256. [PMID: 30230518 DOI: 10.3928/19404921-20180809-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
With the unprecedented growth of technology for disease prevention and management, little is known about the experience and adoption of such technology in African American older adults with hypertension. A 90-minute focus group session was used to explore African American older adults' (N = 21) experiences with using technology (mobile devices and applications) for hypertension self-management. Twenty participants reported owning smartphones and used this technology to communicate; seek, acquire, and share information; engage in entertainment; and organize and manage time. Participants expressed concerns about not being informed or trained sufficiently to integrate technology for hypertension self-management. There is a need to develop novel hypertension self-management interventions that integrate technology and training programs for this marginalized population that may help improve blood pressure control and address important clinical and public health priorities of uncontrolled hypertension. [Res Gerontol Nurs. 2018; 11(5):249-256.].
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Nelson K, Fennell T, Gray KE, Williams JL, Lutton MC, Silverman J, Jain K, Augustine MR, Kopf W, Taylor L, Sayre G, Vanderwarker C. Veteran peer Coaches Optimizing and Advancing Cardiac Health (Vet-COACH); design and rationale for a randomized controlled trial of peer support among Veterans with poorly controlled hypertension and other CVD risks. Contemp Clin Trials 2018; 73:61-67. [PMID: 30172037 DOI: 10.1016/j.cct.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peer support can improve health for patients with chronic conditions; however, evidence for disease prevention is less clear and peer recruitment strategies are not well described. This paper describes a study protocol to evaluate a peer support intervention to improve hypertension control and reduce cardiovascular disease (CVD) risk. METHODS & RESEARCH DESIGN Target enrollment for this two-site study is n = 400. Eligibility criteria include Veterans enrolled in Veterans Health Administration (VHA) primary care with poorly controlled hypertension and one other cardiovascular disease risk (smoking, overweight/obesity, or hyperlipidemia) who live in census tracts with high rates of hypertension. Enrolled participants are randomized to a home-based peer delivered self-management intervention (5 home visits and 5 phone calls with a peer health coach) versus usual care. The primary outcome is a change in systolic blood pressure (SBP) and secondary outcomes include change in CVD risk and health care use. RESULTS Trial results are pending and participant enrollment is ongoing. We recruited peer coaches from Veterans who lived in census tracks with the highest rates of hypertension. To recruit Veteran peer coaches, we asked primary care providers (n = 41) and team nurses (n = 35) to nominate patients who they thought would be a good fit for the peer coach position (based on successful self-management and health care navigation) (n = 73 nominated from 964 patients). We interviewed 12 Veterans and trained 5 peer coaches. CONCLUSIONS Results of this trial will inform peer support programs targeted to provide community-based delivery of prevention services to patients in high-risk areas. TRIAL REGISTRATION Clinicaltrial.gov identifier NCT02697422 TRIAL STATUS: Enrollment for the randomized trial phase began in September 2017 and will be complete September 2019.
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Affiliation(s)
- Karin Nelson
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA; VA Puget Sound Healthcare System, General Internal Medicine Service, USA; University of Washington, School of Medicine, Department of Medicine, USA; University of Washington School of Public Health, Department of Health Services, USA.
| | - Tiffanie Fennell
- VA Puget Sound Healthcare System, General Internal Medicine Service, USA; University of Washington, School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kristen E Gray
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA
| | - Jennifer L Williams
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA
| | - Marie C Lutton
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA
| | - Julie Silverman
- VA Puget Sound Healthcare System, General Internal Medicine Service, USA
| | - Kamala Jain
- VA Puget Sound Healthcare System, General Internal Medicine Service, USA
| | | | - Walter Kopf
- VA Puget Sound Healthcare System, General Internal Medicine Service, USA; University of Washington, School of Social Work, USA
| | - Leslie Taylor
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA
| | - George Sayre
- VA Puget Sound Healthcare System, Health Services Research & Development Center of Innovation, USA; University of Washington School of Public Health, Department of Health Services, USA
| | - Christopher Vanderwarker
- VA Puget Sound Healthcare System, General Internal Medicine Service, USA; University of Washington, School of Medicine, Department of Medicine, USA
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Gorina M, Limonero JT, Álvarez M. Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review. Int J Nurs Stud 2018; 86:139-150. [PMID: 30007585 DOI: 10.1016/j.ijnurstu.2018.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.
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Affiliation(s)
- Marta Gorina
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Carrer de la Riba, 90, 08221 Terrassa, Barcelona, Spain.
| | - Joaquín T Limonero
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - María Álvarez
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
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Georgiopoulos G, Kollia Z, Katsi V, Oikonomou D, Tsioufis C, Tousoulis D. Nurse’s Contribution to Alleviate Non-adherence to Hypertension Treatment. Curr Hypertens Rep 2018; 20:65. [DOI: 10.1007/s11906-018-0862-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
BACKGROUND Hypertension (HTN) is a global public health issue. Self-care is an essential component of HTN treatment, but no instruments are available with which to measure self-care of HTN. OBJECTIVES The purpose of this study is to test the psychometric properties of the Self-care of Hypertension Inventory (SC-HI). METHODS Using the Self-care of Chronic Illness theory, we developed a 24-item measure of maintenance, monitoring, and management appropriate for persons with chronic HTN, tested it for content validity, and then tested it in a convenience sample of 193 adults. Exploratory factor analysis was used to identify measure structure. Cronbach's α and factor determinacy scores and were used to assess reliability. Validity was tested with the Medical Outcomes Study General Adherence Scale and the Decision Making Competency Inventory. RESULTS Seventy percent of the sample was female; mean age was 56.4 ± 13 years; mean duration of HTN was 11 ± 9 years. Removal of 1 item on alcohol consumption resulted in a unidimensional self-care maintenance factor with acceptable structure and internal consistency (α = .83). A multidimensional self-care management factor included "consultative" and "autonomous" factors (factor determinacy score = 0.75). A unidimensional confidence factor captured confidence in and persistence with each aspect of self-care (α = .83). All the self-care dimensions in the final 23-item instrument were associated with treatment adherence and several with decision making. CONCLUSION These findings support the conceptual basis of self-care in patients with HTN as a process of maintenance, monitoring, and management. The SC-HI confidence scale is promising as a measure of self-efficacy in self-care.
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Scala D, Menditto E, Caruso G, Monetti VM, Orlando V, Guerriero F, Buonomo G, Caruso D, D'Avino M. Are you more concerned about or relieved by medicines? An explorative randomized study of the impact of telephone counseling by pharmacists on patients' beliefs regarding medicines and blood pressure control. PATIENT EDUCATION AND COUNSELING 2018; 101:679-686. [PMID: 29249596 DOI: 10.1016/j.pec.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim was to determine the impact of a telephone counseling service, provided bi-monthly by pharmacist, on patients' beliefs about antihypertensive medicines and blood pressure (BP) control. METHODS Either hypertensive patients were randomly assigned to a control group (CG, usual care) or an intervention group (IG). All patients had BP values registered and filled in the Italian version of the Belief Medicine Questionnaire (BMQ). After 12 months, patients filled in the BMQ again and had their self-reported BP registered. The intervention consisted of an educational/counseling session based on patients' needs assessment provided bi-monthly by a pharmacist for one year via telephone. RESULTS 80 CG and 84 IG patients were recruited. After 12 months, there were significant differences between IG and CG for both BMQ's Necessity and Concern score (p < 0.001; p < 0.001 respectively) and a significant reduction in BP values in IG (p < 0.001). CONCLUSIONS The intervention improves BP control by modifying patients' perception about treatments and involving patients as participants in the management of their health. PRACTICE IMPLICATIONS This paper could serve as a guideline for other studies to confirm the effectiveness of this intervention in modifying health behavior, and the role of hospital pharmacist.
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Affiliation(s)
- Daniela Scala
- Nuclear Medicine Cardarelli Hospital, Road Cardarelli 9, 80131 Naples, Italy.
| | - Enrica Menditto
- CIRFF, Center for Pharmacoeconomics Research, University of Naples Federico II, Road Domenico Montesano, 49 80131 Naples, Italy.
| | - Giuseppe Caruso
- Emergency Department Cardarelli Hospital, Road Cardarelli 9, 80131 Naples, Italy.
| | - Valeria Marina Monetti
- CIRFF, Center for Pharmacoeconomics Research, University of Naples Federico II, Road Domenico Montesano, 49 80131 Naples, Italy.
| | - Valentina Orlando
- CIRFF, Center for Pharmacoeconomics Research, University of Naples Federico II, Road Domenico Montesano, 49 80131 Naples, Italy.
| | - Francesca Guerriero
- CIRFF, Center for Pharmacoeconomics Research, University of Naples Federico II, Road Domenico Montesano, 49 80131 Naples, Italy
| | - Giuseppe Buonomo
- Samnium Medica, Road Aldo Moro, 31G, 82018 San Giorgio del Sannio (Benevento), Italy.
| | - Domenico Caruso
- Internal Medicine1, Cardarelli Hospital, Road Cardarelli 9, 80131 Naples, Italy.
| | - Maria D'Avino
- Internal Medicine1, Cardarelli Hospital, Road Cardarelli 9, 80131 Naples, Italy.
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Wu JR, Cummings DM, Li Q, Hinderliter A, Bosworth HB, Tillman J, DeWalt D. The effect of a practice-based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich) 2018; 20:757-764. [PMID: 29577574 DOI: 10.1111/jch.13265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/31/2022]
Abstract
Low adherence to anti-hypertensive medications contributes to worse outcomes. The authors conducted a secondary data analysis to examine the effects of a health-coaching intervention on medication adherence and blood pressure (BP), and to explore whether changes in medication adherence over time were associated with changes in BP longitudinally in 477 patients with hypertension. Data regarding medication adherence and BP were collected at baseline, 6, 12, 18, and 24 months. The intervention resulted in increases in medication adherence (5.75→5.94, P = .04) and decreases in diastolic BP (81.6→76.1 mm Hg, P < .001) over time. The changes in medication adherence were associated with reductions in diastolic BP longitudinally (P = .047). Patients with low medication adherence at baseline had significantly greater improvement in medication adherence and BP over time than those with high medication adherence. The intervention demonstrated improvements in medication adherence and diastolic BP and offers promise as a clinically applicable intervention in rural primary care.
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Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Alan Hinderliter
- Division of Cardiology, School of Medicine, Chapel Hill, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences at Duke University, Durham, NC, USA
| | - Jimmy Tillman
- Open Water Coaching and Consulting, LLC, Cape Carteret, NC, USA
| | - Darren DeWalt
- Department of General Internal Medicine, School of Medicine, Chapel Hill, NC, USA
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Zullig LL, Bosworth HB. Importance and Challenges of Moving Stroke Prevention into the Community. Circ Cardiovasc Qual Outcomes 2018; 11:e004513. [PMID: 29321136 DOI: 10.1161/circoutcomes.117.004513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leah L Zullig
- From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, NC (L.L.Z., H.B.B.); and Department of Population Health Sciences (L.L.Z., H.B.B.), School of Nursing (H.B.B.), and Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC
| | - Hayden B Bosworth
- From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, NC (L.L.Z., H.B.B.); and Department of Population Health Sciences (L.L.Z., H.B.B.), School of Nursing (H.B.B.), and Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC.
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1912] [Impact Index Per Article: 273.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Bukstein DA. Patient adherence and effective communication. Ann Allergy Asthma Immunol 2017; 117:613-619. [PMID: 27979018 DOI: 10.1016/j.anai.2016.08.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/07/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Poor adherence to inhaled corticosteroid medication is a critical problem for asthma because it contributes to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid use. OBJECTIVE To discuss evidence-based, time-efficient strategies that can be adopted by most practitioners to try to increase patient adherence. METHODS Asthma management guidelines and other key publications are used to enhance discussion. RESULTS Establishing patient-centered, collaborative care that permits effective patient-practitioner communication can improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision making, in which the patient and the practitioner share relevant information, discuss risks vs benefits of various treatment options, express treatment preferences, deliberate the options, and agree on treatment. Asthma self-management education, which emphasizes self-efficacy, is also essential. The education necessary to provide those skills depends in part on consideration of the patient's health literacy. Practitioners also have at their disposal a variety of tips and techniques to improve communication and gather information not only at the patient-practitioner level but also at the practitioner-practitioner level, such as within a group practice or within a health care system. CONCLUSION To improve patient adherence, clinicians need to consider a variety of factors and implement strategies that directly target underlying issues. Strategies may include customizing and simplifying learning and intervention regimens, identifying barriers to adherence and addressing them, ensuring patient support structures are in place, and improving self-efficacy and health literacy.
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Affiliation(s)
- Don A Bukstein
- Allergy Asthma Sinus Center, Madison and Milwaukee, Wisconsin.
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Barnason S, White-Williams C, Rossi LP, Centeno M, Crabbe DL, Lee KS, McCabe N, Nauser J, Schulz P, Stamp K, Wood K. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/hcq.0000000000000025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Barriers to Patient-Centered Care in Hypertension. Can J Cardiol 2017; 33:586-590. [DOI: 10.1016/j.cjca.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022] Open
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Jackson GL, Roumie CL, Rakley SM, Kravetz JD, Kirshner MA, Del Monte PS, Bowen ME, Oddone EZ, Weiner BJ, Shaw RJ, Bosworth HB. Linkage between theory-based measurement of organizational readiness for change and lessons learned conducting quality improvement-focused research. Learn Health Syst 2017; 1:e10013. [PMID: 31245556 PMCID: PMC6516710 DOI: 10.1002/lrh2.10013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 11/21/2022] Open
Abstract
Organizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) is an example of an innovation that seeks to enhance delivery of care for patients with hypertension. We describe the link between organizational readiness for change (ORC), assessed as the project began, and barriers and facilitators occurring during the process of implementing a primary care innovation. Each of 3 Veterans Affairs medical centers provided a half-time nurse and implemented a nurse-delivered, telephone-based self-management support program for patients with uncontrolled hypertension. As the program was starting, we assessed the ORC and factors associated with ORC. On the basis of consensus of medical center and research partners, we enumerated implementation process barriers and facilitators. The primary ORC barrier was unclear long-term commitment of nursing to provide continued resources to the program. Three related barriers included the need to address: (1) competing organizational demands, (2) differing mechanisms to integrate new interventions into existing workload, and (3) methods for referring patients to disease and self-management support programs. Prior to full implementation, however, stakeholders identified a high level of commitment to conduct nurse-delivered interventions fully using their skills. There was also a significant commitment from the core implementation team and a desire to improve patient outcomes. These facilitators were observed during the implementation of HTN-IMPROVE. As demonstrated by the link between barriers to and facilitators of implementation anticipated though the evaluation of ORC and what was actually observed during the process of implementation, this project demonstrates the practical utility of assessing ORC prior to embarking on the implementation of significant new clinical innovations.
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Affiliation(s)
- George L. Jackson
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
| | - Christianne L. Roumie
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Health Services Research & DevelopmentVA Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineVanderbilt UniversityNashvilleTN
| | - Susan M. Rakley
- Division of General Internal MedicineDuke UniversityDurhamNC
- Durham VA Medical CenterDurhamNC
| | - Jeffrey D. Kravetz
- VA Connecticut Healthcare SystemWest HavenCT
- School of MedicineYale UniversityNew HavenCT
| | - Miriam A. Kirshner
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
| | | | - Michael E. Bowen
- Departments of Internal Medicine, Clinical Sciences, and PediatricsUniversity of Texas Southwestern Medical CenterDallasTX
| | - Eugene Z. Oddone
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
| | - Bryan J. Weiner
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNC
| | - Ryan J. Shaw
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- School of NursingDuke UniversityDurhamNC
| | - Hayden B. Bosworth
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
- School of NursingDuke UniversityDurhamNC
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNC
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Cené CW, Halladay JR, Gizlice Z, Donahue KE, Cummings DM, Hinderliter A, Miller C, Johnson LF, Garcia B, Tillman J, Little EP, Rachide MR, Keyserling TC, Ammerman A, Zhou H, Wu J, DeWalt D. A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices. J Clin Hypertens (Greenwich) 2017; 19:351-360. [PMID: 27886435 PMCID: PMC8031107 DOI: 10.1111/jch.12944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 01/03/2023]
Abstract
The Southeastern United States has the highest prevalence of hypertension and African Americans have disproportionately worse blood pressure control. The authors sought to evaluate the effect of a multicomponent practice-based quality improvement intervention on lowering mean systolic blood pressure (SBP) at 12 and 24 months compared with baseline among 525 patients, and to assess for a differential effect of the intervention by race (African Americans vs white). At 12 months, both African Americans (-5.0 mm Hg) and whites (-7.8 mm Hg) had a significant decrease in mean SBP compared with baseline, with no significant between-group difference. Similarly, at 24 months, mean SBP decreased in both African Americans (-6.0 mm Hg) and whites (-7.2 mm Hg), with no significant difference between groups. Notably, no significant racial disparity in mean SBP at baseline was shown. The intervention was effective in lowering mean SBP in both African Americans and whites but there was no differential effect of the intervention by race.
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Affiliation(s)
- Crystal W. Cené
- Department of MedicineUNC Chapel HillChapel HillNCUSA
- Cecil R. Sheps Center for Health Services ResearchUNC Chapel Hill, Chapel HillNCUSA
| | - Jacqueline R. Halladay
- Department of Family MedicineUNC Chapel HillChapel HillNCUSA
- Cecil R. Sheps Center for Health Services ResearchUNC Chapel Hill, Chapel HillNCUSA
| | - Ziya Gizlice
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
| | - Katrina E. Donahue
- Department of Family MedicineUNC Chapel HillChapel HillNCUSA
- Cecil R. Sheps Center for Health Services ResearchUNC Chapel Hill, Chapel HillNCUSA
| | - Doyle M. Cummings
- Department of Family MedicineEast Carolina UniversityGreenvilleNCUSA
| | | | - Cassandra Miller
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
| | - Larry F. Johnson
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
| | - Beverly Garcia
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
| | - Jim Tillman
- Community Care Plan of Eastern North CarolinaKinstonNCUSA
| | | | | | - Thomas C. Keyserling
- Department of MedicineUNC Chapel HillChapel HillNCUSA
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
| | - Alice Ammerman
- Center for Health Promotion and Disease PreventionUNC Chapel HillChapel HillNCUSA
- Department of NutritionGillings School of Global Public HealthChapel HillNCUSA
| | - Haibo Zhou
- Department of BiostatisticsUNC Chapel HillChapel HillNCUSA
| | - Jia‐Rong Wu
- School of NursingUNC Chapel HillChapel HillNCUSA
| | - Darren DeWalt
- Department of MedicineUNC Chapel HillChapel HillNCUSA
- Cecil R. Sheps Center for Health Services ResearchUNC Chapel Hill, Chapel HillNCUSA
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Influence of a Trans-Theoretical Model Based Intervention on Physical Activity in Hypertensive Patients: A Randomised Clinical Trial. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.42655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, Miller CL, Garcia BA, Little E, Rachide M, Tillman J, Ammerman AS, DeWalt D. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. PATIENT EDUCATION AND COUNSELING 2017; 100:542-549. [PMID: 27776790 PMCID: PMC5350034 DOI: 10.1016/j.pec.2016.10.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/14/2016] [Accepted: 10/16/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Lower health literacy is associated with poorer health outcomes. Few interventions poised to mitigate the impact of health literacy in hypertensive patients have been published. We tested if a multi-level quality improvement intervention could differentially improve Systolic Blood Pressure (SBP) more so in patients with low vs. higher health literacy. METHODS We conducted a non-randomized prospective cohort trial of 525 patients referred with uncontrolled hypertension. Stakeholder informed and health literacy sensitive strategies were implemented at the practice and patient level. Outcomes were assessed at 0, 6, 12, 18 and 24 months. RESULTS At 12 months, the low and higher health literacy groups had statistically significant decreases in mean SBP (6.6 and 5.3mmHg, respectively), but the between group difference was not significant (Δ 1.3mmHg, P=0.067). At 24 months, the low and higher health literacy groups reductions were 8.1 and 4.6mmHg, respectively, again the between group difference was not significant (Δ 3.5mmHg, p=0.25). CONCLUSIONS/PRACTICE IMPLICATIONS A health literacy sensitive multi-level intervention may equally lower SBP in patients with low and higher health literacy. Practical health literacy appropriate tools and methods can be implemented in primary care settings using a quality improvement approach.
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Affiliation(s)
- Jacqueline R Halladay
- Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA.
| | - Katrina E Donahue
- Department of Family Medicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA
| | - Crystal W Cené
- Department of M edicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA
| | - Quefeng Li
- Department of Biostatistics, UNC Chapel Hill, Chapel Hill, USA
| | - Doyle M Cummings
- Department of Family medicine, East Carolina University, NC, USA
| | | | - Cassandra L Miller
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA
| | - Beverly A Garcia
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA
| | | | | | - Jim Tillman
- Community Care Plan of Eastern North Carolina, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, UNC Chapel Hill, USA
| | - Darren DeWalt
- Department of M edicine, UNC Chapel Hill, USA; Cecil R. Sheps Center for Health Services Research, Chapel Hill, USA
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Bartlett Ellis RJ, Knisely MR, Boyer K, Pike C. Pillbox intervention fidelity in medication adherence research: A systematic review. Nurs Outlook 2017; 65:464-476. [PMID: 28187900 DOI: 10.1016/j.outlook.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/04/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pillboxes are widely available, have evidence of effectiveness, but translating pillboxes in self-management interventions requires an understanding of intervention components. PURPOSE To review components of intervention design, interventionist training, delivery, receipt, enactment, and targeted behaviors in adherence studies. METHODS Five multidisciplinary databases were searched to find reports of controlled trials testing pillboxes and medication adherence interventions in adults managing medications. Details of treatment fidelity, that is, design, training, delivery, receipt, and enactment, were abstracted. FINDINGS A total of 38 articles reporting 40 studies were included. Treatment fidelity descriptions were often lacking, especially reporting receipt and enactment, important for both control and intervention groups. Clearly reported details are needed to avoid making assumptions when translating evidence. CONCLUSION These findings serve as a call to action to explicitly state intervention details. Lack of reported intervention detail is a barrier to translating which components of pillboxes work in influencing medication adherence behaviors and outcomes.
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Affiliation(s)
| | - Mitchell R Knisely
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Kiersten Boyer
- Science of Nursing Care Department, Indiana University School of Nursing, Indianapolis, IN
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Salisbury C, O’Cathain A, Thomas C, Edwards L, Montgomery AA, Hollinghurst S, Large S, Nicholl J, Pope C, Rogers A, Lewis G, Fahey T, Yardley L, Brownsell S, Dixon P, Drabble S, Esmonde L, Foster A, Garner K, Gaunt D, Horspool K, Man MS, Rowsell A, Segar J. An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Thomas
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simon Brownsell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lisa Esmonde
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mei-See Man
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Rowsell
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
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Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM, Pappas Y, Gagnon M, Julious SA, Xiang L, Oldenburg B, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12:CD009921. [PMID: 27960229 PMCID: PMC6463821 DOI: 10.1002/14651858.cd009921.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. OBJECTIVES To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. SEARCH METHODS We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. SELECTION CRITERIA Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to select and extract data and to appraise eligible studies. MAIN RESULTS We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. AUTHORS' CONCLUSIONS ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
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Affiliation(s)
- Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Lambert M Felix
- Edge Hill UniversityFaculty of Health and Social CareSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Marie‐Pierre Gagnon
- Traumatologie – Urgence – Soins IntensifsCentre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé10 Rue de l'Espinay, D6‐727QuébecQCCanadaG1L 3L5
| | - Steven A Julious
- University of SheffieldMedical Statistics Group, School of Health and Related ResearchRegent Court, 30 Regent StreetSheffieldUKS1 4DA
| | - Liming Xiang
- Nanyang Technological UniversityDivision of Mathematical Sciences, School of Physical and Mathematical Sciences21 Nanyang LinkSingaporeSingapore
| | - Brian Oldenburg
- University of MelbourneMelbourne School of Population and Global HealthMelbourneVictoriaAustralia
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Johnson HM, LaMantia JN, Warner RC, Pandhi N, Bartels CM, Smith MA, Lauver DR. MyHEART: A Non Randomized Feasibility Study of a Young Adult Hypertension Intervention. JOURNAL OF HYPERTENSION AND MANAGEMENT 2016; 2:016. [PMID: 28191544 PMCID: PMC5300088 DOI: 10.23937/2474-3690/1510016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the United States, young adults (18-39 year-olds) have the lowest hypertension control rates (35%) compared to middle-aged (58%) and older (54%) adults. Ambulatory care for hypertension management often focuses on medication with little time for self-management and behavioral counseling. This study was designed to evaluate the feasibility of MyHEART, a telephone-based health coach self-management intervention for young adults. The goals were to determine the intervention's ability to: 1) recruit young adults with uncontrolled hypertension, 2) maintain ongoing communication between the coach and participants, 3) increase participants' engagement in self-management, 4) document coach-patient communication in the electronic health record, and 5) assess patient acceptability. METHODS Eligible participants were identified through the electronic health record. Inclusion criteria included 18-39 year-olds, with ICD-9 hypertension diagnoses and uncontrolled hypertension (≥ 140/90 mmHg), receiving regular primary care at a large multispecialty group practice. The intervention consisted of 6 telephone self-management sessions by a health coach targeting lifestyle modifications. Patients completed an open-ended acceptability survey. RESULTS Study uptake was 47% (9 enrolled/19 eligible). Mean (SD) age was 35.8 (2.6) years, 78% male, and 33% Black. Over 85% of enrolled young adults maintained communication with their health coach. At baseline, 11% reported checking their blood pressure outside of clinic; 44% reported blood pressure monitoring after the study. All coach-patient encounters were successfully documented in the electronic health record for primary care provider review. Open-ended responses from all surveys indicated that participants had a positive experience with the MyHEART intervention. CONCLUSIONS This study demonstrated that MyHEART was feasible and acceptable to young adults with uncontrolled hypertension. Health coaches can effectively maintain ongoing communication with young adults, document communication in the electronic health record, and increase engagement with home blood pressure monitoring. The results of this study will inform a multi-center young adult randomized controlled trial of MyHEART.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, USA
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, USA
| | - Ryan C Warner
- Department of Counselor Education and Counseling Psychology, Marquette University, USA
| | - Nancy Pandhi
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, USA
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, USA
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, USA
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, USA
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Kahwati L, Viswanathan M, Golin CE, Kane H, Lewis M, Jacobs S. Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis. Syst Rev 2016; 5:83. [PMID: 27209092 PMCID: PMC4875709 DOI: 10.1186/s13643-016-0255-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to improve medication adherence are diverse and complex. Consequently, synthesizing this evidence is challenging. We aimed to extend the results from an existing systematic review of interventions to improve medication adherence by using qualitative comparative analysis (QCA) to identify necessary or sufficient configurations of behavior change techniques among effective interventions. METHODS We used data from 60 studies in a completed systematic review to examine the combinations of nine behavior change techniques (increasing knowledge, increasing awareness, changing attitude, increasing self-efficacy, increasing intention formation, increasing action control, facilitation, increasing maintenance support, and motivational interviewing) among studies demonstrating improvements in adherence. RESULTS Among the 60 studies, 34 demonstrated improved medication adherence. Among effective studies, increasing patient knowledge was a necessary but not sufficient technique. We identified seven configurations of behavior change techniques sufficient for improving adherence, which together accounted for 26 (76 %) of the effective studies. The intervention configuration that included increasing knowledge and self-efficacy was the most empirically relevant, accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %). CONCLUSIONS This analysis extends the completed review findings by identifying multiple combinations of behavior change techniques that improve adherence. Our findings offer direction for policy makers, practitioners, and future comparative effectiveness research on improving adherence.
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Affiliation(s)
| | | | - Carol E Golin
- Departments of Medicine and Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Heather Kane
- RTI International, Research Triangle Park, NC, USA
| | - Megan Lewis
- RTI International, Research Triangle Park, NC, USA
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, USA
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Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients. Contemp Clin Trials 2016; 48:12-20. [PMID: 26995281 DOI: 10.1016/j.cct.2016.03.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. METHODS Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. RESULTS Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. CONCLUSIONS Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.
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Hedegaard U, Hallas J, Ravn-Nielsen LV, Kjeldsen LJ. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care. Res Social Adm Pharm 2016; 12:302-18. [DOI: 10.1016/j.sapharm.2015.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
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Conn VS, Ruppar TM, Chase JAD, Enriquez M, Cooper PS. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis. Curr Hypertens Rep 2016; 17:94. [PMID: 26560139 DOI: 10.1007/s11906-015-0606-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA.
| | - Todd M Ruppar
- School of Nursing, University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA
| | - Jo-Ana D Chase
- School of Nursing, University of Missouri, S343 Sinclair Building, Columbia, MO, 65211, USA
| | - Maithe Enriquez
- School of Nursing, University of Missouri, S327 Sinclair Building, Columbia, MO, 65211, USA
| | - Pamela S Cooper
- School of Nursing, University of Missouri, S318 Sinclair Building, Columbia, MO, 65211, USA
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Magrin ME, D'Addario M, Greco A, Miglioretti M, Sarini M, Scrignaro M, Steca P, Vecchio L, Crocetti E. Social support and adherence to treatment in hypertensive patients: a meta-analysis. Ann Behav Med 2016; 49:307-18. [PMID: 25341642 DOI: 10.1007/s12160-014-9663-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is important to examine factors associated with patient adherence to hypertension control strategies. PURPOSE A meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients. METHODS Journal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review. RESULTS Findings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses. CONCLUSIONS Functional social support, but not structural social support, was associated with adherence in hypertensive patients.
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Hedegaard U, Kjeldsen LJ, Pottegård A, Henriksen JE, Lambrechtsen J, Hangaard J, Hallas J. Improving Medication Adherence in Patients with Hypertension: A Randomized Trial. Am J Med 2015; 128:1351-61. [PMID: 26302142 DOI: 10.1016/j.amjmed.2015.08.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. RESULTS At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. CONCLUSIONS A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.
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Affiliation(s)
- Ulla Hedegaard
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark; Clinical Pharmacy Department, Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark.
| | | | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jess Lambrechtsen
- Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jørgen Hangaard
- Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
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McLean G, Murray E, Band R, Saunderson K, Hanlon P, Little P, McManus RJ, Yardley L, Mair FS. Digital Interventions to Promote Self-Management in Adults With Hypertension: Protocol for Systematic Review and Meta-Analysis. JMIR Res Protoc 2015; 4:e133. [PMID: 26589728 PMCID: PMC4704904 DOI: 10.2196/resprot.4648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/14/2015] [Accepted: 09/20/2015] [Indexed: 01/06/2023] Open
Abstract
Background Digital interventions, defined as any intervention accessed and taking input from patients in the form of a computer/Web-based program or mobile phoned-based app, can potentially help empower patients to self-manage long-term conditions such as hypertension. Importantly, digital interventions have the potential to provide patients with personalized information and support for active involvement in treatment as well as cost saving. Objective The purpose of this systematic review is to synthesize the evidence for using digital interventions to support patient self-management of hypertension, and determine their impact on control and reduction of blood pressure, other clinical outcomes, quality of life, medication adherence, health service utilization, and economic benefits. Methods A systematic search of bibliographic databases including Medline, Embase, CINAHL, and PsycINFO will be undertaken. Abstracts and citations will be independently screened by 2 researchers against predetermined inclusion criteria. Any disagreements will be resolved by discussion and further consideration of the inclusion criteria. Only randomized controlled trials which have been published in peer peer-reviewed journals with a diagnosis of hypertension will be considered. Inclusion criteria will be (1) adults (age ≥ 18 years) with hypertension (as defined by the primary authors); (2) an interactive digital intervention compared with usual care; and (3) outcomes of objectively measured change in blood pressure. Data extraction from identified articles will be undertaken by 2 independent reviewers using a uniform template. The main outcomes are systolic blood pressure (SBP) and diastolic blood pressure (DBP), and quality of life indicators. Secondary outcomes include cost- effectiveness, medication adherence, emotional well-being, and physical activity. Risk of bias of included studies will be assessed using the Cochrane tool. Results Our research is currently ongoing. Data will be summarized narratively, and if possible, meta-analyses will be performed to assess the impact of the interventions on outcomes. Conclusions By summarizing and synthesizing available data, this review will help inform policy on the use of digital interventions for self-management of hypertension and will clarify areas for further research. Trial Registration Prospero 2014: CRD42014010268; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014010268 (Archived by WebCite at http://www.webcitation.org/6c5alQQJL)
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Affiliation(s)
- Gary McLean
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
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Crowley MJ, Edelman D, McAndrew AT, Kistler S, Danus S, Webb JA, Zanga J, Sanders LL, Coffman CJ, Jackson GL, Bosworth HB. Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. Telemed J E Health 2015; 22:376-84. [PMID: 26540163 DOI: 10.1089/tmj.2015.0145] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. MATERIALS AND METHODS We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. RESULTS At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. CONCLUSIONS A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.
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Affiliation(s)
- Matthew J Crowley
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,2 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University , Durham, North Carolina
| | - David Edelman
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Ann T McAndrew
- 4 Home Telehealth Program, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Susan Kistler
- 4 Home Telehealth Program, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Susanne Danus
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Jason A Webb
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina.,5 Department of Psychiatry and Behavioral Medicine, Duke University , Durham, North Carolina.,6 Mental Health Service, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Joseph Zanga
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina.,5 Department of Psychiatry and Behavioral Medicine, Duke University , Durham, North Carolina.,6 Mental Health Service, Durham Veterans Affairs Medical Center , Durham, North Carolina
| | - Linda L Sanders
- 3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Cynthia J Coffman
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,7 Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, North Carolina
| | - George L Jackson
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
| | - Hayden B Bosworth
- 1 Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University , Durham, North Carolina
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