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McCulley C, Katz P, Trupin L, Yelin EH, Barton JL. Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse Cohort of Adults with Rheumatoid Arthritis. J Rheumatol 2018; 45:1636-1642. [PMID: 30219761 DOI: 10.3899/jrheum.171339] [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] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients' adherence to disease-modifying antirheumatic drugs (DMARD) is often suboptimal. We examined associations among medication beliefs, self-efficacy, and adherence to medications in RA. METHODS Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Bivariate and multivariate logistic regression identified correlates of poor adherence to synthetic DMARD and prednisone as well as to biologic therapy, including medication concerns and necessity. RESULTS There were 362 patients who reported taking a synthetic DMARD and/or prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively. There were 64% who reported concern about taking medicines, 81% about longterm effects, and 47% about becoming too dependent on medicines. In multivariate analyses, the BMQ necessity score was independently associated with better adherence to oral DMARD or prednisone (adjusted OR 0.61, 95% CI 0.41-0.91), while self-efficacy was associated with greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI 1.01-1.59). Beliefs in medicines and self-efficacy were not associated with adherence to biologics. CONCLUSION In a diverse cohort of patients with RA, stronger beliefs in the necessity of medication were associated with better adherence to oral DMARD or prednisone, while higher self-efficacy was associated with poor adherence. Providers can play important roles in eliciting patient beliefs about medications to improve adherence and ultimately health outcomes.
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Affiliation(s)
- Caroline McCulley
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Patricia Katz
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Laura Trupin
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Edward H Yelin
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA.,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System
| | - Jennifer L Barton
- From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA. .,C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System.
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Weech-Maldonado R, Miller MJ, Lord JC. The Relationships Among Socio-Demographics, Perceived Health, and Happiness. APPLIED RESEARCH IN QUALITY OF LIFE 2017; 12:289-302. [PMID: 28757904 PMCID: PMC5531614 DOI: 10.1007/s11482-017-9517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article explores explore the relationships among socio-demographics, perceived health, and happiness in a patient population of 221 adults recruited from 39 primary care practices in Alabama. We also explored whether the relationship between socio-demographics and happiness is mediated by perceived health. The dependent variable, happiness, was dichotomized as happy versus unhappy. Independent variables or correlates of happiness included race (Black or White), age (< 65 vs. 65 and older), gender (male vs. female), perceived income (sufficient vs. insufficient to meet basic needs), health literacy (adequate vs. inadequate), and self-rated health (excellent/very good/good vs. poor/fair). Data were analyzed using generalized linear latent and mixed models to examine the relationship between happiness and its correlates. Our findings suggest that adequate health literacy and better perceived health are associated with an increase in the likelihood of happiness. In addition, the relationship between perceived sufficient income and happiness is mediated by perceived health; whereas, individuals with sufficient income are more likely to have better perceived health, and as a result more likely to be happy. Other individual factors, such as gender, age, and race were not significantly associated with being happy or having higher perceived health in any of the models. Results suggest that policies aimed at increasing health literacy, promoting health, and reducing income disparities may be associated with greater happiness.
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Affiliation(s)
- Robert Weech-Maldonado
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
| | - Michael J Miller
- Texas A&M University, Department of Pharmaceutical Sciences, College Station, TX, USA
| | - Justin C Lord
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
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Barton JL, Trupin L, Tonner C, Imboden J, Katz P, Schillinger D, Yelin E. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol 2015; 41:1290-7. [PMID: 24931952 DOI: 10.3899/jrheum.131350] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA. METHODS Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. RESULTS Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort. CONCLUSION This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.
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Affiliation(s)
- Jennifer L Barton
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Laura Trupin
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Chris Tonner
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - John Imboden
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Patricia Katz
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Dean Schillinger
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Edward Yelin
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
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Abstract
OBJECTIVE The aim of this study was to evaluate screening questions for estimating nonsteroidal anti-inflammatory drug (NSAID) risk knowledge. METHODS Cross-sectional data from a telephone interview of NSAID users 50 years or older from 39 physician practices in Alabama were used. Patient-reported awareness of prescription NSAID risk and health literacy were the independent variables, and a cumulative index score of objectively tested knowledge of 4 prominent NSAID risks was the dependent variable. General linearized latent and mixed model ordered logistic regression was used to estimate associations among the independent variables, covariates, and objectively tested NSAID risk knowledge. Population-averaged probabilities for levels of objectively tested NSAID risk knowledge were subsequently estimated. RESULTS Subjective awareness of any prescription NSAID risk (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.55-3.74), adequate health literacy (AOR, 1.71; 95% CI, 1.04-2.83), and physician counseling about 1 or more NSAID risks (AOR, 1.69; 95% CI, 1.09-2.61) were significantly and positively associated with NSAID risk knowledge. The probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions was 70% in the absence of any subjective risk awareness and in less than adequate health literacy. Whereas the probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions increased to 86% in the presence of subjective awareness of any prescription NSAID risk and adequate health literacy. CONCLUSIONS Screening questions for subjective NSAID risk awareness and health literacy are predictive of objectively tested NSAID knowledge and can be used to triage patients as well as subsequently initiate and direct a conversation about NSAID risk.
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Hamrosi KK, Raynor DK, Aslani P. Pharmacist and general practitioner ambivalence about providing written medicine information to patients—A qualitative study. Res Social Adm Pharm 2013; 9:517-30. [DOI: 10.1016/j.sapharm.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/18/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
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Sand-Jecklin K, Coyle S. Efficiently assessing patient health literacy: the BHLS instrument. Clin Nurs Res 2013; 23:581-600. [PMID: 23729022 DOI: 10.1177/1054773813488417] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although health literacy limitations are common among patient populations, no efficient yet comprehensive health literacy assessment tool is available to nurses for use in busy health care settings. This study presents beginning evidence for the validity and reliability of a new health literacy assessment tool, the Brief Health Literacy Screen (BHLS). One hundred patients attending four primary care clinics completed the BHLS and the Test of Functional Health Literacy in Adults (TOFHLA) short form and answered questions about the health literacy tools. Findings indicated significant correlations between BHLS and shortened version of the TOFHLA (S-TOFHLA) scores, with higher correlations between BHLS items addressing written health literacy and the S-TOFHLA. Comparative discrimination findings were significant at BHLS cut point of 18 and S-TOFHLA cut point less than 23. Patients rated the BHLS significantly less difficult to complete than the S-TOFHLA. Results of preliminary testing indicate the BHLS is a potentially efficient, effective, and patient-friendly screening tool for health literacy.
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Affiliation(s)
| | - Sue Coyle
- West Virginia University School of Nursing, Morgantown, WV, USA
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Mollerup A, Veien NK, Johansen JD. Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial. BMC DERMATOLOGY 2012; 12:6. [PMID: 22691871 PMCID: PMC3492110 DOI: 10.1186/1471-5945-12-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 02/08/2023]
Abstract
Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.
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Affiliation(s)
- Annette Mollerup
- National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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