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Swetlitz N, Hinton L, Rivera M, Liu M, Fernandez AC, Garcia ME. Barriers and facilitators to depression care among Latino men in a primary care setting: a qualitative study. BMC PRIMARY CARE 2024; 25:30. [PMID: 38245674 PMCID: PMC10799470 DOI: 10.1186/s12875-024-02275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND In the United States, Latinos face a wide array of cultural and structural barriers to accessing and utilizing mental health care. Latino men specifically are at high risk of receiving inadequate mental health care, possibly due to additional obstacles they experience that are related to masculinity. Among men more generally, greater adherence to emotional control and self-reliance is associated with higher depression severity and less depression help-seeking. Men experience more stigma toward depression and help-seeking and are less likely to be diagnosed with depression than women. However, Latino men's barriers and facilitators to depression care remain largely unexplored. The objective of this study was to examine barriers and facilitators to depression care that are related to masculinity among English- and Spanish-speaking Latino men in a primary care setting. METHODS We used convenience and purposive sampling to recruit primary care patients who self-identified as Latino men, spoke English or Spanish, and screened positive for depressive symptoms on the Patient Health Questionnaire-2 or had a history of depression. Semi-structured interviews were conducted between December 2020 and August 2021. The interview guide examined views and experiences of depression, masculinity, and barriers and facilitators to engaging in depression care. Utilizing consensual qualitative research and thematic analysis informed by modified grounded theory, barriers and facilitators to depression care were identified. RESULTS We interviewed thirteen participants who varied in English proficiency, education, income, and country of origin. Barriers and facilitators were placed into three domains-Self-Recognition of Depression, Seeking Help for Depression, and Depression Diagnosis and Treatment. Participants described aspects of masculinity as barriers (emotional control and pressure to provide), facilitators (honesty, courage, collaboration, practicality, and responsibility), or both (self-reliance and autonomy). CONCLUSIONS Masculinity influences barriers and facilitators for depression care among Latino men at the levels of self-recognition, seeking help, and diagnosis and treatment. Clinicians may promote Latino men's engagement in depression care by understanding patients' values and framing depression care as affirming masculinity. Providing education to primary care physicians and other healthcare professionals on gender and depression and addressing structural barriers are essential to providing access to all who need depression care.
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Affiliation(s)
- Nathan Swetlitz
- UC Berkeley, UCSF Joint Medical Program, University of California, Berkeley, Berkeley, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Morgan Rivera
- University of California, Berkeley, Berkely, CA, USA
| | - Mishen Liu
- University of California, Berkeley, Berkely, CA, USA
| | - Anna Claire Fernandez
- UC Berkeley, UCSF Joint Medical Program, University of California, Berkeley, Berkeley, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, San Francisco, CA, USA
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Padamsee TJ, Phommasathit C, Swinehart-Hord P, Chettri S, Clevenger K, Rayo MF, Agnese DM, Bazan JG, Jones N, Lee CN. Patient-driven decisions and perceptions of the 'safest possible choice': insights from patient-provider conversations about how some breast cancer patients choose contralateral prophylactic mastectomy. Psychol Health 2023:1-25. [PMID: 38044547 DOI: 10.1080/08870446.2023.2290170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Observe patient-clinician communication to gain insight about the reasons underlying the choice of patients with unilateral breast cancer to undergo contralateral prophylactic mastectomy (CPM), despite lack of survival benefit, risk of harms, and cautions expressed by surgical guidelines and clinicians. METHODS & MEASURES WORDS is a prospective study that explored patient-clinician communication and patient decision making. Participants recorded clinical visits through a downloadable mobile application. We analyzed 44 recordings from 22 patients: 9 who chose CPM, 8 who considered CPM but decided against it, and 5 who never considered CPM. We used abductive analysis combined with constructivist grounded theory methods. RESULTS Decisions to undergo CPM are patient-driven and motivated by perceptions that CPM is the most aggressive, and therefore safest, treatment option available. These decisions are shaped not primarily by the content of conversations with clinicians, but by the history of cancer in patients' families, their own first-hand experiences with cancers among loved ones, fear for their children, and anxiety about cancer recurrence. CONCLUSION The perception that CPM is the safest, most aggressive option strongly influences patients, despite scientific evidence to the contrary. Future efforts to address high CPM rates should focus on patient-driven decision making and cancer-related fears.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Crystal Phommasathit
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Shibani Chettri
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Kaleigh Clevenger
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Michael F Rayo
- Department of Integrated Systems Engineering, The Ohio State University College of Engineering, Columbus, Ohio, USA
| | - Doreen M Agnese
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | | | - Clara N Lee
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, Ohio, USA
- James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Yakubu RA, Coleman A, Ainyette A, Katyayan A, Enard KR. Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure. Prev Chronic Dis 2023; 20:E82. [PMID: 37733952 PMCID: PMC10516202 DOI: 10.5888/pcd20.230086] [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: 09/23/2023] Open
Abstract
INTRODUCTION Forty-seven percent of all adults in the US have a diagnosis of high blood pressure. Among all US emergency department (ED) users, an estimated 45% have high blood pressure. The success of high blood pressure interventions in reducing ED visits is partially predicated on patients' adherence to treatment plans. One method for promoting adherence to treatment plans is shared decision-making between patients and medical providers. METHODS We conducted a cross-sectional observational study using 2015-2019 Medical Expenditure Panel Survey data. We used studies on shared decision-making as a guide to create a predictor variable for shared decision-making. We determined covariates according to the Andersen Behavioral Model of Health Services Use. ED use was the outcome variable. We used cross tabulation to compare covariates of ED use and multivariable logistical regression to assess the association between shared decision-making and ED use. Our sample size was 30,407 adults. RESULTS Less than half (39.3%) of respondents reported a high level of shared decision-making; 23.3% had 1 or more ED visits. In the unadjusted model, respondents who reported a high level of shared decision-making were 20% less likely than those with a low level of shared decision-making to report 1 or more ED visits (odds ratio [OR], 0.80; 95% CI, 0.75-0.86; P <.001). After adjusting for covariates, a high level of shared decision-making was still associated with lower odds of ED use (OR, 0.86; 95% CI, 0.76-0.97; P = .01). CONCLUSION Shared decision-making may be an effective method for reducing ED use among patients with high blood pressure.
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Affiliation(s)
- R Aver Yakubu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
- Saint Louis University, Department of Health Management and Policy, 3545 Lafayette Ave, St Louis, MO 63104
| | - Alyssa Coleman
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Alina Ainyette
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Anisha Katyayan
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Kimberly R Enard
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
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Ogawa T, Fujimoto S, Omon K, Ishigaki T, Morioka S. Shared decision-making in physiotherapy: a cross-sectional study of patient involvement factors and issues in Japan. BMC Med Inform Decis Mak 2023; 23:135. [PMID: 37488562 PMCID: PMC10367402 DOI: 10.1186/s12911-023-02208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making. METHODS The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement. RESULTS Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score. CONCLUSIONS The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.
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Affiliation(s)
- Tatsuya Ogawa
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, 3-2-2 Sasayuridai, Kanmaki-Cho, Kitakatsuragi-Gun, Nara, 639-0218, Japan.
| | - Shuhei Fujimoto
- Kyoto University Graduate School of Public Health, Yoshida-Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan
- Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-Ku, Shizuoka-Shi, Shizuoka, 420-0881, Japan
| | - Kyohei Omon
- Rehabilitation Center, Kishiwada Rehabilitation Hospital, 2-8-10 Kanmatsu-Cho, Kishiwada-Shi, Osaka, 596-0827, Japan
- Department of Cognitive Behavioral Science, Kyoto University Graduate School of Human and Environmental Studies, Yoshida-Nihonmatsucho, Sakyo-Ku, Kyoto City, 606-8501, Japan
| | - Tomoya Ishigaki
- Department of Physical Therapy, Faculty of Rehabilitation, Nagoya Gakuin University, 3-1-17 Taiho, Atsuta-Ku, Nagoya-Shi, Aichi, 456-0062, Japan
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, 9-25-202 Kourien-Cho, Hirakata-Shi, Osaka, 573-0086, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan
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Dilles T, Mortelmans L, Loots E, Sabbe K, Feyen H, Wauters M, Haegdorens F, De Baetselier E. People-centered care and patients' beliefs about medicines and adherence: A cross-sectional study. Heliyon 2023; 9:e15795. [PMID: 37251820 PMCID: PMC10208933 DOI: 10.1016/j.heliyon.2023.e15795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction People-centered care (PCC) strategies are believed to improve overall health outcomes. Medicines use is essential for the treatment of many patients with chronic conditions. Non-adherence rates are high and result in poor health outcomes, and increased healthcare utilization and costs. This study aimed to explore the relationship between PCC and adherence to medicines for persons with chronic medicines use, as well as the extent to which patients' beliefs about medicines are influenced by their level of perceived PCC. Methods A cross-sectional survey design was performed with adults using at least 3 chronic medicines per day. To measure the degree of medicines adherence, patients' ideas about medication, and PCC, four validated questionnaires were used: The Medication Adherence Report Scale (MARS-5), Beliefs about medicines questionnaire (BMQ), Client-Centered Care Questionnaire (CCCQ) and the Shared Decision Making Questionnaire (SDM-Q-9). Socio-demographics, health status, and drug-related burden were questioned as potential factors to impact the relationship between PCC and adherence. Results A sample of 459 persons participated. The mean score on the CCCQ (adjusted to pharmacotherapy) was 52.7 on 75 (sd = 8.83, range [18-70]). The top 20% scored 60 or more, the 20% lowest scores were 46 or less. Adherence levels were high, with a mean score of 22.6 on 25 on the MARS-5, and 88% scoring 20 or more. An increase in PCC corresponded to a higher chance of medicines adherence (OR 1.07, 95%CI [1.02-1.12]), corrected for age, the burden due to chronic diseases, the impact of side effects on daily life, and participants' beliefs about medicines. PCC showed positive correlations with the necessity of medicines use (r = 0.1, p = 0.016) and the balance between necessity and concerns (r = 0.3, p < 0.001); and negative correlations with levels of concerns (r = -0.3, p < 0.001) and scores on harmfulness (r = -0.3, p < 0.001) and overuse of medicines (r = -0.4, p < 0.001). Conclusion Patients with chronic medicine use perceived an average high level of people-centeredness in the pharmaceutical care they received. This PCC was weakly positively associated with adherence to their medicines. The higher PCC was evaluated, the more patients believed in the necessity of the medicines use and the better the balance between necessity and concerns. The people-centeredness of pharmaceutical care showed several shortcomings and can still be improved. As such, healthcare providers are advised to actively engage in PCC, and not to wait passively for information provided by the patient.
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Al-Noumani H, Al Omari O, Al-Naamani Z. Role of Health Literacy, Social Support, Patient-Physician Relationship, and Health-Related Quality of Life in Predicting Medication Adherence in Cardiovascular Diseases in Oman. Patient Prefer Adherence 2023; 17:643-652. [PMID: 36935939 PMCID: PMC10022437 DOI: 10.2147/ppa.s401666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose Cardiovascular diseases (CVDs) remain a global health threat, and medication adherence remains low. Medication adherence is a complex phenomenon and is affected by many factors that require investigation. Oman has limited literature examining medication adherence and influencing factors among patients with CVDs. This study examined the influence of health literacy, social support, the patient-physician relationship, and health-related quality of life on medication adherence among patients with cardiovascular diseases. Patients and Methods This cross-sectional study used a correlation design. The study included 360 participants with CVDs. Descriptive statistics, independent t-test, one-way ANOVA, and multiple regression analysis were utilized for data analyses. Results Findings revealed that higher social support (B=0.117; p=0.033), good patient-physician relationship (B=0.124; p < 0.01), better mental health (B=0.045; p < 0.01), more bodily pain (B=0.030; p < 0.01), and unemployment (B=1.297; p < 0.01) were predictors of higher adherence. High school education and above predicted lower medication adherence (B= -1.255; p= 0.019), while health literacy was not a significant predictor of medication adherence (B= 0.061; p= 0.289). Conclusion To improve medication adherence, healthcare providers and researchers should consider improving patients' social support, mental health, and the patient-physician relationship. In addition, patients' socioeconomic status should always be considered and examined as an influencing factor of medication adherence.
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Affiliation(s)
- Huda Al-Noumani
- Adult Health and Critical Care Department, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Omar Al Omari
- Fundamental and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Oman
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Rus IA, Kudela M, Suffredini G, Ariyo PT, Hensley NB, Abernathy JH. Implementing change in the care of the complex cardiac patient. Curr Opin Anaesthesiol 2023; 36:57-60. [PMID: 36550605 DOI: 10.1097/aco.0000000000001213] [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: 12/24/2022]
Abstract
PURPOSE OF REVIEW Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly specialized physicians and a need for better communication and planning with the patients and within the care team. RECENT FINDINGS In the field of cardiac surgery, the heart team model has been advocated and implemented as a vehicle to optimize decision making prior to procedure, care during the procedure and in the recovery process. The goal is to provide a treatment path that prioritizes the patient's goals and to anticipate and minimize complications. SUMMARY In this review, we discuss the concepts of shared decision making (SDM) and implementation science in the context of the complex cardiac patient. We also review the most recent evidence for their use in cardiac surgery. We argue that a team model not only bridges knowledge gaps but provides a multidisciplinary environment for the practice of SDM and implementation of evidence-based practices. Be believe this will provide patients with a better experience as they navigate their care and improve their medical outcomes as well.
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Affiliation(s)
- Ioana A Rus
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, USA
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Rosenthal DM, Schoenthaler A, Heys M, Ucci M, Hayward A, Teakle A, Lakhanpaul M, Lewis C. How Does Living in Temporary Accommodation and the COVID-19 Pandemic Impact under 5s' Healthcare Access and Health Outcomes? A Qualitative Study of Key Professionals in a Socially and Ethnically Diverse and Deprived Area of London. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1300. [PMID: 36674056 PMCID: PMC9859054 DOI: 10.3390/ijerph20021300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Background: Children < 5 years living in temporary accommodation (U5TA) are vulnerable to poor health outcomes. Few qualitative studies have examined service provider perspectives in family homelessness; none have focused on U5TA with a cross-sector approach. This study explored professionals’ perspectives of the barriers and facilitators, including pandemic-related challenges, experienced by U5TA in accessing healthcare and optimising health outcomes, and their experiences in delivering services. Methods: Sixteen semi-structured online interviews were conducted. Professionals working in Newham (London) with U5TA families were recruited from non-profit organisations, the health sector, and Local Authority. A thematic analysis was conducted. Findings: Professionals described barriers including poor parental mental health; unsuitable housing; no social support; mistrust of services; immigration administration; and financial insecurity. Digital poverty, language discordance, and the inability to register and track U5TA made them even less visible to services. Professionals tried to mitigate barriers with improved communication, and through community facilitators. Adverse pandemic effects on U5TA health included delay and regression in developmental milestones and behaviours. In-person services were reduced, exacerbating pre-existing barriers. Interpretation: COVID-19 further reduced the ability of professionals to deliver care to U5TA and significantly impacted the lives of U5TA with potential life-long risks. Innovative and tailored cross-sector strategies are needed, including co-production of public health services and policies focusing on early development, mental health support, employment training, and opportunities for parents/carers.
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Affiliation(s)
- Diana Margot Rosenthal
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London WC1E 7HB, UK
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY 10016, USA
| | - Michelle Heys
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Specialist Children and Young People’s Services, East London NHS Foundation Trust, London E15 4PT, UK
| | - Marcella Ucci
- UCL Institute for Environmental Design and Engineering, The Bartlett School of Environment, Energy and Resources, University College London, London WC1H 0NN, UK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, University College London, London WC1E 7HB, UK
- UCL Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Ashlee Teakle
- Public Health, London Borough of Newham, London E16 2QU, UK
| | - Monica Lakhanpaul
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- Community Paediatrics, Whittington Health NHS, London N19 5NF, UK
| | - Celine Lewis
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London WC1N 3BH, UK
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A Shared Decision-making Process may Affect Bariatric Procedure Selection and Alter Surgical Outcomes: a Single-unit Retrospective Study. Obes Surg 2023; 33:195-203. [PMID: 36318398 DOI: 10.1007/s11695-022-06351-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE A shared decision-making (SDM) process centered on the patient perspective may increase understanding and treatment satisfaction. This study aimed to investigate whether SDM would increase the acceptance of bariatric/metabolic surgeries, change treatment decisions, and affect 1-year results. MATERIALS AND METHODS This retrospective analysis enrolled 315 consecutive patients with a body mass index between 32.5 and 50 kg/m2 and aged 20-65 years who underwent consultation for a primary bariatric/metabolic procedure within 2 years before (pre-SDM) or after (post-SDM) SDM program implementation to assist in the decision to undergo Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery. Consent rate, procedure choice, weight loss, comorbidity remission, etc., were compared between periods and procedures. Statistical tests were two-sided, with p < 0.05 considered significant. RESULTS More eligible patients underwent metabolic/bariatric procedures post-SDM than pre-SDM (115/159 [72%] vs. 106/156 [68%]; p = 0.395), and a stronger preference for RYGB post-SDM was observed (71% vs. 62%; p = 0.153). Significantly more patients with diabetes (28 [34.1%] vs. 5 [15.2%]; p = 0.041) chose RYGB over SG post-SDM. Patients who underwent RYGB had a higher diabetes remission rate both pre-SDM (70.0% vs. 58.3%; p = 0.571) and post-SDM (76.2% vs. 66.7%; p = 0.712) than those who underwent SG. While 1-year weight loss was similar between procedures, adherence to nutritional supplementation did not appear to be broadly enhanced post-SDM. CONCLUSION SDM influenced procedure selection toward RYGB, which was more popular than SG among patients with diabetes. Higher diabetes remission was achieved with RYGB, although the results of other effects deserve further study.
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Ballengee LA, Bosworth HB, Zullig LL. The role of accountability in adherence programs. PATIENT EDUCATION AND COUNSELING 2022; 105:2635-2636. [PMID: 35667936 DOI: 10.1016/j.pec.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- L A Ballengee
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - H B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - L L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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Poleon S, Sabbagh N, Racette L. Whitecoat Adherence in Patients With Primary Open-Angle Glaucoma. Front Med (Lausanne) 2022; 9:867884. [PMID: 35665331 PMCID: PMC9160987 DOI: 10.3389/fmed.2022.867884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Whitecoat adherence refers to improved medication adherence in the days surrounding clinic visits. This may lead to clinical measures that are not representative of those outside of clinical encounters. In glaucoma, whitecoat adherence to prescribed hypotensive therapy may lead to intraocular pressure readings within the target range, which may impact clinical decision-making. We aimed to quantify and identify factors associated with whitecoat adherence. Methods In this cohort study, patients with primary open-angle glaucoma were selected from an ongoing longitudinal NIH-funded study if they used hypotensive eyedrops, had a clinic visit during the parent study, and had adherence data during the 28 days evenly bracketing the clinic visit. Adherence within the implementation phase was measured using Medication Event Monitoring System (MEMS) caps. Wilcoxon tests were used to compare mean adherence between the following periods: Pre14-4 (days 14 to 4 preceding the clinic visit) and Pre3-1 (days 3 to 1 preceding the visit); Post1-3 (days 1 to 3 following the clinic visit) and Post4-14 (days 4 to 14 following the visit). Analyses were performed in the full sample and in patients with optimal (≥80%, n = 49) and suboptimal adherence (<80%, n = 17). Results Sixty-six patients were included, of which 51.5% were female. Mean age was 70.8 ± 8.1 years. In the 6 months evenly bracketing the clinic visit, mean and median adherence were 86.3% (standard deviation = 17.7) and 95.6% (interquartile range = 21.2), respectively. Overall, mean adherence increased from Pre14-4 to Pre3-1 (85.5% ± 21.2 to 88.5% ± 23.2, p = 0.01) and decreased from Post1-3 to Post4-14 (87.0 ± 23.9 to 84.9 ± 23.3, p = 0.02). In patients with optimal adherence, adherence increased from Pre14-4 to Pre3-1 (94.0 ± 11.7 to 97.7 ± 7.4, p = 0.001) and from Post1-3 to Post4-14 (95.2 ± 12.0 to 95.4 ± 5.7, p = 0.007). Whitecoat adherence was not observed in patients with suboptimal adherence. Conclusion We documented the presence of whitecoat adherence in this cohort. Due to its potential impact on clinical outcomes and decisions, providers should remain vigilant for this phenomenon and prioritize it during patient-provider discussions.
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Affiliation(s)
- Shervonne Poleon
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nouran Sabbagh
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery, AL, United States
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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12
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Pathak A, Poulter NR, Kavanagh M, Kreutz R, Burnier M. Improving the Management of Hypertension by Tackling Awareness, Adherence, and Clinical Inertia: A Symposium Report. Am J Cardiovasc Drugs 2022; 22:251-261. [PMID: 34751917 PMCID: PMC8576089 DOI: 10.1007/s40256-021-00505-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/01/2022]
Abstract
Hypertension remains the leading cause of global mortality, with elevated systolic blood pressure (BP) leading to 10.8 million deaths each year. Despite this, only around 50% of individuals with hypertension are aware of their condition. Alongside low awareness rates, lack of patient adherence to medication and therapeutic inertia have been identified as factors contributing to the lack of hypertension control worldwide. This report summarizes presentations from the “one of a kind” Servier-sponsored symposium, Improving the Management of Hypertension: Acting on Key Factors, which was conducted as part of the European Society of Hypertension (ESH)-International Society of Hypertension (ISH) 2021 ON-AIR meeting. The symposium focused on how low awareness, therapeutic inertia, and nonadherence can be addressed by combining the experience of a patient with the expertise of physicians. May Measurement Month, the ongoing global BP measurement program, is raising awareness of hypertension in over 90 countries, and the 2018 European Society of Cardiology/ESH guidelines and the 2020 ISH guidelines now include recommendations that specifically address low adherence and therapeutic inertia, including involving patients in a shared decision-making process and the use of single-pill combination therapy. Understanding the role of emotion in decision making and addressing the different psychological states and attitudes in the patient’s “cycle of change” are key to effective shared decision making and improving adherence. Raised blood pressure (hypertension) is involved in the death of around 10.8 million people throughout the world each year. However, only about half of the people with hypertension are aware of their condition. In addition, many patients who are prescribed blood pressure-lowering medications do not take their pills regularly (intentional or nonintentional low adherence). Many doctors are not as strict as they should be in ensuring blood pressure control of their hypertensive patients (therapeutic inertia). This report presents ideas and data from a “first of its kind” symposium sponsored by Servier as part of the European Society of Hypertension (ESH)-International Society of Hypertension (ISH) 2021 ON-AIR meeting involving both patient and physicians. The report summarizes the ways in which low awareness, therapeutic inertia, and lack of adherence can be addressed and includes insights into patients’ perspectives. An ongoing global blood pressure screening program called May Measurement Month was discussed, which has detected almost a million people with untreated or inadequately treated hypertension worldwide since 2017. Recent ESH and ISH guidelines for managing hypertension now include recommendations on how to address low adherence and therapeutic inertia. Crucially, doctors should involve their patients with hypertension in decisions about their own treatment, which will help improve adherence to medication and ultimately reduce hypertension-related serious adverse events (e.g. heart attacks, strokes and deaths).
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Affiliation(s)
- Atul Pathak
- Department of Cardiovascular Medicine, ESH Hypertension Center of Excellence, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, BP 489, MC 98012, Monte Carlo, Monaco.
- UMR UT3 CNRS 5288, Toulouse, France.
| | - Neil R Poulter
- School of Public Health, Imperial College London, London, UK
| | | | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
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13
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Vakkalanka JP, Lund BC, Arndt S, Field W, Charlton M, Ward MM, Carnahan RM. Therapeutic relationships between Veterans and buprenorphine providers and effects on treatment retention. Health Serv Res 2022; 57:392-402. [PMID: 34854083 PMCID: PMC8928033 DOI: 10.1111/1475-6773.13919] [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] [Received: 07/12/2021] [Revised: 10/27/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the extent to which there was any therapeutic relationship between Veterans and their initial buprenorphine provider and whether the presence of this relationship influenced treatment retention. DATA SOURCES National, secondary administrative data used from the Veterans Health Administration (VHA), 2008-2017. STUDY DESIGN Retrospective cohort study. The primary exposure was a therapeutic relationship between the Veteran and buprenorphine provider, defined as the presence of a previous visit or medication prescribed by the provider in the 2 years preceding buprenorphine treatment initiation. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. DATA COLLECTION/EXTRACTION METHODS Adult Veterans (age ≥ 18 years) diagnosed with opioid use disorder and treated with buprenorphine or buprenorphine/naloxone within the VHA system were included in this study. We excluded those receiving buprenorphine patches, those with documentation of a metastatic tumor diagnosis within 2 years prior to buprenorphine initiation, and those without geographical information on rurality. PRINCIPAL FINDINGS A total of 28,791 Veterans were included in the study. Within the overall study sample, 56.3% (n = 16,206) of Veterans previously had at least one outpatient encounter with their initial buprenorphine provider, and 24.9% (n = 7174) of Veterans previously had at least one prescription from that provider in the 2 years preceding buprenorphine initiation. There was no significant or clinically meaningful association between therapeutic relationship history and treatment retention when defined as visit history (aHR: 0.99; 95% CI: 0.96, 1.02) or medication history (aHR: 1.03; 95% CI: 1.00, 1.07). CONCLUSIONS Veterans initiating buprenorphine frequently did not have a therapeutic history with their initial buprenorphine provider, but this relationship was not associated with treatment retention. Future work should investigate how the quality of Veteran-provider therapeutic relationships influences opioid use dependence management and whether eliminating training requirements for providers might affect access to buprenorphine, and subsequently, treatment initiation and retention.
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Affiliation(s)
- Jayamalathi Priyanka Vakkalanka
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Department of Emergency MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Brian C. Lund
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Center for Comprehensive Access and Delivery Research and EvaluationIowa City Veterans Affairs Health Care SystemIowa CityIowaUSA
| | - Stephan Arndt
- Department of BiostatisticsUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - William Field
- Department of Occupational and Environmental HealthUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Mary Charlton
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Marcia M. Ward
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Ryan M. Carnahan
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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14
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Wagner J, Cummings C, Feinn R, Kanc K, Kos M. Impact of COVID on Professionals Addressing Psychosocial Needs of People With Diabetes: An International Survey. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:828719. [PMID: 36992771 PMCID: PMC10012139 DOI: 10.3389/fcdhc.2022.828719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
We investigated how COVID-19 has disrupted the work of health professionals who address behavioral and psychosocial needs of people with diabetes (PWD). English language emails were sent to members of five organizations that address psychosocial aspects of diabetes, inviting them to complete a one-time, anonymous, online survey. On a scale from 1=no problem, to 5=serious problem, respondents reported problems with the healthcare system, their workplaces, technology, and concerns about the PWD with whom they work. Respondents (n=123) were from 27 countries, primarily in Europe and North America. The typical respondent was a woman, aged 31-40 years, who worked in an urban hospital in medicine or psychology/psychotherapy. Most judged that the COVID lockdown in their region was moderate or severe. Over half felt moderate to serious levels of stress/burnout or mental health issues. Most participants reported moderate to severe problems due to the lack of clear public health guidelines, concerns with COVID safety of themselves, PWD, and staff, and a lack of access or knowledge on the part of PWD to use diabetes technology and telemedicine. In addition, most participants reported concerns with the psychosocial functioning of PWD during the pandemic. Overall, the pattern of findings reveals a high level of detrimental impact, some of which may be ameliorated with changes in policy and additional services for both health professionals and the PWD with whom they work. Concerns about PWD during the pandemic must go beyond their medical management and also consider the health professionals who provide them with behavioral and psychosocial support.
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Affiliation(s)
- Julie Wagner
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut, Farmington, CT, United States
- Department of Psychiatry, School of Medicine, University of Connecticut, Farmington, CT, United States
- *Correspondence: Julie Wagner,
| | - Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Karin Kanc
- Jazindiabetes, Private Diabetes Centre, Ljubljana, Slovenia
| | - Miha Kos
- Ustanova Hiša eksperimentov, Ljubljana, Slovenia
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15
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Patient-reported outcomes for medication-related quality of life: A scoping review. Res Social Adm Pharm 2022; 18:3501-3523. [DOI: 10.1016/j.sapharm.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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16
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Xu X, Guo T, Liu Z, Chen P, Zhang Y, Ji Q, Xie H. A Systematic Review of Patient Preferences, Expectations, and Values for the Management and Treatment of Hypertension. Patient Prefer Adherence 2022; 16:2867-2876. [PMID: 36299561 PMCID: PMC9590339 DOI: 10.2147/ppa.s388356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To comprehensively summarize the evidence on the preferences, expectations, and values of hypertension management and treatment in hypertensive patients. METHODS From inception through January 2022, PubMed, Embase, Web of Science, EBSCO, and China National Knowledge Infrastructure were searched for studies with hypertension value, preference, or expectation. A qualitative retrospective analysis was performed. RESULTS A total of 24 studies involving 8701 participants were included. Although studies on the preferences of hypertensive patients are difficult to standardize, considerable convergence has occurred: 1) Patients preferred treatment regimens with lower incidence of comorbidities, faster response, lower cost, more frequent blood pressure monitoring, fewer side effects, and more convenient medication. 2) Patients have a crucial role in the treatment, and their physicians are expected to develop a shared patient-centered decision-making model. CONCLUSION The results of this systematic review demonstrated that side effects, cost, and convenience are important factors for patients when selecting a treatment regimen for hypertension. Patients often obtain hypertension information from their physicians and prefer shared patient-centered decision-making.
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Affiliation(s)
- Xianpeng Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Tao Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Zifeng Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Peng Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Ying Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Qingjie Ji
- Quzhou Hospital of Traditional Chinese Medicine, Quzhou, People’s Republic of China
| | - Hui Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- Correspondence: Hui Xie, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, People’s Republic of China, Email
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17
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Steinberg DM, Andresen JA, Pahl DA, Licursi M, Rosenthal SL. "I've Weathered Really Horrible Storms Long Before This…": The Experiences of Parents Caring for Children with Hematological and Oncological Conditions during the Early Months of the COVID-19 Pandemic in the U.S. J Clin Psychol Med Settings 2021; 28:720-727. [PMID: 33492628 PMCID: PMC7831624 DOI: 10.1007/s10880-020-09760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Abstract
The societal impact of COVID-19 is vast, thus it is imperative to understand how vulnerable groups, such as children with chronic medical conditions are affected. This understanding can prepare psychologists and other healthcare providers to meet their current and future needs. A convenience sample of 11 parents of children with hematological/oncological conditions was recruited. They participated in semi-structured interviews on the effect of the COVID-19 pandemic on their children. Qualitative analysis identified common themes. Parental responses focused on the pandemic's impact on children's general daily life and healthcare. Themes of caution, uncertainty, adaptation, and the role of the healthcare providers and early medical experiences emerged. Concerns about vulnerability, changes in routine, the importance of virtual connections, and the pivotal role of providers have implications for children with and without medical conditions. The adaptation and resilience of the families provide a sense of hope in an uncertain time.
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Affiliation(s)
- Dara M. Steinberg
- Department of Pediatrics, Division of Hematology, Oncology & Stem Cell Transplantation, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
| | - Jane A. Andresen
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Daniel A. Pahl
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, USA
| | - Maureen Licursi
- Morgan Stanley Children’s Hospital, NewYork-Presbyterian Hospital, New York, USA
| | - Susan L. Rosenthal
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, 161 Fort Washington Avenue—IP 7, New York, NY 10032 USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
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18
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Turkson-Ocran RAN, Ogunwole SM, Hines AL, Peterson PN. Shared Decision Making in Cardiovascular Patient Care to Address Cardiovascular Disease Disparities. J Am Heart Assoc 2021; 10:e018183. [PMID: 34612050 PMCID: PMC8751878 DOI: 10.1161/jaha.120.018183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - S Michelle Ogunwole
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD
| | - Anika L Hines
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD.,Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond VA
| | - Pamela N Peterson
- Division of Cardiology University of Colorado, Anschutz Medical Campus Aurora CO.,Division of Cardiology Denver Health Medical Center Denver CO
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19
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Pasadyn SR, Roselli EE, Artis AS, Pasadyn CL, Phelan D, Blackstone EH. From Court to Couch: Exercise and Quality of Life after Acute Type A Aortic Dissection. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:171-179. [PMID: 34610642 PMCID: PMC8654512 DOI: 10.1055/s-0041-1731403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background
Acute Type A aortic dissection can be physically and mentally stressful with little known about survivors' postrepair activity levels, exercise habits, and quality of life (QOL). This study was aimed to describe pre- and postdissection changes regarding exercise, understand physician recommendations, quantify use of cardiac rehabilitation, and assess QOL in dissection survivors.
Methods
A total of 295 acute Type A aortic dissection survivors were surveyed about exercise, cardiac rehabilitation, QOL, sexual activity, and posttraumatic stress disorder (PTSD) with 137 (46%) respondents.
Results
Respondents were less likely to participate in competitive athletics after than before dissection (1/131 [0.76%] vs. 26/131 [20%],
p
[McNemar test] < 0.0001) or lift heavy objects (11/111 [9.9%] vs. 41/111 [37%],
p
< 0.0001). Forty-eight of 132 respondents (36%) did not participate in cardiac rehabilitation. Compared with general population norms, respondents reported lower median QOL physical component scores (40 [26, 51; 15th, 85th percentile],
p
< 0.0001); these were lower in respondents who did not exercise (Hodges–Lehmann [HL; 95% confidence interval (CI)]: –6.8 [–11, –2.4],
p
= 0.002), limited sexual activity (–8.0 [–13, –4.3],
p
= 0.0002), or screened positive for PTSD (–10 [–14, –5.3],
p
= 0.0002). Median mental component scores were similar to general population norms (HL [95% CI]: 55 [34, 61],
p
= 0.24) but were lower among respondents who did not exercise (–4.2 [–7.8, –1.0],
p
= 0.01), limited sexual activity (–5.5 [–10, –1.8],
p
= 0.003), or screened positive for PTSD (–16 [–22, –10],
p
< 0.0001).
Conclusion
Physicians should prescribe cardiac rehabilitation, encourage appropriate exercise, promote resumption of sexual activity, and identify and treat PTSD after surgery for acute Type A aortic dissection.
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Affiliation(s)
- Selena R Pasadyn
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amanda S Artis
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Cassandra L Pasadyn
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
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20
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Rothen JP, Rutishauser J, Walter PN, Hersberger KE, Arnet I. Vitamin D oral intermittent treatment (DO IT) study, a randomized clinical trial with individual loading regimen. Sci Rep 2021; 11:18746. [PMID: 34548526 PMCID: PMC8455639 DOI: 10.1038/s41598-021-97417-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Comparison of several regimens of oral vitamin D including an individually calculated loading regimen with the aim of achieving serum values > 75 nmol/l. Interventional, randomized, 3-arm study in vitamin D-deficient outpatients. Participants were allocated to supplementation of 24,000 IU vitamin D monthly over three months, using either a monthly drinking solution (Vi-De 3) or capsule (D3 VitaCaps), or an individualized loading regimen with the capsules taken weekly. For the loading regimen, the cumulative dose was calculated according to baseline 25-hydroxy-vitamin D (25(OH)D) serum value and body weight. Main inclusion criteria were age ≥ 18 years and 25(OH)D serum concentration < 50 nmol/l. The primary outcome was 25(OH)D serum concentration one week after treatment termination. Secondary endpoints were patient's preferences and adverse events. Full datasets were obtained from 52 patients. Mean 25(OH)D values were statistically significant higher after a loading regimen compared to a monthly administration of 24,000 IU vitamin D (76.4 ± 15.8 vs 61.4 ± 10.8 nmol/l; p < 0.01). All patients treated with the loading regimen reached sufficient 25(OH)D values > 50 nmol/l. Serum 25(OH)D values > 75 nmol/l were observed more frequently in patients taking the loading regimen (47% vs 11% drinking solution vs 12% capsules). Vitamin D-related adverse effects did not occur in any treatment groups. Capsules were preferred by 88.5% of the patients. Compared to treatments with monthly intake of 24,000 IU vitamin D, the intake of an individually calculated weekly loading regimen was able to raise serum concentrations > 50 nmol/l in all cases within a safe range.
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Affiliation(s)
- Jean-Pierre Rothen
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4001, Basel, Switzerland.
| | - Jonas Rutishauser
- Clinical Trial Unit, University Hospital of Basel, Kantonsspital Baden, Basel, Switzerland
| | - Philipp N Walter
- Institute of Laboratory Medicine, Solothurner Spitäler, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4001, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4001, Basel, Switzerland
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21
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Chang TJ, Bridges JFP, Bynum M, Jackson JW, Joseph JJ, Fischer MA, Lu B, Donneyong MM. Association Between Patient-Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design. J Am Heart Assoc 2021; 10:e019943. [PMID: 34238022 PMCID: PMC8483480 DOI: 10.1161/jaha.120.019943] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background We assessed the associations between patient-clinician relationships (communication and involvement in shared decision-making [SDM]) and adherence to antihypertensive medications. Methods and Results The 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient-clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self-reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey-weighted multivariable-adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient-clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty-five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient-clinician communication (OR, 1.38; 95% CI, 1.14-1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08-1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications. Conclusions Patient-clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.
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Affiliation(s)
| | - John F P Bridges
- Department of Biomedical Informatics Ohio State College of Medicine Columbus OH
| | - Mary Bynum
- Healthcare Management Franklin University Columbus OH
| | - John W Jackson
- Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Joshua J Joseph
- College of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics Brigham & Women's Hospital Boston MA
| | - Bo Lu
- College of Public Health Ohio State University Columbus OH
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22
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Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic. Qual Life Res 2021; 31:193-204. [PMID: 34156596 PMCID: PMC8218571 DOI: 10.1007/s11136-021-02917-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
Purpose We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic. Methods A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates. Results Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL. Conclusion Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.
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Alvarez C, Hines AL, Carson KA, Andrade N, Ibe CA, Marsteller JA, Cooper LA. Association of Perceived Stress and Discrimination on Medication Adherence among Diverse Patients with Uncontrolled Hypertension. Ethn Dis 2021; 31:97-108. [PMID: 33519160 PMCID: PMC7843046 DOI: 10.18865/ed.31.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Uncontrolled hypertension is a significant risk factor for cardiovascular morbidity and mortality. In the United States, many patients remain uncontrolled, in part, due to poor medication adherence. Efforts to improve hypertension control include not only attending to medical management of the disease but also the social determinants of health, which impact medication adherence, and ultimately blood pressure control. Purpose To determine which social determinants - health care access or community and social stressors - explain medication adherence. Methods In this cross-sectional analysis, we used baseline data (N=1820, collected August 2017 to October 2019) from a pragmatic trial, which compares the effectiveness of a multi-level intervention including collaborative care and a stepped approach with enhanced standard of care for improving blood pressure. We used logistic regression analyses to examine the association between patient experiences of care and community and social stressors with medication adherence. Results The participants represented a diverse sample: mean age of 60 years; 59% female; 57.3% Black, 9.6% Hispanic, and 33.2% White. All participants had a blood pressure reading ≥140/90 mm Hg (mean blood pressure - 152/85 mm Hg). Half of the participants reported some level of non-adherence to medication. Regression analysis showed that, compared with Whites, Blacks (AOR .47; 95% CIs: .37-.60, P<.001) and Hispanics (AOR .48; 95% CIs: .32- .73, P<.001) were less likely to report medication adherence. Also part-time workers (AOR .57; 95% CIs: .38-.86, P<.05), and those who reported greater perceived stress (AOR .94; 95% CIs: .91 - .98, P<.001) and everyday discrimination (AOR .73; 95% CIs: .59 - .89; P<.001) had lower odds of medication adherence. Among Blacks, greater perceived stress (AOR .93; 95% CIs: .88-.98, P<.001) and everyday discrimination (AOR .63; 95% CIs: .49 - .82, P<.005) were negatively associated with medication adherence. Among Hispanics, greater report of everyday discrimination (AOR .36; 95% CIs: .14 - .89, P<.005) was associated with lower odds of medication adherence. Among Whites, the negative effect of perceived stress on medication adherence was attenuated by emotional support. Conclusions Using the social determinants of health framework, we identified associations between stress, everyday discrimination and medication adherence among non-Hispanic Blacks and Hispanics that were independent of health status and other social determinants. Programs to enhance self-management for African American and Hispanic patients with uncontrolled blood pressure should include a specific focus on addressing social stressors.
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Affiliation(s)
- Carmen Alvarez
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD
| | - Anika L Hines
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA
| | - Kathryn A Carson
- Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Nadia Andrade
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Chidinma A Ibe
- Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Jill A Marsteller
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - Lisa A Cooper
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD
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Theodoridis X, Pittas S, Bogdanos DP, Grammatikopoulou MG. Social Media as Tools to Study Dietary Habits of Patients with Rheumatic Diseases: Learning from Relevant Work on Inflammatory Bowel Diseases. Mediterr J Rheumatol 2020; 31:382-383. [PMID: 33521568 PMCID: PMC7841103 DOI: 10.31138/mjr.31.4.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Xenophon Theodoridis
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Pittas
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Division of Transplantation Immunology and Mucosal Biology, MRC Centre for Transplantation, King’s College London Medical School, SE5 9RS, London, United Kingdom
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Wilton-Clark MS, Feasel AL, Kline GA, Billington EO. Autonomy begets adherence: decisions to start and persist with osteoporosis treatment after group medical consultation. Arch Osteoporos 2020; 15:138. [PMID: 32888079 DOI: 10.1007/s11657-020-00809-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Many individuals prescribed osteoporosis pharmacotherapy either do not start or do not persist with treatment. In this study, women who attended a group medical visit at an osteoporosis center which involved fracture risk assessment and focused on autonomous decision-making made treatment decisions with high confidence. Those who started pharmacotherapy were highly persistent. PURPOSE Adherence and persistence with osteoporosis pharmacotherapy is low, possibly reflecting lack of confidence in physicians' treatment recommendations. We evaluated treatment decisions, decisional confidence, and 12-month treatment adherence among women who attended a group bone health consultation that fostered autonomous decision-making. METHODS We prospectively assessed postmenopausal women referred to an osteoporosis clinic who chose to attend a group medical visit in lieu of one-on-one consultation. The group visit was facilitated by a specialist physician and nurse, involving estimation of 10-year major osteoporotic fracture risk (using FRAX®) and extensive education regarding fracture consequences and potential advantages and disadvantages of pharmacotherapy. No direct advice was given by the specialist. Post-consult, participants made an autonomous decision regarding treatment intent and followed up with their family physician to enact their chosen plan. Intentions to initiate pharmacotherapy were assessed immediately post-consult. Treatment status and decisional confidence were evaluated 3 and 12 months later. Three-month treatment status was considered to reflect final treatment decision. Persistence was defined as proportion of participants on treatment at 3 months who remained treated at 12 months. RESULTS One hundred one women (mean (SD) age, 62.7 years (5.8); median (IQR) FRAX®, 10.7% (8.3-17.6)) participated. Immediately post-consult, 27 (26.7%) intended to initiate treatment. At 3 months, 23 (22.8%) were treated, and at 12 months, 21 (91.3%) remained persistent. Of 89 questionnaire respondents at 12 months, 85 (95.5%) reported confidence in their treatment decision. CONCLUSION When postmenopausal women are provided with individualized fracture risk estimates and enabled to make autonomous decisions regarding pharmacotherapy, ultimate decisions to receive treatment are made with confidence and result in high persistence at 12 months.
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Affiliation(s)
- Madeline S Wilton-Clark
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Lynn Feasel
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada.,Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada
| | - Gregory A Kline
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada.,Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada.,Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emma O Billington
- Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada. .,Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada. .,Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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26
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Insights into the choice between intravenous infusion and subcutaneous injection: physician and patient characteristics driving treatment in SLE. Clin Rheumatol 2020; 40:581-590. [PMID: 32623647 PMCID: PMC7817604 DOI: 10.1007/s10067-020-05226-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
Abstract
Introduction/objectives Multiple modes of administration are available for systemic lupus erythematosus (SLE) treatments. This study examined patient and physician characteristics associated with the choice of weekly subcutaneous (SC) injection or monthly intravenous (IV) infusion for an unspecified SLE treatment. Methods This was a cross-sectional, US web-based survey using a direct elicitation, stated-preference methodology (HO-16-16706). Two hundred patients and 200 physicians were asked to choose between IV or SC administration in a hypothetical scenario. Pairwise and multivariate analyses estimated the odds ratio (OR) for the likelihood of choosing SC over IV for respondent characteristics. Results Among patients, taking non-steroidal anti-inflammatory drugs increased the likelihood of choosing SC injection (OR 3.884), whilst having SLE-related skin problems, a fear of needles or self-injection, and never needing help around the house decreased the likelihood (OR 0.28, 0.13, 0.12, respectively; all p ≤ 0.05). Among physicians, > 95% recommended SC injection for patients who live or work far from an infusion center, prefer SC administration, and never or rarely miss medication doses. Physician characteristics including age and treatment practice also influenced choice. Conclusions Patient and physician characteristics influence choice of SC versus IV therapy for SLE. These findings might inform shared decision-making, which could lead to improved patient outcomes.Key Points • Data regarding patient and physician preference for different modes of administration of SLE therapy are sparse. • This cross-sectional, US web-based study showed that patient and physician characteristics influence choice of SC versus IV therapy for SLE. • A degree of disconnect exists between how factors influence patients’ choice and how those characteristics influence physicians’ choice of SLE treatment mode of administration. • The findings from this study might inform shared decision-making, which could improve alignment between treatment choice and patient preferences, treatment satisfaction, adherence, and improved patient outcomes. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05226-w) contains supplementary material, which is available to authorized users.
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Daundasekara SS, Arlinghaus KR, Johnston CA. Quality of Life: The Primary Goal of Lifestyle Intervention. Am J Lifestyle Med 2020; 14:267-270. [PMID: 32477025 PMCID: PMC7232900 DOI: 10.1177/1559827620907309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In much of lifestyle medicine, health-related quality of life (HRQoL) is a primary focus with the assumption that symptom reduction increases quality of life (QoL) in a more global sense. Lifestyle medicine research has shown that reducing symptoms increases the likelihood that QoL is improved. However, little information is available as to the impact of interventions when they are not effective in creating the desired healthy outcomes. It is possible that some lifestyle interventions have a negative impact on QoL, especially when a patient is not "successful" in reducing their symptomatology. Considering QoL from a broader perspective as an outcome in combination with traditional health outcomes may improve provider-patient rapport and empower patients to provide feedback on treatment, which, in turn, may improve overall treatment.
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Affiliation(s)
| | | | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas
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28
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Joko T, Nagai Y, Mori R, Tanaka K, Oshima Y, Hikichi Y, Komori T, Carrasco J, Maculaitis MC, Will O, Beusterien K, Takahashi K. Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment. Patient Prefer Adherence 2020; 14:553-567. [PMID: 32214802 PMCID: PMC7082633 DOI: 10.2147/ppa.s228890] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In Japan, intravitreal anti-vascular endothelial growth factor (anti-VEGF) dosing regimens for wet age-related macular degeneration (wAMD) include pro re nata, every 2 months, and treat-and-extend, resulting in different outcomes and patient burden. Although reflecting patient preferences in treatment decision-making is desirable, few studies have examined this in Japan. This study assessed the patients willingness to trade-off between different dosing regimens. PATIENTS AND METHODS Patients with wAMD were recruited from four Japanese university hospitals to complete a face-to-face cross-sectional survey. In a discrete choice experiment, patients were asked to choose their preferred option from two anti-VEGF treatment profiles shown side-by-side across a series of choice tasks. The profiles varied on four attributes: number of injections in 12 months, number of physician consultations in 12 months, chance of 1-year visual acuity (VA) improvement, and chance of 2-year VA maintenance. Preference weights were estimated using hierarchical Bayes' models. RESULTS Overall, 120 patients (30 treatment naïve and 90 anti-VEGF experienced) completed the survey. Patients were willing to accept an increase from three to approximately eight injections in 12 months to increase the chance of 1-year VA improvement from 25% to 40%. They would be willing to accept 11 injections in 12 months if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attributes were increasing the chance of 2-year VA maintenance and reducing the number of injections in 12 months, which were each about twice as important as decreasing physician consultations in 12 months and increasing the chance of 1-year VA improvement (p<0.001). Among the dosing regimens, patients most preferred treat-and-extend because of its higher chance of 2-year VA maintenance. CONCLUSION Informing patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment may increase the acceptance of an optimal treatment regimen and number of injections.
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Affiliation(s)
- Takeshi Joko
- Department of Ophthalmology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Yoshimi Nagai
- Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Ryusaburo Mori
- Division of Ophthalmology, Department of Visual Sciences, Nihon University of School of Medicine, Chiyoda-ku, Tokyo, Japan
| | - Koji Tanaka
- Division of Ophthalmology, Department of Visual Sciences, Nihon University of School of Medicine, Chiyoda-ku, Tokyo, Japan
| | - Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Hikichi
- Department of Market Access, Bayer Yakuhin, Ltd., Chiyoda-ku, Tokyo, Japan
| | - Tetsushi Komori
- Department of Research & Product Development, Bayer Yakuhin, Ltd., Kita-Ku, Osaka, Japan
| | - Joao Carrasco
- Department of Market Access, Bayer Consumer Care AG, Basel, Canton of Basel-Stadt, Switzerland
| | | | | | | | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata, Osaka, Japan
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Italian Society of Arterial Hypertension (SIIA) Position Paper on the Role of Renal Denervation in the Management of the Difficult-to-Treat Hypertensive Patient. High Blood Press Cardiovasc Prev 2020; 27:109-117. [DOI: 10.1007/s40292-020-00367-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
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30
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Kamimura A, Higham R, Rathi N, Panahi S, Lee E, Ashby J. Patient-Provider Relationships Among Vulnerable Patients: The Association With Health Literacy, Continuity of Care, and Self-Rated Health. J Patient Exp 2020; 7:1450-1457. [PMID: 33457601 PMCID: PMC7786733 DOI: 10.1177/2374373519895680] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While the patient–provider relationship is one factor that can improve access to primary care for underserved populations, vulnerable patients often experience challenges to have a good relationship with providers. The purpose of this study is to examine factors that affect patient–provider relationship among vulnerable patients; in particular, among uninsured primary care patients. This study focused on health literacy, continuity of care, and self-rated health as predictors of patient–provider relationship. A self-administered survey was collected from uninsured primary care patients utilizing a free clinic in the metropolitan area in the Rocky Mountain Region in the United States from May to July in 2018. Higher levels of health literacy and continuity of care are associated with a better patient–provider relationship. Better self-rated health is associated with better patient–provider relationship. Health literacy may improve by the communication and connection with a specific provider because patients better understand the care and/or medications that are being prescribed. Seeing the same provider helps patients develop a better relationship and make clinical decisions in a way that they prefer. Improving the patient–provider relationship can potentially change health outcomes positively for vulnerable patients. Informing patients that they can request a specific medical provider may allow them to increase continuity of care, and improve communication, partnering, connection, and patient centeredness, leading to an increase in health literacy and better self-rated health.
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Affiliation(s)
| | | | | | | | - Edward Lee
- University of Utah, Salt Lake City, UT, USA
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Hentzen C, Turmel N, Chesnel C, Miget G, Le Breton F, Charlanes A, Tan E, Amarenco G. What criteria affect a patient's choice of catheter for self‐catheterization? Neurourol Urodyn 2019; 39:412-419. [DOI: 10.1002/nau.24223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/28/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Claire Hentzen
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Nicolas Turmel
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Camille Chesnel
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Gabriel Miget
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Frederique Le Breton
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Audrey Charlanes
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Eliane Tan
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Gérard Amarenco
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
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Langford AT, Williams SK, Applegate M, Ogedegbe O, Braithwaite RS. Partnerships to Improve Shared Decision Making for Patients with Hypertension - Health Equity Implications. Ethn Dis 2019; 29:97-102. [PMID: 30906156 PMCID: PMC6428173 DOI: 10.18865/ed.29.s1.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Shared decision making (SDM) has increasingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hypertension is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds promise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hypertension. These options include medication and/or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on "the best" plan of action for hypertension management can be challenging because patients have different goals and preferences for treatment. As hypertension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient preferences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.
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Affiliation(s)
- Aisha T. Langford
- NYU School of Medicine, Department of Population Health, New York, NY
| | | | - Melanie Applegate
- NYU School of Medicine, Department of Population Health, New York, NY
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