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Lavigne JE, Stover AN, Gamble A, Tudor G, Cross WF, Carpenter DM. A randomized controlled trial protocol for a virtual, scalable suicide prevention gatekeeper training program for community pharmacy staff (Pharm-SAVES). Contemp Clin Trials Commun 2024; 38:101268. [PMID: 38380343 PMCID: PMC10878835 DOI: 10.1016/j.conctc.2024.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Background Suicide prevention gatekeeping is a skill that may support community (retail) pharmacists in managing patients who present with suicide warning signs. A brief, virtual, case-based training intervention was tailored to the retail setting (Pharm-SAVES). To test training effectiveness, a randomized controlled trial (RCT) protocol was developed for use in pharmacies across four states. Objective To introduce the trial protocol for assessing the effectiveness for increasing the proportion of staff who recognize patients displaying warning signs and self-report engaging in gatekeeping, including asking if the patient is considering suicide. Methods This study uses a parallel cluster-randomized controlled trial to recruit 150 pharmacy staff in community pharmacies in four states with two groups (intervention and control). The control group completes Pharm-SAVES online suicide prevention gatekeeper training and all assessment surveys at baseline after training and at 1-month follow-up. The experimental group completes all control group training and assessments plus interactive video role-play patient cases. Conclusion We hypothesize that compared to those in the control group, experimental group trainees exposed to the interactive video role play patient cases will be more likely to recognize warning signs in patient cases and self-report engaging in gatekeeping.
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Affiliation(s)
- Jill E. Lavigne
- Wegmans School of Pharmacy, St John Fisher University, United States
| | | | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Gail Tudor
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Wendi F. Cross
- University of Rochester School of Medicine and Dentistry, United States
| | - Delesha M. Carpenter
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
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Beznos B, Sayner R, Carpenter DM, Budenz DL, Muir KW, Annis IE, Romero MS, Tudor G, Garcia N, Robin AL, Sleath B. Do African American patients with glaucoma ask their eye providers the questions they have? Eye (Lond) 2024; 38:279-283. [PMID: 37524828 PMCID: PMC10811192 DOI: 10.1038/s41433-023-02674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE The objective of this study was to describe what questions patients checked on a glaucoma question prompt list and how often patients asked the same checked questions during medical visits. DESIGN A randomized controlled trial was conducted to test the effectiveness of a pre-visit video/glaucoma question prompt list intervention to increase African American patient question-asking during medical visits. METHODS Adult African American patients with glaucoma and a history of non-adherence to glaucoma medications were enrolled and randomized into intervention and usual care groups from three glaucoma practices. Visits were audio-recorded, transcribed, and coded for the questions patients asked during their visits. Researchers collected the pre-visit question prompt lists from the intervention group and compared their checked questions to the questions patients asked during their visit. RESULTS Ninety-three subjects were randomized to the question prompt list intervention group. Subjects checked an average of 6.77 questions on the prompt list. Of the subjects who checked at least one question, 54.8% asked their provider at least one of the questions they checked. The most common questions asked about glaucoma medications that they had checked were "What time(s) of day should I take my drops?" (50.0%, 9 out of 18) and "How many times a day do I use my glaucoma medicines?" (50.0%, 3 out of 6). CONCLUSION Although African American subjects with glaucoma have questions about glaucoma and their medications, few asked all their questions during visits. Future research should focus on how to improve question asking using a question prompt list.
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Affiliation(s)
- Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Budenz
- Department of Ophthalmology, UNC school of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA
- Durham VA Medical Center, Health Services Research and Development, Durhaml, NC, USA
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Ophthalmology and International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Beznos B, Carpenter DM, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Robin AL. African American patient-provider communication about glaucoma vision quality-of-life. Eye (Lond) 2024; 38:343-348. [PMID: 37580416 PMCID: PMC10810853 DOI: 10.1038/s41433-023-02693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND/OBJECTIVES Little is known about African American patient-provider communication about glaucoma-related quality-of-life. The objectives of this study were to: (a) examine associations between patient socio-demographics and vision quality-of-life, (b) describe the extent to which eye care providers and patients discuss glaucoma-related quality-of-life, and (c) examine associations between patient and provider characteristics, whether the patient was in the intervention or usual care group, and whether the patient and provider discuss one or more glaucoma-related quality-of-life domains. METHODS Adult African American patients with glaucoma who reported non-adherence to glaucoma medications were enrolled from three sites. Patients completed a vision quality-of-life VFQ-25 assessment. Patients were randomized into intervention and control groups with intervention group members receiving a glaucoma question prompt list and watching a video before a provider visit. Audio recordings from these visits were transcribed and assessed for glaucoma-related quality-of-life discussions. RESULTS One hundred and eighty-nine patients were enrolled. Glaucoma-related quality-of-life was discussed during 12.3% of visits (N = 23). Patients initiated discussion 56.5% (N = 13) of the time and providers 43.5% (N = 10) of the time. Patients with worse health literacy (p < 0.001), more depressive symptoms (p < 0.05), and more severe glaucoma (p < 0.001) were significantly more likely to have worse vision-related quality-of-life. Glaucoma-related quality-of-life was significantly more likely to be discussed when African American patients saw African American providers (p < 0.05). CONCLUSION Patients and providers rarely discussed the patient's glaucoma-related quality-of-life. The intervention did not significantly increase communication about glaucoma-related quality-of-life. Residency programs should consider enhancing training regarding discussing patients' quality-of-life.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA
- Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA
| | | | | | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan L Robin
- Wilmer Institute, Johns Hopkins University, Baltimore, MD, USA
- American Glaucoma Society, San Francisco, CA, USA
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Sleath B, Carpenter DM, Budenz DL, Muir KW, Romero MS, Adjei AA, Beznos B, Tudor G, Garcia N, Robin AL. A Previsit Intervention's Influence on Glaucoma Topics Discussed between Black Patients and Providers. Ophthalmol Glaucoma 2024; 7:75-81. [PMID: 37442227 DOI: 10.1016/j.ogla.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The objectives of this study were to conduct a randomized controlled trial testing the effectiveness of a previsit glaucoma video/question prompt list intervention, and to examine the impact on how often providers educate Black patients about glaucoma and glaucoma medication topics during visits. DESIGN A randomized controlled trial of a glaucoma question prompt list/video intervention. PARTICIPANTS Black patients with a diagnosis of glaucoma who are taking 1 or more glaucoma medications and report being nonadherent. METHODS One hundred eighty-nine Black patients with glaucoma were enrolled and assigned to either a usual care or an intervention group where they watched a video emphasizing the importance of asking questions and received a glaucoma question prompt list to complete before clinic visits. Visits were audio-taped and patients were interviewed after visits. MAIN OUTCOME MEASURES Whether the provider educates about different glaucoma and glaucoma medication topics. RESULTS Patients in the intervention group were significantly more likely to ask providers 1 or more questions about glaucoma and its treatment. Providers were significantly more likely to educate intervention patients about their diagnosis (P = 0.001), intraocular pressure (P = 0.03), the likelihood of the need for long-term therapy (P = 0.001), and the physical changes associated with glaucoma (P = 0.001) than usual-care patients. Providers were also significantly more likely to educate intervention patients about the purpose of their medications (P = 0.03) and side effects (P = 0.001) than usual-care patients. Providers only educated 29% of patients about adherence (33% of intervention group patients and 25% of usual-care patients). Few providers educated patients about barriers and fears/concerns in using glaucoma medications, the cost of medications and insurance coverage, how to administer eye drops, and nasolacrimal occlusion. CONCLUSIONS The intervention significantly increased provider education about many glaucoma and glaucoma medication topics. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina; Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina
| | | | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, New Hampshire
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, Michigan; Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland
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Sleath B, Carpenter DM, Budenz DL, Muir KW, Romero MS, Tudor G, Garcia N, Adjei AA, Robin AL. Provider use of a participatory decision-making style with African American patients with glaucoma. Patient Educ Couns 2023; 111:107679. [PMID: 36848727 DOI: 10.1016/j.pec.2023.107679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To examine whether non-adherent African American patients with glaucoma who received a question prompt list and video intervention were more likely to be given treatment options, have their input included into treatment regimens, and rate their providers as using more of a participatory decision-making style. METHODS African American patients with glaucoma taking one or more glaucoma medications and reported being non-adherent were randomized to a pre-visit video and glaucoma question prompt list intervention or usual care. RESULTS 189 African American patients with glaucoma participated. Providers gave patients treatment choices during 5.3% of visits and included patient input into treatment regimen decisions during 2.1% of visits. Male patients and patients with more years of education were significantly more likely to rate their providers as using more of a participatory decision-making style. CONCLUSION African American patients with glaucoma rated their providers high on using a participatory decision-making style. Yet, providers infrequently presented non-adherent patients with medication treatment options, and it was rare for providers to include patient input into treatment decisions. PRACTICE IMPLICATIONS Providers should provide non-adherent patients with different glaucoma treatment options. Non-adherent African American patients with glaucoma should be encouraged to ask their providers for different medication treatment options.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA; Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA
| | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alan L Robin
- Wilmer Eye Institute, Johns Hopkins University Baltimore, MD, USA; Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; Executive Vice President, American Glaucoma Society, San Francisco, CA, USA
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Sleath B, Carpenter DM, Davis SA, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Adjei AA, Robin AL. Improving Black Patient Question-Asking and Provider Education During Glaucoma Visits. Ophthalmol Glaucoma 2023; 6:206-214. [PMID: 36967704 DOI: 10.1016/j.ogla.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 04/26/2023]
Abstract
PURPOSE The objectives of this study were to conduct a randomized, controlled trial testing the effectiveness of a previsit glaucoma video/question prompt list intervention to increase Black patient question-asking and provider education about glaucoma and glaucoma medications during visits. DESIGN A randomized, controlled trial of a glaucoma question prompt list/video intervention. PARTICIPANTS Black patients with a glaucoma diagnosis who were currently taking 1 or more glaucoma medications and reported being nonadherent. METHODS One hundred and eighty-nine Black patients with glaucoma were enrolled into a randomized, controlled trial and assigned to either a usual care or an intervention group where they watched a video emphasizing the importance of asking questions and received a glaucoma question prompt list to complete before clinic visits. Visits were audiotaped and patients were interviewed after visits. MAIN OUTCOME MEASURES Outcome measures were if the patient asked 1 or more questions about glaucoma and glaucoma medications and the number of glaucoma and glaucoma medication areas the provider educated the patient about during the visit. RESULTS Patients in the intervention group were significantly more likely to ask 1 or more questions about glaucoma than patients in the usual care group (odds ratio, 5.4; 95% confidence interval [CI], 2.8-10.4). Patients in the intervention group were significantly more likely to ask 1 or more questions about glaucoma medications than patients in the usual care group (odds ratio, 2.8; 95% CI, 1.5-5.4). Patients in the intervention group were significantly more likely to receive more areas of education about glaucoma from their providers during visits (β = 0.94; 95% CI, 0.49-1.4). Patients who asked 1 or more questions about glaucoma medications were significantly more likely to receive more areas of education about glaucoma medications from providers (β = 1.8; 95% CI, 1.2-2.5). CONCLUSIONS The intervention increased patient question-asking about glaucoma and glaucoma medications and provider education about glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina; Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina
| | | | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, New Hampshire
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, Michigan; Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland
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Sleath B, Carpenter D, Davis SA, Garcia N, Reuland DS, Tudor G, Loughlin CE. Adolescent asthma management self-efficacy and responsibility: impact on asthma control and quality-of-life. J Asthma 2023; 60:331-338. [PMID: 35286174 DOI: 10.1080/02770903.2022.2051541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the extent to which adolescent asthma management self-efficacy, outcome expectations, and asthma responsibility were associated with asthma control and quality-of-life. Adolescent self-efficacy and outcome expectations are important components of social cognitive theory, which guided this research. METHODS English- and Spanish-speaking adolescents ages 11-17 with persistent asthma were recruited at four pediatric clinics. Adolescents were interviewed and parents completed questionnaires. Multiple linear regression was used to analyze the data. RESULTS Three hundred and fifty-nine adolescents were recruited. Older adolescent age, male gender, and higher adolescent asthma management self-efficacy were significantly associated with higher adolescent responsibility; outcome expectations were not significantly associated with responsibility. Adolescent ratings of their own responsibility were higher than parent ratings of their child's responsibility for almost all asthma management tasks. Adolescents with higher reported asthma management self-efficacy were significantly more likely to have better quality-of-life and controlled asthma. Adolescents with more positive outcome expectations were significantly more likely to have controlled asthma. Being Native American was associated with worse quality-of-life and asthma not being controlled. Being Black was associated with asthma not being controlled. CONCLUSIONS Parents and providers should work to improve adolescent self-efficacy in managing their asthma because it is associated with asthma responsibility, asthma control, and quality-of-life. Providers need to especially work with Native American and Black adolescents to improve quality-of-life and asthma control.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Carpenter DM, Davis SA, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Adjei AA, Robin AL. Acceptance of a Pre-visit Intervention to Engage African American Glaucoma Patients during Visits. Optom Vis Sci 2022; 99:838-843. [PMID: 36594752 DOI: 10.1097/opx.0000000000001959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
SIGNIFICANCE The glaucoma question prompt list/video intervention was well received by patients. Eighty-seven percent of patients recommended that other patients should watch the educational video before their visits, and 89% said that other patients should complete the question prompt list before visits. PURPOSE The objectives of this study were to (a) describe patient feedback on a glaucoma question prompt list/video intervention designed to motivate African American patients to be more engaged during visits and (b) examine patient demographics associated with acceptance of the intervention. METHODS We are conducting a randomized controlled trial of a glaucoma question prompt list/video intervention. African American patients with glaucoma were enrolled and assigned to a control group or an intervention group where they watched a video emphasizing the importance of asking questions and received a prompt list to complete before visits. All patients were interviewed after visits and are being followed up for 12 months. RESULTS One hundred eighty-nine African American patients with glaucoma were enrolled into the larger trial. Of the 93 patients randomized to the intervention group, 89% said that patients should complete the prompt lists before visits, and 87% recommended that patients should watch the video before visits. Older patients were significantly less likely to believe that other patients should watch the video before their visits (t = -3.7, P = .04). Patients with fewer years of education were significantly more likely to rate the video as being more useful than patients with more years of education (Pearson correlation, -0.27; P = .01). Patients who reported being less adherent on the visual analog scale were more likely to rate the video as being more useful (Pearson correlation, -0.23; P = .03). CONCLUSIONS This study demonstrates that the question prompt list/video was accepted by the majority of African American patients who received the intervention.
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Affiliation(s)
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, New Hampshire
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Gamble A, Mashburn T, Kennelty KA, Look KA, Westrick SC, Evon DM, Tudor G, Carpenter DM. Addressing the opioid epidemic through community pharmacy engagement: Study protocol for a randomized controlled trial. Contemp Clin Trials 2022; 121:106920. [PMID: 36096283 PMCID: PMC10731677 DOI: 10.1016/j.cct.2022.106920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Despite the authority to dispense naloxone, pharmacists have been reluctant to offer and dispense it, often due to discomfort communicating about the sensitive topic of opioid overdose. Because existing online naloxone trainings do not sufficiently address how to communicate effectively with patients about naloxone, Nalox-Comm, a training module designed to improve pharmacists' self-efficacy to engage in naloxone discussions, was developed. OBJECTIVE To describe the study protocol to evaluate the effectiveness of the Nalox-Comm training module on naloxone dispensing rates. METHODS A randomized controlled trial, which began in July 2021, is used to evaluate the pre-post Nalox-Comm training intervention. Sixty pharmacists are being recruited from 62 pharmacies part of a single grocery store chain in rural counties of the southeastern United States. After completing a baseline survey, pharmacists are observed by simulated patients (SPs) who rate the quality of their pre-training naloxone communication. Pharmacists are then invited to complete either a basic online naloxone training module (control group) or a newly developed Nalox-Comm training (experimental group), after which they complete a post-training survey and are observed a second time by SPs. Three months post-training, study participants complete a final follow-up survey. Naloxone dispensing records are obtained from each participating pharmacy to assess change in naloxone dispensing rates. CONCLUSION Informed by rural pharmacist stakeholders, the Nalox-Comm training module addresses communication barriers specific to rural communities. Compared to those in the control group, we hypothesize that pharmacies in the experimental group will dispense more naloxone in the three months post-training intervention.
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Affiliation(s)
- Abigail Gamble
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, 114 Karpen Hall, 1 University Heights, Campus Box 2125, Asheville, NC 28804, USA.
| | - Trish Mashburn
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, 114 Karpen Hall, 1 University Heights, Campus Box 2125, Asheville, NC 28804, USA
| | - Korey A Kennelty
- University of Iowa, College of Pharmacy, 115 S Grand Ave, Iowa City, IA 52242, USA
| | - Kevin A Look
- University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
| | - Salisa C Westrick
- Auburn University, Harrison College of Pharmacy, 2316 Walker Building, Auburn, AL 36849, USA
| | - Donna M Evon
- University of North Carolina at Chapel Hill, Department of Medicine, Burnett Womack Building, UNC Liver Center, Campus Box 7584, Chapel Hill, NC 27599, USA
| | - Gail Tudor
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, 114 Karpen Hall, 1 University Heights, Campus Box 2125, Asheville, NC 28804, USA
| | - Delesha M Carpenter
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, 114 Karpen Hall, 1 University Heights, Campus Box 2125, Asheville, NC 28804, USA
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Davis SA, Beznos B, Carpenter DM, Tudor G, Garcia N, Sleath B. Trends in Adolescent Asthma Responsibility Over a 12-Month Study Period. J Adolesc Health 2022; 70:478-482. [PMID: 34823985 PMCID: PMC8889904 DOI: 10.1016/j.jadohealth.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to assess factors that influence adolescent asthma responsibility and how patient- and parent-reported asthma responsibility changes over a 12-month period. METHODS One hundred sixty-four adolescents and their parents completed questionnaires at baseline and 12 months, including the asthma responsibility questionnaire, in which higher scores indicate greater adolescent responsibility. Multiple linear regression was used to assess how baseline asthma responsibility, self-efficacy, outcome expectations, and demographic characteristics were associated with 12-month asthma responsibility. RESULTS Asthma responsibility as reported by both adolescents and parents shifted significantly toward the adolescent over the study period (p < .001). Most individual scale items (e.g., noticing signs and symptoms of asthma, starting treatment when symptoms occur) also showed significant shifts toward greater adolescent responsibility. In the regression models, higher baseline asthma responsibility and older age were significant predictors of both higher adolescent- and parent-reported 12-month asthma responsibility, while female gender and mild asthma severity also predicted higher parent-reported asthma responsibility. CONCLUSIONS Asthma responsibility shifted toward adolescents over a 12-month period. Regardless of age and gender, all types of adolescents were able to improve their responsibility level based on adolescent-reported results. Older females, according to parent-reported results, were more likely to improve their responsibility. Providers need to make sure adolescents are learning all the necessary skills to manage asthma independently before they reach adulthood.
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Affiliation(s)
- Scott A. Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Delesha M. Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Beznos B, Sayner R, Carpenter DM, Davis SA, Lee C, Loughlin CE, Pepper JK, Garcia N, Tudor G, Sleath B. Communication About Adolescent and Caregiver Smoking and Vaping During Pediatric Asthma Visits: Implications for Providers. J Pediatr Health Care 2021; 35:401-407. [PMID: 34059406 DOI: 10.1016/j.pedhc.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/03/2020] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although rates of cigarette smoking among U.S. adolescents have declined, rates of vaping (i.e., using e-cigarettes) have increased. We conducted a secondary analysis of 359 transcripts of medical visits of adolescents with asthma to examine communication about caregiver and adolescent smoking and vaping. METHOD Adolescents aged 11-17 years with persistent asthma and their parents were enrolled from four pediatric clinics in 2015-2017. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched a video and then completed an asthma question prompt list before their visits. RESULTS Forty providers and 359 patients participated. Providers, adolescents, and caregivers discussed smoking during 38.2% of their visits. Vaping was never discussed. DISCUSSION There is room to improve how often providers in a primary care setting discuss smoking and vaping. Further investigation might focus on how a smoking and vaping prompt list for adolescents could increase tobacco discussions during visits.
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Sleath B, Carpenter DM, Davis SA, Sayner R, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Provider-adolescent discussion and provider education about asthma triggers during pediatric visits: results of a randomized trial. J Asthma 2020; 58:1565-1573. [PMID: 32867560 DOI: 10.1080/02770903.2020.1817936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We examined how an asthma question prompt list with video intervention influenced discussion of and provider education about asthma triggers. METHODS English or Spanish-speaking adolescents ages 11-17 with persistent asthma and their caregivers were enrolled from four pediatric clinics. Adolescents were randomized to the intervention or usual care groups. Adolescents in the intervention group watched the video on an iPad and then completed a one-page asthma question prompt list before their visits. All visits were audio-recorded. Generalized Estimating Equations were used to predict the number of trigger areas discussed and the number of areas providers educated adolescents about during visits. RESULTS Forty providers and 359 patients participated. Triggers were discussed during 89% of intervention group visits and 81% of usual care visits; providers educated adolescents about triggers during 59% of intervention group visits and 46% of usual care visits. More triggers were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents in the intervention group and when adolescents asked one or more questions during visits. More trigger areas were significantly more likely to be discussed if the adolescent was White and male. Providers were significantly more likely to educate adolescents whose family spoke Spanish at home about more trigger areas than adolescents who spoke English at home. CONCLUSIONS More trigger areas were significantly more likely to be discussed and providers educated about more trigger areas during visits of adolescents who received the intervention and when adolescents asked one or more questions.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Health Professions at Southern, New Hampshire University, Manchester, NH, USA
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Sleath B, Carpenter D, Sayner R, Davis SA, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Questions and reported medication problems from pediatric patients and caregivers after intervention. Am J Health Syst Pharm 2020; 76:366-373. [PMID: 31361837 DOI: 10.1093/ajhp/zxy057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The effectiveness of an asthma question prompt list with video intervention to increase question-asking during pediatric office visits among youth who reported medication problems was evaluated. METHODS English- or Spanish-speaking youth age 11-17 years with persistent asthma and their caregivers were enrolled from 4 pediatric clinics in a randomized controlled trial. Youth were randomized to intervention or usual care groups. Youth in the intervention group watched an educational video with their caregivers on an iPad. The youth then received a 1-page asthma question prompt list to complete before their visits. The audio of all baseline medical visits was recorded. Youth were interviewed and caregivers completed questionnaires at baseline and 6 months later. RESULTS A total of 40 providers and 359 of their patients participated. Youth who reported at least 1 medication problem who were in the intervention group were significantly more likely to ask 1 or more questions about medications during their visits than youth in the usual care group (odds ratio = 3.1, 95% confidence interval = 2.0, 4.1). Seventy-four percent of youth and 71% caregivers who reported the youth had problems using asthma medications at baseline still reported 1 or more problems 6 months later. CONCLUSION Among youth who reported 1 or more problems with using their asthma medications, the intervention significantly increased youth question-asking. Many youth- and caregiver-reported problems with using asthma medications persisted over time.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Ceila E Loughlin
- Professor, Clinical Associate Professor, Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, ME
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Sleath B, Carpenter D, Davis SA, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE. The impact of a question prompt list and video intervention on teen asthma control and quality-of-life one year later: results of a randomized trial. J Asthma 2019; 57:1029-1038. [PMID: 31311361 DOI: 10.1080/02770903.2019.1633542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study examined whether youth who received an asthma question prompt list/video intervention were more likely to have their asthma controlled and better quality-of-life at 12 months than youth who received usual care.Methods: English or Spanish-speaking youth ages 11-17 were enrolled and randomized to intervention or usual care. The 185 youth and parents in the intervention group watched the video on an iPad and then received a one-page asthma question prompt list to complete before their visits. One hundred seventy-four received usual care. Baseline and 6-month visits were audio-tape recorded. Generalized Estimating Equations were used to predict a youth's quality-of-life and whether asthma was controlled at 12 months.Results: Asthma control and quality-of-life improved significantly from baseline to 12-month follow-up in both intervention and usual care groups. Baseline asthma control and quality-of-life were significantly associated with 12-month asthma control and quality-of-life, respectively. Adolescents on a control medication at baseline were significantly more likely to have their asthma controlled at 12 months.Conclusions: Asthma control and quality-of-life did not improve significantly more in the intervention group than in the usual care group.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Davis SA, Carpenter D, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE, Sleath B. Effect of an Asthma Question Prompt List and Video Intervention on Adolescents' Medication Adherence 12 Months Later. Ann Pharmacother 2019; 53:683-689. [PMID: 30758220 DOI: 10.1177/1060028019831259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Many adolescents do not obtain the maximum benefit from their asthma medications. Improving patient-provider communication may improve adolescents' asthma knowledge, adherence, and clinical outcomes. OBJECTIVE To determine how a question prompt list and educational video intervention affect youth- and caregiver-reported medication adherence and self-reported medication problems. METHODS Adolescents with persistent asthma (n = 359; 56.4% with moderate to severe asthma) and their caregivers were enrolled in a randomized controlled trial at 4 pediatric clinics. Intervention group families received a question prompt list and watched a short video before seeing the provider; control families received usual care. Youth- and caregiver-reported medication adherence was measured with a Visual Analog Scale, ranging from 0 to 100. Generalized estimating equations were used to determine how the intervention and covariates were associated with medication adherence and reported problems at 12 months. RESULTS The intervention was not a significant predictor of medication adherence at 12 months. Higher caregiver education was associated with higher youth-reported adherence (β = 1.1; 95% CI = 0.1, 2.1; P = 0.036) and caregiver-reported adherence (β = 1.2; 95% CI = 0.3, 2.0; P = 0.006). The intervention was associated with fewer caregiver-reported problems at 12 months (β = -0.32; 95% CI = -0.48, -0.16; P < 0.001). CONCLUSIONS AND RELEVANCE A question prompt list and educational video decreased the number of caregiver-reported medication problems, but did not significantly affect medication adherence. Further research is needed to develop more effective interventions to improve medication adherence and outcomes.
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Affiliation(s)
- Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Improving youth question-asking and provider education during pediatric asthma visits. Patient Educ Couns 2018; 101:1051-1057. [PMID: 29402570 PMCID: PMC5963523 DOI: 10.1016/j.pec.2018.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits. METHODS English or Spanish-speaking youth ages 11-17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the video on an iPad and then completed an asthma question prompt list before their visits. Generalized estimating equations were used to analyze the data. RESULTS Forty providers and 359 patients participated. Intervention group youth were significantly more likely to ask one or more questions about medications, triggers, and environmental control than usual care youth. Providers were significantly more likely to educate intervention group youth about rescue medications, triggers, and environmental control. Intervention group caregivers were not significantly more likely to ask questions. CONCLUSION The intervention increased youth question-asking and provider education about medications, triggers, and environmental control. The intervention did not impact caregiver question-asking. PRACTICE IMPLICATIONS Providers/practices should consider having youth complete question prompt lists and watch the video with their parents before visits to increase youth question-asking during visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Daniel S Reuland
- Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, USA
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Sleath B, Carpenter DM, Walsh KE, Davis SA, Hayes Watson C, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Factors associated with adolescent and caregiver reported problems in using asthma medications. J Asthma 2018; 56:451-457. [PMID: 29668340 DOI: 10.1080/02770903.2018.1466312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to: (a) describe the types of medication problems/concerns youth with asthma and their caregivers reported and (b) examine the association between sociodemographic characteristics and youth and caregiver reported medication problems/concerns. METHODS English- and Spanish-speaking youth ages 11-17 with persistent asthma were recruited at four pediatric clinics. Youth were interviewed and caregivers completed questionnaires about reported asthma medication concerns/problems. Multiple logistic regression was used to analyze the data. RESULTS Three hundred and fifty-nine youth were recruited. Eighty percent of youth and 70% of caregivers reported one or more problems in using asthma medications. The most commonly reported problems by youth were: (a) hard to remember when to take the asthma medication (54%) and (b) hard to use asthma medication at school (34%). Younger children were significantly more likely to report difficulty in understanding their asthma medication's directions and difficulty reading the print on the medication's package. Caregivers' top-reported problem was that it is hard for their child to remember to take their asthma medications (49%). Caregivers without Medicaid were significantly more likely to express difficulty paying for their child's asthma medications. CONCLUSIONS Difficulty remembering to take asthma medication was a significant problem for youth and their caregivers. Providers should work with youth and their caregivers to identify asthma medication problems and discuss strategies to address those problems.
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Affiliation(s)
- Betsy Sleath
- a University of North Carolina at Chapel Hill, Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , Chapel Hill , USA
| | - Delesha M Carpenter
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Kathleen E Walsh
- c The James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center , Cincinnati , USA
| | - Scott A Davis
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Claire Hayes Watson
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Charles Lee
- g Polyglot Systems, Inc. , Morrisville , USA
| | - Ceila E Loughlin
- d University of North Carolina at Chapel Hill, Division of Pediatric Pulmonology, School of Medicine , Chapel Hill , USA
| | - Nacire Garcia
- b University of North Carolina at Chapel Hill, Eshelman School of Pharmacy , Chapel Hill , USA
| | - Daniel S Reuland
- e Division of General Internal Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Gail Tudor
- f Department of Science and Mathematics , Husson University , Bangor , USA
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Sleath B, Gratie D, Carpenter D, Davis SA, Lee C, Loughlin CE, Garcia N, Reuland DS, Tudor G. Reported Problems and Adherence in Using Asthma Medications Among Adolescents and Their Caregivers. Ann Pharmacother 2018; 52:855-861. [PMID: 29592540 DOI: 10.1177/1060028018766603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many factors affect youth adherence to asthma medications. Better understanding of the relationship between problems reported by youth in using asthma medications, self-efficacy, outcome expectations, and adherence is needed. OBJECTIVE The study examined the relationship between youth and caregiver problems in using asthma medications, asthma management self-efficacy, outcome expectations, and youth- and caregiver-reported adherence to asthma controller medications. METHODS Adolescents with persistent asthma and their caregivers were recruited at 4 pediatric practices. Youth were interviewed after their medical visit while caregivers completed a questionnaire. Multivariable linear regression was used to analyze the data. RESULTS Of 359 participating youth, 319 were on controller medications. Youth reported 60% average adherence, whereas caregivers reported 69%. Youth who reported difficulty using their inhaler correctly and youth who reported difficulty remembering to take their medications were significantly less likely to be adherent. Caregivers who reported that it was hard to remember when to give the asthma medications were significantly less likely to report their child being adherent. Both youth and caregivers with higher outcome expectations were significantly more likely to self-report being adherent. CONCLUSIONS Pharmacists and other health care providers should consider asking youth and caregivers about problems in using asthma medications, self-efficacy in managing asthma, and outcome expectations for following treatment regimens, so that they can help youth overcome difficulties they might have in managing their asthma.
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Affiliation(s)
- Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Gratie
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles Lee
- 2 Polyglot Systems, Inc, Morrisville, NC, USA
| | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, Garcia N, Etheridge D, Rivera-Duchesne L, Reuland DS, Batey K, Duchesne C, Tudor G. Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits. Patient Educ Couns 2017; 100:2005-2011. [PMID: 28550963 PMCID: PMC5600669 DOI: 10.1016/j.pec.2017.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objectives of this study were to: (a) describe teen feedback on an asthma question prompt list/video intervention designed to motivate teens to be more engaged during visits and (b) examine teen demographics associated with teen acceptance of the intervention. METHODS Two hundred and fifty-nine teens ages 11 to 17 with persistent asthma were enrolled into a randomized, controlled trial and assigned to either a standard care or an intervention group where they watched an educational video with their parents and received a prompt list to complete before visits. Teens were interviewed after visits. RESULTS Of the 185 teens randomized to the intervention group: 93% said teens should complete the prompt lists before visits; 95% recommended teens should watch the video before visits; teens with moderate/severe persistent asthma were significantly more likely to find the prompt list useful; non-White teens were significantly more likely to find the prompt list and video more useful. CONCLUSIONS Teens exposed to the question prompt list/video had very positive feedback about the intervention. PRACTICE IMPLICATIONS Providers/practices should consider having teens complete question prompt lists during pre-visit wait time for use during visits and watch the video with their parents before visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Charles Lee
- Polyglot Systems, Inc., 2000 Aerial Center Pkwy, Morrisville, NC 27560, USA.
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, CB 7217, Chapel Hill, NC 27599-7217, USA.
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Dana Etheridge
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Laura Rivera-Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Daniel S Reuland
- University of North Carolina at Chapel Hill, School of Medicine, Division of General Internal Medicine and Clinical Epidemiology, USA
| | - Karolyne Batey
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Cristina Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Gail Tudor
- Department of Science and Mathematics, Director of Institutional Research, Husson University, Bangor, ME 04401-2929, USA.
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Baxter B, Evans J, Morris R, Ghafoor U, Nana M, Weldon T, Tudor G, Hildebrandt T. Neonatal lumbar puncture: are clinical landmarks accurate? Arch Dis Child Fetal Neonatal Ed 2016; 101:F448-50. [PMID: 26785857 DOI: 10.1136/archdischild-2015-308894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/28/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The intercristal line (ICL), defined by the superior aspect of the iliac crest, is used to clinically identify the entry point for lumbar puncture (LP) in neonates. Accepted practice is to insert the needle at the L3/4 or L4/5 intervertebral space. AIM To investigate the vertebral level crossed by the ICL as determined by manual palpation and the ability of manual palpation to reliably identify a specified intervertebral space. METHOD A total of 30 term neonates were recruited. Paediatricians identified and marked the ICL and the intervertebral space above, with babies in left lateral position. The anatomical positions of both points and the end of the conus medullaris were confirmed using ultrasonography. RESULTS The ICL was marked from L2/3 to L5/S1. In 25 babies (83%), the ICL was identified at the desired vertebral level between L3/4 and L4/5. The intervertebral space above this line was marked between L1/2 to L4/5. The potential site for LP was identified higher than intended in 11 cases (36%). The end of the conus medullaris ranged from L1 to L3 terminating at L2 or lower in 11 cases (36%). CONCLUSIONS There are wide variations in the positions of the ICL and potential LP site. Using the ICL to guide LP does not appear to be accurate, raising the possibility of potential spinal cord damage.
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Affiliation(s)
- B Baxter
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - J Evans
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - R Morris
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - U Ghafoor
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - M Nana
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - T Weldon
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - G Tudor
- Department of Radiology, Princess of Wales Hospital, Bridgend, UK
| | - T Hildebrandt
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
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Sleath B, Carpenter DM, Lee C, Loughlin CE, Etheridge D, Rivera-Duchesne L, Reuland DS, Batey K, Duchesne CI, Garcia N, Tudor G. The development of an educational video to motivate teens with asthma to be more involved during medical visits and to improve medication adherence. J Asthma 2016; 53:714-9. [PMID: 27145093 DOI: 10.3109/02770903.2015.1135945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our objective was to develop a series of short educational videos for teens and parents to watch before pediatric visits to motivate teens to be more actively involved during their visits. METHODS The development of the short educational videos was theoretically guided by Social Cognitive Theory. First we conducted four focus groups with teens (ages 11 to 17) with asthma, four focus groups with the teens' parents, and seven focus groups with pediatric providers from four clinics. The research team, which included two teens with asthma and their parents, analyzed the focus group transcripts for themes and then developed the initial video script. Next, a visual storyboard was reviewed by focus groups with parents and four with teens to identify areas of the script for improvement. The English videos were then produced. Focus groups with Hispanic parents and teens were then conducted for advice on how to modify the videos to make a more culturally appropriate Spanish version. RESULTS Based on focus group results, teen newscasters narrate six one- to two-minute videos with different themes: (a) how to get mom off your back, (b) asthma triggers, (c) staying active with asthma, (d) tracking asthma symptoms, (e) how to talk to your doctor and (f) having confidence with asthma. Each video clip has three key messages and emphasizes how teens should discuss these messages with their providers. CONCLUSIONS Teens, parents, and providers gave us excellent insight into developing videos to increase teen involvement during medical visits.
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Affiliation(s)
- Betsy Sleath
- a Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Delesha M Carpenter
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Charles Lee
- c Polyglot Systems Inc. , Morrisville , NC , USA
| | - Ceila E Loughlin
- d University of North Carolina at Chapel Hill, School of Medicine , Chapel Hill , NC , USA
| | - Dana Etheridge
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Laura Rivera-Duchesne
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Daniel S Reuland
- e School of Medicine, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Karolyne Batey
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Cristina I Duchesne
- b Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Nacire Garcia
- a Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Sleath B, Carpenter DM, Blalock SJ, Sayner R, Muir KW, Slota C, Giangiacomo AL, Hartnett ME, Tudor G, Robin AL. Applying the resources and supports in self-management framework to examine ophthalmologist-patient communication and glaucoma medication adherence. Health Educ Res 2015; 30:693-705. [PMID: 26338986 PMCID: PMC4668753 DOI: 10.1093/her/cyv034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/06/2015] [Indexed: 05/04/2023]
Abstract
Little is known about how ophthalmologist-patient communication over time is associated with glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to glaucoma medications measured electronically over an 8-month period. In this longitudinal prospective cohort study, the main variables studied were ophthalmologist communication-individualized assessment, collaborative goal setting and skills enhancement. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited from six ophthalmology clinics. Patients' baseline and next follow-up visits were videotape-recorded. Patients were interviewed after their visits. Patients used medication event monitoring systems (MEMS) for 8 months after enrollment into the study, and adherence was measured electronically using MEMS for 240 days after their visits. Two hundred and seventy-nine patients participated. Patient race and regimen complexity were negatively associated with glaucoma medication adherence over an 8-month period. Provider communication behaviors, including providing education and positive reinforcement, can improve patient adherence to glaucoma medications over an 8-month period.
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Affiliation(s)
- B Sleath
- UNC Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services Research,
| | - D M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - S J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - R Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - K W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA
| | - C Slota
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - A L Giangiacomo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - M E Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA
| | - G Tudor
- Department of Science and Mathematics, Director of Institutional Research, Husson University, Bangor, ME 04401, USA
| | - A L Robin
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA, Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD 21215, USA
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Sayner R, Carpenter DM, Robin AL, Blalock SJ, Muir KW, Vitko M, Hartnett ME, Lawrence SD, Giangiacomo AL, Tudor G, Goldsmith JA, Sleath B. How glaucoma patient characteristics, self-efficacy and patient-provider communication are associated with eye drop technique. Int J Pharm Pract 2015; 24:78-85. [PMID: 26303667 DOI: 10.1111/ijpp.12215] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to examine the extent to which patient characteristics, eye drop technique self-efficacy, and ophthalmologist-patient communication about eye drop administration are associated with glaucoma patients' ability to instil a single drop, have the drop land in the eye, and avoid touching the applicator tip of the medication bottle to the eye or face while self-administering eye drops. METHODS Glaucoma patients (n = 279) were recruited from six ophthalmology clinics. Medical visits were videotape-recorded. Afterwards, patients were interviewed and demonstrated administering an eye drop on a videotaped-recording. Generalized estimating equations were used to analyse the data. KEY FINDINGS Ophthalmologists provided eye drop administration instruction to 40 patients. Patients with more years of education were significantly more likely to both instil a single drop (P = 0.017) and have the drop land in their eye (P = 0.017). Women were significantly more likely to touch the applicator tip to their eyes or face (P = 0.014). Patients with severe glaucoma (P = 0.016), women (P = 0.026), and patients who asked at least one eye drop administration question (P = 0.001) were significantly less likely to instil a single drop. Patients with arthritis were significantly less likely to have the drop land in their eye (P = 0.008). African American patients were significantly less likely to touch the applicator tip to their eyes or face (P = 0.008). CONCLUSIONS Some glaucoma patients have a difficult time self-administering eye drops. As so few patients received eye drop administration instruction from their providers, there is an opportunity for pharmacists to complement care.
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Affiliation(s)
- Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Asheville, NC, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of International Health, Bloomberg School of Public Health, Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, NC, USA
| | - Michelle Vitko
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Elizabeth Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Scott D Lawrence
- Glaucoma Service, University of North Carolina Kittner Eye Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gail Tudor
- Department of Science and Mathematics, Institutional Research, Husson University, Bangor, ME, USA
| | - Jason A Goldsmith
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sayner R, Carpenter DM, Blalock SJ, Robin AL, Muir KW, Hartnett ME, Giangiacomo AL, Tudor G, Sleath B. Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors. Clin Ther 2015; 37:1975-85. [PMID: 26164785 DOI: 10.1016/j.clinthera.2015.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Glaucoma medications can improve clinical outcomes when patients adhere to their medication regimen. Providers often ask patients with glaucoma to self-report their adherence, but the accuracy of self-reporting has received little scientific attention. The purpose of this article was to compare a self-reported medication adherence measure with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors. An additional goal was to identify which patient characteristics were associated with overreporting adherence on the self-reported measure. METHODS English-speaking adult patients with glaucoma were recruited from 6 ophthalmology practices for this observational cohort study. Patients were interviewed after their initial visit and were given MEMS contains, which recorded adherence over a 60-day period. MEMS percent adherence measured the percentage of the prescribed number of doses taken. MEMS-measured timing adherence assessed the percent doses taken on time. Patients self-reported adherence to their glaucoma medications on a visual analog scale (VAS) ~60 days after the baseline visit. Bivariate analyses and logistic regressions were used to analyze the data. Self-reported medication adherence on the VAS was plotted against MEMS adherence to illustrate the discrepancy between self-reported and electronically monitored adherence. FINDINGS The analyses included 240 patients who returned their MEMS containers and self-reported medication adherence at the 60-day follow-up visit. Compared with MEMS-measured percent adherence, 31% of patients (n = 75) overestimated their adherence on the VAS. Compared with MEMS-measured timing adherence, 74% (n = 177) of patients overestimated their adherence. For the MEMS-measured percent adherence, logistic regression revealed that patients who were newly prescribed glaucoma medications were significantly more likely to overreport adherence on the VAS (odds ratio, 3.07 [95% CI, 1.22-7.75]). For the MEMS-measured timing adherence, being male (χ(2) test, 6.78; P = 0.009) and being prescribed glaucoma medications dosed multiple times daily (χ(2) test, 4.02; P = 0.045) were significantly associated with patients overreporting adherence. However, only male sex remained a significant predictor of overreporting adherence in the logistic regression (odds ratio, 4.05 [95% CI, 1.73-9.47]). IMPLICATIONS Many patients with glaucoma, especially those newly diagnosed, overestimated their medication adherence. Because patients were likely to overreport the percent doses taken and timing adherence, providers may want to ask patients additional questions about when they take their glaucoma medications to potentially detect issues with taking these medications on time.
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Affiliation(s)
- Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Alan L Robin
- Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, Maryland; Department of Ophthalmology and Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina; Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina
| | - Mary Elizabeth Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | | | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, Maine
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sleath B, Blalock SJ, Carpenter DM, Sayner R, Muir KW, Slota C, Lawrence SD, Giangiacomo AL, Hartnett ME, Tudor G, Goldsmith JA, Robin AL. Ophthalmologist-patient communication, self-efficacy, and glaucoma medication adherence. Ophthalmology 2015; 122:748-54. [PMID: 25542521 PMCID: PMC4994530 DOI: 10.1016/j.ophtha.2014.11.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To examine the associations of provider-patient communication, glaucoma medication adherence self-efficacy, and outcome expectations with glaucoma medication adherence. DESIGN Prospective, observational cohort study. PARTICIPANTS Two hundred seventy-nine patients with glaucoma who were newly prescribed or taking glaucoma medications were recruited at 6 ophthalmology clinics. METHODS Patients' visits were video recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits. MAIN OUTCOME MEASURES The following adherence variables were measured for the 60-day period after their visits: whether the patient took 80% or more of the prescribed doses, percentage of the correct number of prescribed doses taken each day, and percentage of the prescribed doses taken on time. RESULTS Higher glaucoma medication adherence self-efficacy was associated positively with better adherence with all 3 measures. Black race was associated negatively with percentage of the correct number of doses taken each day (β = -0.16; P < 0.05) and whether the patient took 80% or more of the prescribed doses (odds ratio, 0.37; 95% confidence interval, 0.16-0.86). Physician education about how to administer drops was associated positively with percentage of the correct number of doses taken each day (β = 0.18; P < 0.01) and percentage of the prescribed doses taken on time (β = 0.15; P < 0.05). CONCLUSIONS These findings indicate that provider education about how to administer glaucoma drops and patient glaucoma medication adherence self-efficacy are associated positively with adherence.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, and Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina
| | - Catherine Slota
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott D Lawrence
- Glaucoma Service, Kittner Eye Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Mary Elizabeth Hartnett
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, Maine
| | - Jason A Goldsmith
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Alan L Robin
- Department of Ophthalmology, University of Maryland, Baltimore, Maryland; Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan; Department of International Health, Bloomberg School of Public Health, and Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Carpenter DM, Stover A, Slota C, Ayala GX, Yeatts K, Tudor G, Davis S, Williams D, Sleath B. An evaluation of physicians’ engagement of children with asthma in treatment-related discussions. J Child Health Care 2014; 18:261-74. [PMID: 23818146 PMCID: PMC5379471 DOI: 10.1177/1367493513489780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela Stover
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Slota
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- Graduate School of Public Health, San Diego State University, California, USA
| | - Karen Yeatts
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Maine, USA
| | | | - Dennis Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA,Cecil G Sheps Center for Health Services Research, North Carolina, USA
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Sleath B, Sayner R, Blalock SJ, Carpenter DM, Muir KW, Hartnett ME, Tudor G, Lawrence S, Giangiacomo AL, Robin AL. Patient question-asking about glaucoma and glaucoma medications during videotaped medical visits. Health Commun 2014; 30:660-668. [PMID: 25061778 DOI: 10.1080/10410236.2014.888387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients' visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.
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Affiliation(s)
- Betsy Sleath
- a Division of Pharmaceutical Outcomes and Policy , University of North Carolina Eshelman School of Pharmacy
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Gillette C, Carpenter DM, Ayala GX, Williams DM, Davis S, Tudor G, Yeatts K, Sleath B. How often do providers discuss asthma action plans with children? Analysis of transcripts of medical visits. Clin Pediatr (Phila) 2013; 52:1161-7. [PMID: 24137029 DOI: 10.1177/0009922813506256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine how often providers discussed asthma action plans with children and their caregivers and child, clinical, and provider characteristics that were associated with those discussions. METHOD This was a cross-sectional analysis of audio-recorded visits between 35 general pediatric providers and 260 children (8-16 years old) with asthma and their caregivers. The visits were transcribed into text. The transcripts were coded for discussions about written asthma action plans. RESULTS Providers discussed written asthma action plans with 21.0% of children and caregivers. Providers were significantly more likely to discuss asthma action plans when the child was enrolled in Medicaid, the visit was asthma related, the visit was longer, the provider was not White, or more provider education. CONCLUSION In our sample, providers rarely discussed action plans with children and their caregivers. Providers should discuss asthma action plans with every child with persistent asthma and their caregivers and revise them regularly.
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Andrianirina A, Renard C, Akladios C, Baldauf J, Tudor G, Le Van Quyen P, Madis S, Bellocq J, Avérous G. Y-a-t-il une place pour le test HPV dans les frottis ASC-H ? Ann Pathol 2013. [DOI: 10.1016/j.annpat.2013.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sleath B, Carpenter DM, Beard A, Gillette C, Williams D, Tudor G, Ayala GX. Child and caregiver reported problems in using asthma medications and question-asking during paediatric asthma visits. Int J Pharm Pract 2013; 22:69-75. [PMID: 23718931 DOI: 10.1111/ijpp.12043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The objectives of the study were to describe the extent to which lay caregivers and children who reported asthma medication problems asked medication questions during their medical visits. METHODS Children with asthma ages 8 through 16 years and their caregivers were recruited at five paediatric practices and their medical visits were audiotape recorded. Children were interviewed after their medical visits and caregivers completed questionnaires. A home visit was conducted 1 month later. Generalized estimating equations were used to analyse the data. KEY FINDINGS Two hundred and ninety six families participated. Among those caregivers who reported asthma medication problems, only 35% had asked at least one medication question during the visit. Among children who reported asthma medication problems, only 11% had asked at least one medication question during their consultation. Caregivers and children who reported a problem with their asthma medications were significantly more likely to have asked medication questions if providers had asked more questions about control medications. Children who reported higher asthma management self-efficacy were significantly more likely to have asked an asthma medication question. CONCLUSIONS Only one in three caregivers and one in 10 children who reported an asthma medication problem asked a question during their medical visits and many still reported these problems 1 month later. Pharmacists should encourage caregivers and children to report problems they may be having using their asthma medications.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Michault C, Ambrosetti D, Tudor G, Devouassoux-Shisheboran M, Bellocq JP, Michiels JF. Cancer de l’ovaire – comptes rendus ACP des pièces d’exérèse pour tumeurs malignes et frontières de l’ovaire. Bilan d’une évaluation de l’AFAQAP sur 23 structures en 2011. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Michault C, Ambrosetti D, Tudor G, Vacher-Lavenu MC, Bellocq JP, Michiels JF. Cancer du col utérin – comptes rendus ACP des pièces d’exérèse pour carcinome invasif. Bilan d’une évaluation de l’AFAQAP sur 26 structures en 2011. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Than MM, Witherspoon J, Tudor G, Saklani A. Gastric outlet obstruction secondary to percutaneous endoscopic gastrostomy tube placement. Endoscopy 2012; 44 Suppl 2 UCTN:E269-70. [PMID: 22814915 DOI: 10.1055/s-0032-1309712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M M Than
- Department of Colorectal Surgery, Princess of Wales Hospital, Bridgend, United Kingdom.
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Sleath B, Carpenter DM, Slota C, Williams D, Tudor G, Yeatts K, Davis S, Ayala GX. Communication during pediatric asthma visits and self-reported asthma medication adherence. Pediatrics 2012; 130:627-33. [PMID: 22945409 PMCID: PMC3457624 DOI: 10.1542/peds.2012-0913] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our objectives were to examine how certain aspects of provider-patient communication recommended by national asthma guidelines (ie, provider asking for child and caregiver input into the asthma treatment plan) were associated with child asthma medication adherence 1 month after an audio-taped medical visit. METHODS Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All medical visits were audio-tape recorded. Children were interviewed 1 month after their medical visits, and both children and caregivers reported the child's control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence 1 month later. RESULTS Children (n = 259) completed a home visit interview ∼1 month after their audio-taped visit, and 216 of these children were taking an asthma control medication at the time of the home visit. Children reported an average control medication adherence for the past week of 72%, whereas caregivers reported the child's average control medication adherence for the past week was 85%. Child asthma management self-efficacy was significantly associated with both child- and caregiver-reported control medication adherence. When providers asked for caregiver input into the asthma treatment plan, caregivers reported significantly higher child medication adherence 1 month later. CONCLUSIONS Providers should ask for caregiver input into their child's asthma treatment plan because it may lead to better control medication adherence.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Beard Hall, CB# 7360, Chapel Hill, NC 27599-7360, USA.
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Sleath B, Carpenter DM, Ayala GX, Williams D, Davis S, Tudor G, Yeatts K, Gillette C. Communication during pediatric asthma visits and child asthma medication device technique 1 month later. J Asthma 2012; 49:918-25. [PMID: 22974226 DOI: 10.3109/02770903.2012.719250] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated how provider demonstration of and assessment of child use of asthma medication devices and certain aspects of provider-patient communication during medical visits is associated with device technique 1 month later. METHODS Two hundred and ninety-six children aged 8-16 years with persistent asthma and their caregivers were recruited at five North Carolina pediatric practices. All of the medical visits were audio-tape recorded. Children were interviewed 1 month later and their device technique was observed and rated. RESULTS If the provider asked the child to demonstrate metered dose inhaler technique during the medical visit, then the child was significantly more likely to perform a greater percentage of inhaler steps correctly 1 month later. Children with higher asthma management self-efficacy scores were significantly more likely to perform a greater percentage of diskus steps correctly. Additionally, children were significantly more likely to perform a greater percentage of diskus steps correctly if the provider discussed a written action plan during the visit. Children were significantly more likely to perform a greater percentage of turbuhaler steps correctly if they asked more medication questions. CONCLUSIONS Providers should ask children to demonstrate their inhaler technique during medical visits so that they can educate children about proper technique and improve child asthma management self-efficacy. Providers should encourage children to ask questions about asthma medication devices during visits and they should discuss asthma action plans with families.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, 27599-7573, USA.
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Washington D, Yeatts K, Sleath B, Ayala GX, Gillette C, Williams D, Davis S, Tudor G. Communication and education about triggers and environmental control strategies during pediatric asthma visits. Patient Educ Couns 2012; 86:63-69. [PMID: 21600721 PMCID: PMC3168678 DOI: 10.1016/j.pec.2011.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 03/08/2011] [Accepted: 04/09/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine the extent to which providers, caregivers, and pediatric asthma patients discussed environmental trigger control during primary care visits, and any demographic characteristics associated with having these discussions. METHODS Children ages 8-16 with persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio-tape recorded. We administered questionnaires to the child's caregiver following the visit. RESULTS Two hundred and ninety-six patients had useable audio-tape data. Providers typically discussed at least one type of asthma trigger during these visits (86% of visits). The most common discussions were about exercise (70%), the weather/season (42%), and allergies/pollen (35%). Environmental control strategies were discussed less frequently (27% of visits). Providers educated the patient and their caregiver about environmental control strategies during 14% of the visits. CONCLUSION Although providers frequently discuss some environmental triggers and provide education, there is room for more comprehensive discussions of these issues, which may contribute to decreased asthma exacerbations. PRACTICE IMPLICATIONS Providers, or alternatively, asthma health educators, should devote more time to discussing environmental asthma triggers and control strategies with pediatric asthma patients and their families, as they are important components of overall asthma control.
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Affiliation(s)
- Deidre Washington
- Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, University of North Carolina, USA.
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Sleath BL, Carpenter DM, Sayner R, Ayala GX, Williams D, Davis S, Tudor G, Yeatts K. Child and caregiver involvement and shared decision-making during asthma pediatric visits. J Asthma 2011; 48:1022-31. [PMID: 22022958 PMCID: PMC3263821 DOI: 10.3109/02770903.2011.626482] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine (1) the extent to which caregivers and children asked asthma management questions during pediatric asthma visits; (2) the extent to which providers engaged in shared decision-making with these caregivers and children; and (3) the factors associated with question asking and shared decision-making. METHODS Children aged 8-16 years with mild persistent asthma, moderate persistent asthma, or severe persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio tape recorded. Generalized estimating equations were used to analyze the data. RESULTS Only 13% of children and 33% of caregivers asked one or more questions about asthma management. Caregivers were more likely to ask questions about their child's medications. Providers obtained child input into their asthma management plan during only 6% of encounters and caregiver input into their child's asthma management plan during 10% of visits. CONCLUSION Given the importance of involving patients during healthcare visits, providers need to consider asking for and including child and caregiver inputs into asthma management plans so that shared decision-making can occur more frequently.
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Affiliation(s)
- Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7573, USA.
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Renard C, Michiels JF, Emprou C, Tudor G, Weingertner N, Erb S, Muller J, Bellocq JP. Cancer de la prostate – comptes rendus ACP des pièces d’exérèse. Bilan d’une évaluation de l’AFAQAP sur 26 structures en 2010. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Sleath B, Ayala GX, Washington D, Davis S, Williams D, Tudor G, Yeatts K, Gillette C. Caregiver rating of provider participatory decision-making style and caregiver and child satisfaction with pediatric asthma visits. Patient Educ Couns 2011; 85:286-9. [PMID: 20971603 PMCID: PMC3070191 DOI: 10.1016/j.pec.2010.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 09/14/2010] [Accepted: 09/25/2010] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between caregiver ratings of provider use of a participatory decision-making style and caregiver and child satisfaction with their pediatric asthma visits. METHODS Children ages 8 through 16 with persistent asthma and their caregivers were recruited at five pediatric practices. Children were interviewed and caregivers completed questionnaires after their child's medical visits. Generalized estimating equations were used to analyze the data. RESULTS Three hundred and twenty children were recruited. Caregivers were significantly more satisfied with providers who they perceived as using more of a participatory decision-making style (beta=17.80, p<0.001). Children (beta=-0.10, p<0.05) and caregivers (beta=-0.21, p<0.01) were significantly more satisfied with younger providers. Children were significantly more satisfied with providers who knew them better as a person (beta=2.87, p<0.001). CONCLUSIONS Caregivers were more satisfied with providers who they perceived as involving them more during treatment decisions made during pediatric asthma visits. PRACTICE IMPLICATIONS Providers should attempt to use a more participatory decision-making style with families during pediatric asthma visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes & Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC 27599-7573, USA.
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Renard C, Galateau-Sallé F, Tudor G, Emprou C, Erb S, Muller J, Michiels JF, Bellocq JP. Cancer du poumon – comptes rendus ACP des pièces d’exérèse. Bilan d’une évaluation de l’AFAQAP sur 20 structures en 2010. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Tudor G, Ambrosetti D, Michiels JF, Renard C, Emprou C, Erb S, Muller J, Bellocq JP. Cancer du rein – comptes rendus ACP des pièces d’exérèse. Bilan d’une évaluation de l’AFAQAP sur 15 structures en 2010. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Renard C, Mathelin C, Weingertner N, Tudor G, Bellocq JP, Chenard MP. Perte d’expression de HER2 entre carcinome in situ et infiltrant : réalité ou biais d’échantillonnage ? À propos d’une série de 100 cancers du sein. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tudor G, de Micco C, Renard C, Emprou C, Erb S, Muller J, Michiels JF, Bellocq JP. Cancer de la thyroïde – comptes rendus ACP des pièces d’exérèse. Bilan d’une évaluation de l’AFAQAP sur 32 structures en 2010. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sleath B, Carpenter DM, Ayala GX, Williams D, Davis S, Tudor G, Yeatts K, Gillette C. Provider Discussion, Education, and Question-Asking about Control Medications during Pediatric Asthma Visits. Int J Pediatr 2011; 2011:212160. [PMID: 21860627 PMCID: PMC3155790 DOI: 10.1155/2011/212160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 05/09/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022] Open
Abstract
Background. Few studies have explored how providers communicate about control medications during pediatric asthma visits. Objectives. The purpose of this study was to: (a) describe the extent to which providers discuss, educate, and ask children and their caregivers questions about control medications and (b) examine how child, caregiver, and provider characteristics are associated with provider communication about control medications during pediatric asthma visits. Methods. Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at five pediatric practices in nonurban areas of North Carolina. After audio-tape recording medical visits, caregivers completed questionnaires and children were interviewed. Generalized estimating equations were used to analyze the data. Results. Providers educated families about control medications during 61% of the visits, and they asked questions about control medications during 67% of visits. Providers were significantly more likely to discuss control medications if a child was taking a control medication, if the child had moderate to severe persistent asthma, and if the child was present for an asthma-related visit. Conclusion. Providers need to educate and ask more questions of families about side effects and how well control medications are working.
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Affiliation(s)
- Betsy Sleath
- The University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB No. 7590, Chapel Hill, NC 27599-7590, USA
| | - Delesha M. Carpenter
- The University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Dieo, CA 92182-4162, USA
| | - Dennis Williams
- The University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Stephanie Davis
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7217, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, ME, USA
| | - Karin Yeatts
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA
| | - Chris Gillette
- The University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Sleath B, Ayala GX, Gillette C, Williams D, Davis S, Tudor G, Yeatts K, Washington D. Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics 2011; 127:642-8. [PMID: 21444594 PMCID: PMC3065074 DOI: 10.1542/peds.2010-1206] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits. PATIENTS AND METHODS Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants. RESULTS Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits. CONCLUSIONS There is a need for providers to demonstrate proper asthma medication and monitoring device techniques to children and to have children demonstrate to proficiency. The 2007 National Heart, Lung, and Blood Institute expert panel report on the diagnosis and management of asthma encourages providers to educate children on these techniques.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Beard Hall, CB 7360, Chapel Hill, NC 27599, USA.
| | - Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California; and
| | | | - Dennis Williams
- Pharmacy Practice, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie Davis
- Pharmacy Practice, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Bangor, Maine
| | - Karin Yeatts
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
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Murphy LB, Helmick CG, Schwartz TA, Renner JB, Tudor G, Koch GG, Dragomir AD, Kalsbeek WD, Luta G, Jordan JM. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage 2010; 18:1372-9. [PMID: 20713163 PMCID: PMC2998063 DOI: 10.1016/j.joca.2010.08.005] [Citation(s) in RCA: 211] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 07/30/2010] [Accepted: 08/10/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). DESIGN We analyzed data from the Johnston County Osteoarthritis Project [a longitudinal population-based study of OA in North Carolina, United States (n=3068)]. The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ≥ 2 (anterior-posterior pelvis X-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). RESULTS Lifetime risk of symptomatic hip OA was 25.3% [95% confidence interval (CI)=21.3-29.3]. Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. CONCLUSION The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk.
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Affiliation(s)
- Louise B Murphy
- Arthritis Program, Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,Address correspondence and reprint requests to: Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-51, Atlanta, GA, 30341, USA. Tel: 1-770-488-5102; Fax: 1-770-488-5486;
| | - Charles G. Helmick
- Arthritis Program, Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Jordan B Renner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gary G Koch
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Anca D Dragomir
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - William D Kalsbeek
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Gheorghe Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jackson B, Somerville T, Taylor C, Tudor G, Booth C. 648 Ex vivo assay to monitor response to chemotherapeutic agents in plucked human hairs. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sleath B, Ayala GX, Davis S, Williams D, Tudor G, Yeatts K, Washington D, Gillette C. Child- and caregiver-reported problems and concerns in using asthma medications. J Asthma 2010; 47:633-8. [PMID: 20632916 DOI: 10.3109/02770901003692785] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of the study was to (a) describe the types of medication problems/concerns that asthmatic children and their caregivers reported and (b) examine the association between child and caregiver demographic and sociocultural characteristics and reported asthma medication problems/concerns. METHODS Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at five pediatric practices in nonurban areas of North Carolina. Children were interviewed and caregivers completed questionnaires after their child's medical visits about reported problems/concerns in using asthma medications. Multivariate logistic regression was used to analyze the data. RESULTS Three hundred and twenty children were recruited. Eighty-seven percent of the children reported a problem or concern in using their asthma medications. Approximately 40% of children reported side effects and a similar percent stated that it was hard to understand the directions on their medicines; in addition 60% reported that it was hard to remember when to take their medicines. Females and non-White children were significantly more likely to report they were not sure how to use an inhaler than males and White children. Younger and non-White children were significantly more likely to report it was hard to understand the directions on their medicines than older and White children. Caregivers were most likely to report that their children were bothered a little or a lot by side effects (31%) and a similar percent (29%) were not sure their children were using their inhalers properly. Caregivers without Medicaid were significantly more likely to report difficulty paying for the asthma medications. CONCLUSIONS Medication side effects are a significant problem area for both children and their caregivers, and inhaler skill-based training is particularly needed for non-White children. Health care providers should discuss with children and their caregivers the types of problems/concerns that children may have when using their asthma medications.
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Affiliation(s)
- Betsy Sleath
- Department of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC 27599-7573, USA.
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Beard AJ, Sleath B, Blalock SJ, Roth M, Weinberger M, Tudor G, Chewning B. Predictors of rheumatoid arthritis patient-physician communication about medication costs during visits to rheumatologists. Arthritis Care Res (Hoboken) 2010; 62:632-9. [PMID: 20191466 DOI: 10.1002/acr.20083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To examine the frequency with which medication costs are discussed, and the predictors of these discussions, during visits between rheumatologists and their patients with rheumatoid arthritis (RA). METHODS Audiotapes of medical visits, patient questionnaires, medical records, and physician questionnaires were collected from March 2003 to December 2005. Data were collected from 200 RA patients from 4 rheumatology clinics. Audiotapes were coded for the presence of communication about medication costs using a detailed coding instrument. The final analysis sample included 193 patients and 8 rheumatologists. Stepwise multivariable logistic regression was used to examine the role of patient, physician, medication, and relationship characteristics on discussions of medication costs. RESULTS Despite medication changes being made in more than 50% of the visits, only 34% of those visits included discussions of medication-related costs; 48% of these discussions were initiated by patients. In multivariable logistic regression models, communication about medication costs occurred more often when patients were white (compared with nonwhite) and reported an annual income of $20,000-$59,999 (compared with those earning > or =$60,000). Discussions about medication costs also were more common when physicians were white. CONCLUSION Although medication changes were common, medication costs were only discussed in one-third of the visits. Communication about medication costs was more common among patients who were white and in a middle income category. Disparities in communication about medication costs have the potential to negatively impact prescribing and subsequent medication use. Further research should examine potential disparities in communication about medication costs.
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Affiliation(s)
- Ashley J Beard
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
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Sleath B, Byrd JE, Robin AL, Covert D, Tudor G. Glaucoma patient receipt of information and instruction on how to use their eye drops. International Journal of Pharmacy Practice 2010. [DOI: 10.1211/ijpp.16.1.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objectives
The objectives of the study are: (a) to describe the sources of glaucoma patient's medication information and instruction, and (b) to examine the influence of patient characteristics on the sources of medication information and instruction obtained.
Setting
Four geographically distinct ophthalmology practices in the US.
Method
A survey assessing receipt of information and instruction on how to use eye drops was completed by 324 patients. Multivariable logistic and ordinal regression were used to analyse the data.
Key findings
Fifteen per cent of patients stated that no-one gave them information about their glaucoma medications, and 20% of patients stated that no-one showed them how to use their glaucoma medications. Ophthalmologists were the individuals most likely and ophthalmic technicians were the second-most likely to give the patients information and instruction on how to use their medications. Fourteen per cent of patients stated that pharmacists gave them information about their eye drops. Patients very rarely reported pharmacists or primary care physicians showing them how to use their glaucoma medications. Fourteen per cent of patients reported going to the internet for information. Younger patients were significantly more likely to receive information about glaucoma and glaucoma medications from the internet than older patients.
Conclusion
Patients are receiving information about glaucoma medications from numerous sources, yet almost one out of five glaucoma patients reported receiving no instruction on the instillation of their eye drops. Pharmacists have the opportunity to educate glaucoma patients about using their medications by giving them information and showing them how to administer the medications correctly.
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Affiliation(s)
- Betsy Sleath
- University of North Carolina School of Pharmacy, USA
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, USA
| | - John E Byrd
- University of North Carolina School of Pharmacy, USA
| | - Alan L Robin
- Department of International Health, Bloomberg School of Public Health and Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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