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Park LG, Chi S, Pitsenbarger S, Johnson JK, Shah AJ, Elnaggar A, von Oppenfeld J, Cho E, Harzand A, Whooley MA. Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study. JMIR Cardio 2024; 8:e54823. [PMID: 38483450 PMCID: PMC10941834 DOI: 10.2196/54823] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. OBJECTIVE This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. METHODS We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. RESULTS In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants' feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. CONCLUSIONS Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR.
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Affiliation(s)
- Linda G Park
- Department of Community Health Systems, University of California San Francisco, San Francisco, CA, United States
- Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Serena Chi
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States
| | | | - Julene K Johnson
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Abdelaziz Elnaggar
- Department of Community Health Systems, University of California San Francisco, San Francisco, CA, United States
- Veterans Affairs Medical Center, San Francisco, CA, United States
| | | | - Evan Cho
- College of Medicine, California Northstate University, Elk Grove, CA, United States
| | - Arash Harzand
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Mary A Whooley
- Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
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Park LG, Ng F, Handley MA. The use of the Capability-Opportunity- Motivation Behavior (COM-B) model to identify barriers to medication adherence and the application of mobile health technology in adults with coronary heart disease: A qualitative study. PEC Innov 2023; 3:100209. [PMID: 37753273 PMCID: PMC10518702 DOI: 10.1016/j.pecinn.2023.100209] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Objective Among patients with coronary heart disease, we sought to address the research questions of: 1) What is the acceptability of applying a technology-enabled approach to support medication adherence?; and 2) What are barriers to medication adherence using the Capability-Opportunity-Motivation Behavior (COM-B) model as a guiding framework? Methods Applying qualitative research methods, we employed a series of 3 focus groups per individual (total 9 sessions). Coded data from thematic analysis were mapped to the COM-B model components for meaningful associations. Results Fourteen participants were recruited (median age 69.5 ± 11, 50% female). Barriers to medication adherence were organized along these COM-B domains: psychological capability (forgetfulness, distractions, fear of side effects), physical opportunity (inaccessible medications, inability to renew prescriptions), reflective (burdening family members), and automatic motivation (medication fatigue, health decline). Conclusions Tailored text messaging and mobile phone apps were perceived as helpful tools for medication adherence. The COM-B model was useful to provide a comprehensive, theory-driven evaluation of patients' beliefs and motivations on whether to engage in medication adherence. Innovation To date, text messaging and mobile applications have not been widely implemented in the clinical setting and provide a major opportunity to innovate on approaches to address medication adherence.
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Affiliation(s)
- Linda G. Park
- University of California, San Francisco School of Nursing, Department of Community Health Systems, San Francisco Veterans Affair Medical Center, 2 Koret Way, Room 531A, San Francisco, CA 94143-0610, United States of America
| | - Fion Ng
- Department of Community Health Programs for Youth, San Francisco Department of Public Health, United States of America
| | - Margaret A. Handley
- Departments of Epidemiology and Biostatistics and Medicine, Division of General Internal Medicine, University of California, San Francisco, United States of America
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Harzand A, Alrohaibani A, Idris MY, Spence H, Parrish CG, Rout PK, Nazar R, Davis-Watts ML, Wright PP, Vakili AA, Abdelhamid S, Vathsangam H, Adesanya A, Park LG, Whooley MA, Wenger NK, Zafari AM, Shah AJ. Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial. BMC Cardiovasc Disord 2023; 23:453. [PMID: 37700245 PMCID: PMC10496208 DOI: 10.1186/s12872-023-03471-w] [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: 01/25/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. METHODS Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. RESULTS Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. CONCLUSIONS The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016).
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Affiliation(s)
- Arash Harzand
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Alaaeddin Alrohaibani
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Muhammed Y Idris
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Cate G Parrish
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Pratik K Rout
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rene Nazar
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | - Phyllis P Wright
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | - Alexander A Vakili
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Smah Abdelhamid
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
| | | | | | - Linda G Park
- School of Nursing, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Nanette K Wenger
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - A Maziar Zafari
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amit J Shah
- Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Choi KR, Brush BL, Chapman SA, Costa DK, Feder SL, Gutierrez JI, Heilemann MV, Manojlovich M, Noonan D, Park LG, Potempa K, Sochalski J. Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program. Nurs Outlook 2023; 71:102024. [PMID: 37487421 DOI: 10.1016/j.outlook.2023.102024] [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: 04/06/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership. PURPOSE To evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP. METHODS We describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index). CONCLUSION There were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policy DISCUSSION: This study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.
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Affiliation(s)
- Kristen R Choi
- School of Nursing, University of California, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA; National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Barbara L Brush
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA; National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Deena Kelly Costa
- School of Nursing, Yale University, Orange, CT; Section of Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT; National Clinician Scholars Program, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
| | - Shelli L Feder
- School of Nursing, Yale University, Orange, CT; National Clinician Scholars Program, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT; Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT
| | - José I Gutierrez
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - MarySue V Heilemann
- School of Nursing, University of California, Los Angeles, CA; National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Milisa Manojlovich
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Devon Noonan
- School of Nursing, Duke University, Durham, NC; National Clinician Scholars Program, Clinical and Translational Science Institute, Duke University, Durham, NC
| | - Linda G Park
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Julie Sochalski
- School of Nursing, Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, Philadelphia, PA; National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Abstract
OBJECTIVES This scoping review aims to examine the caregiving experiences of Korean American caregivers of persons with dementia. METHODS A comprehensive electronic search was conducted within 5 databases (PubMed, CINAHL, Web of Science, Embase, PsycINFO-ProQuest) for papers published from 01/01/00 -01/24/22. Seventeen articles met the inclusion criteria. Thematic analysis was used to summarize key findings from these papers. RESULTS Most Korean American dementia caregivers were immigrants and wives/daughters/daughters-in-law. Two themes emerged: 1) how Korean American caregivers perceived their caregiving experiences, and 2) how Korean American caregivers perceived their caregiving support services. Korean American caregivers often experience poor mental health and burden. Social support and familism were found to be two of the most important factors that determine their attitudes toward caregiving. Most reported barriers to utilizing public services. Challenges in finding culturally relevant resources were common. CONCLUSIONS Dementia caregiving is a significant public health problem facing Korean Americans. Recommendations for future research are provided.
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Affiliation(s)
- Van M. Ta Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
- Asian American Research Center on Health (ARCH), University of California San Francisco, San Francisco, California, USA
- Multi-Ethnic Health Equity Research Center (MERC), University of California San Francisco, San Francisco, California, USA
| | - Quyen Ly
- J6-Acuity Adaptable Unit, Stanford Health Care, Stanford, California, USA
| | - Julia von Oppenfeld
- San Francisco Veteran Administration Health Care System, San Francisco, California, USA
| | - Yelim Lee
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yoonmee Joo
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Hye-Won Shin
- Somang Society, Cypress, California, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - YongJoo Rhee
- Department of Health Science, Dongduk Women’s University, Seoul, South Korea
| | - Linda G. Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Park VT, Tsoh JY, Dougan M, Nam B, Tzuang M, Park LG, Vuong QN, Bang J, Meyer OL. Correction: Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS). J Med Internet Res 2022; 24:e42716. [DOI: 10.2196/42716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
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Park VT, Tsoh JY, Dougan M, Nam B, Tzuang M, Park LG, Vuong QN, Bang J, Meyer OL. Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS). J Med Internet Res 2022; 24:e38443. [PMID: 35658091 PMCID: PMC9364971 DOI: 10.2196/38443] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. OBJECTIVE This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19-related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. METHODS COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19-related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19-related characteristics and perceived racial bias. RESULTS A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97% (3749/5068) agreed or strongly agreed with ≥1 COVID-19-related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ≥60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. CONCLUSIONS Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19-specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19-related sequelae.
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Affiliation(s)
- Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
- Asian American Research Center on Health (ARCH), University of California San Francisco, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Janice Y Tsoh
- Asian American Research Center on Health (ARCH), University of California San Francisco, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Marcelle Dougan
- Department of Public Health and Recreation, San Jose State University, San Jose, CA, United States
| | - Bora Nam
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Marian Tzuang
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Quyen N Vuong
- International Children Assistance Network, Milpitas, CA, United States
| | - Joon Bang
- Iona Senior Services, Washington DC, DC, United States
| | - Oanh L Meyer
- Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA, United States
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Ta Park VM, Dougan MM, Meyer OL, Nam B, Tzuang M, Park LG, Vuong Q, Bang J, Tsoh JY. Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings. Int J Environ Res Public Health 2022; 19:924. [PMID: 35055744 PMCID: PMC8776140 DOI: 10.3390/ijerph19020924] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/16/2022]
Abstract
Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020-February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.
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Affiliation(s)
- Van M Ta Park
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA 94143, USA
- Asian American Research Center on Health (ARCH), University of California-San Francisco, San Francisco, CA 94143, USA
| | - Marcelle M Dougan
- Department of Public Health and Recreation, San Jose State University, San Jose, CA 95192, USA
| | - Oanh L Meyer
- Department of Neurology, School of Medicine, University of California, Davis (UCD), Sacramento, CA 95817, USA
| | - Bora Nam
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA 94143, USA
| | - Marian Tzuang
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA 94143, USA
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California-San Francisco, San Francisco, CA 94143, USA
| | - Quyen Vuong
- International Children Assistance Network (ICAN), 532 Valley Way, Milpitas, CA 95035, USA
| | - Joon Bang
- Iona Senior Services, 4125 Albemarle Street NW, Washington, DC 20015, USA
| | - Janice Y Tsoh
- Asian American Research Center on Health (ARCH), University of California-San Francisco, San Francisco, CA 94143, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California-San Francisco, San Francisco, CA 94143, USA
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13
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Elnaggar A, von Oppenfeld J, Whooley MA, Merek S, Park LG. Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study. JMIR Hum Factors 2021; 8:e25356. [PMID: 34473064 PMCID: PMC8446842 DOI: 10.2196/25356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/24/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. OBJECTIVE This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. METHODS We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. RESULTS Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. CONCLUSIONS By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | | | - Mary A Whooley
- Veterans Affairs Medical Center, San Francisco, CA, United States.,Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Stephanie Merek
- Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, CA, United States
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14
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Ta Park VM, Dougan M, Meyer OL, Nam B, Tzuang M, Park LG, Vuong Q, Tsoh JY. Vaccine willingness: Findings from the COVID-19 effects on the mental and physical health of Asian Americans & Pacific Islanders survey study (COMPASS). Prev Med Rep 2021; 23:101480. [PMID: 34307000 PMCID: PMC8283315 DOI: 10.1016/j.pmedr.2021.101480] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022] Open
Abstract
Willingness to get the COVID-19 vaccine is crucial to reduce the current strain on healthcare systems and increase herd immunity, but only 71% of the U.S. public said they would get the vaccine. It remains unclear whether Asian Americans and Pacific Islanders (AAPI), a population with existing inequalities in COVID-19 infection and mortality, are willing to get the vaccine, and the factors associated with vaccine willingness. Given this imperative, we used data from a national, cross-sectional, community-based survey called COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), an ongoing survey study that is available in English and Asian languages (i.e., Simplified or Traditional Chinese, Korean, Vietnamese) to examine vaccine willingness among AAPI. A total of 1,646 U.S. adult AAPI participants completed the survey. Self-reported vaccine willingness showed the proportion who were "unsure" or "probably/definitely no" to getting the COVID-19 vaccine was 25.4%. The odds for vaccine willingness were significantly lower for were Native Hawaiians and Pacific Islanders (vs. Asian Americans), Korean Americans (vs. Chinese and Vietnamese Americans), women (vs. men), heterosexuals (vs. non-heterosexuals), those aged 30-39 and 50-59 (vs. aged < 30), and those who reported having any vaccine concerns (vs. no concerns). AAPIs' willingness to get COVID-19 vaccine varied by groups, which underscores the need for disaggregated AAPI data. A multi-pronged approach in culturally appropriate and tailored health communication and education with AAPI is critical to achieve the goal of health equity for AAPI as it pertains to COVID-19 mortality and morbidity.
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Affiliation(s)
- Van M. Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
- Asian American Research Center on Health (ARCH), University of California, San Francisco, San Francisco, CA, USA
| | - Marcelle Dougan
- Department of Public Health and Recreation, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Oanh L. Meyer
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Bora Nam
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Marian Tzuang
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Linda G. Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, USA
| | - Quyen Vuong
- International Children Assistance Network, Milpitas, CA, USA
| | - Janice Y. Tsoh
- Asian American Research Center on Health (ARCH), University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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15
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Park LG, Elnaggar A, Lee SJ, Merek S, Hoffmann TJ, Von Oppenfeld J, Ignacio N, Whooley MA. Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial. JMIR Form Res 2021; 5:e20468. [PMID: 33861204 PMCID: PMC8087971 DOI: 10.2196/20468] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/14/2020] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313
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Affiliation(s)
- Linda G Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States.,San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States.,San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Sei J Lee
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Stephanie Merek
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Thomas J Hoffmann
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, United States
| | - Julia Von Oppenfeld
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Nerissa Ignacio
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Mary A Whooley
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
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16
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Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, Still CH, Wang TY, Wenger NK. Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2021; 14:e000103. [PMID: 33793309 DOI: 10.1161/hcq.0000000000000103] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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] [Indexed: 11/16/2022]
Abstract
Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.
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17
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Park VT, Ly Q, von Oppenfeld J, Joo Y, Shin H, Rhee Y, Park LG. A scoping review of dementia caregiving for Korean Americans and recommendations for future research. Alzheimers Dement 2020. [DOI: 10.1002/alz.044155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Van Ta Park
- University of California at San Francisco (UCSF) San Francisco CA USA
| | - Quyen Ly
- Stanford Health Care Stanford CA USA
| | - Julia von Oppenfeld
- San Francisco Veteran Administration Health Care System San Francisco CA USA
| | - Yoonmee Joo
- University of California at San Francisco San Francisco CA USA
| | | | | | - Linda G Park
- University of California at San Francisco San Francisco CA USA
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18
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Petersen CL, Minor CM, Mohieldin S, Park LG, Halter RJ, Batsis JA. Remote Rehabilitation: A Field-Based Feasibility Study of an mHealth Resistance Exercise Band. IEEE Int Conf Connect Health Appl Syst Eng Technol 2020; 2020:5-6. [PMID: 34184001 PMCID: PMC8234905] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sarcopenia is the age-related loss of muscle mass and strength that is associated with adverse health outcomes. Resistance-based exercises are effective for mitigation and enhancement of strength; however, adherence is low and challenging to measure when patients are at home. In a single-arm, pilot study of seven older adults, we conducted a field-based usability study evaluating the feasibility and acceptability of using a system consisting of a Bluetooth-connected resistance exercise band and tablet-based app which together we call BandPass in completing four different home-based exercises. The system measured a total of 147 exercises by participants with a mean duration of 94±66 seconds, completing an average of 30±20 repetitions. Though not all patients completed each exercise type, patients were positive about use: patient activation measure: 80.7±14; system usability scale: 6.9±2.9; and confidence in use: 7.7±2.7. The BandPass system demonstrated its ability to collect data on exercise type, force during an exercise, and duration of exercise when older adults use it for monitoring exercise at home.
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Affiliation(s)
| | - Colin M Minor
- Thayer School of Engineering, Dartmouth College, Hanover, USA
| | | | - Linda G Park
- Department of Community Health Systems, University of California, San Francisco, USA
| | - Ryan J Halter
- Thayer School of Engeering, Dartmouth College, Hanover, USA
| | - John A Batsis
- Department of Medicine, University of North Carolina, Chapel Hill, USA
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19
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Elnaggar A, Ta Park V, Lee SJ, Bender M, Siegmund LA, Park LG. Patients' Use of Social Media for Diabetes Self-Care: Systematic Review. J Med Internet Res 2020; 22:e14209. [PMID: 32329745 PMCID: PMC7210496 DOI: 10.2196/14209] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear. Objective The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients’ clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use. Methods We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke. Results After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable. Conclusions The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Sei J Lee
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Melinda Bender
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
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20
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Park LG, Ng F, K Shim J, Elnaggar A, Villero O. Perceptions and experiences of using mobile technology for medication adherence among older adults with coronary heart disease: A qualitative study. Digit Health 2020; 6:2055207620926844. [PMID: 32489672 PMCID: PMC7241207 DOI: 10.1177/2055207620926844] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Medication non-adherence is linked to adverse clinical outcomes (i.e. rehospitalization, mortality) among patients with coronary heart disease. Given its global adoption and growing popularity among older adults, mobile technology may be an effective strategy to improve medication adherence. The aim of this article is to present the perceptions, attitudes, and beliefs of individuals with coronary heart disease about using text messaging and mobile phone applications for medication adherence. METHODS We recruited 28 participants (veterans and non-veterans) with a history of coronary heart disease and antiplatelet medication use in Northern California. We formed six focus groups of individuals who participated in three sessions (total 18 sessions). We analyzed our data using grounded theory. RESULTS The median age was 69.5 ± 10.8 years for non-veterans (50% male) and 70 ± 8.6 years for veterans (100% male). In the first session, we found that participants perceived text message reminders as a convenient, easy, and flexible tool to establish a routine for taking medications. In the second session, participants were eager to use applications for their greater interactivity, individualized health monitoring, and personalized medication information. The third session, participants shared preferred features (i.e. drug interactions, tracking symptoms) after using two applications at home for 2 weeks. CONCLUSIONS Older adults are engaged and can be proficient mobile technology users. Text messaging and mobile phone applications are perceived as helpful tools for medication adherence. Future research should include rigorous clinical trials to test the efficacy of mobile health technology to promote medication adherence in populations that require strict medication adherence.
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Affiliation(s)
- Linda G Park
- Department of Veterans Affairs Medical Center, USA
- University of California, San Francisco School of Nursing, USA
- Department of Community Health Systems, University of California, USA
| | - Fion Ng
- University of California, San Francisco School of Nursing, USA
- Department of Family Health Care Nursing, University of California, USA
| | - Janet K Shim
- University of California, San Francisco School of Nursing, USA
- Department of Social and Behavioral Sciences, University of California, USA
| | - Abdelaziz Elnaggar
- University of California, San Francisco School of Nursing, USA
- Department of Community Health Systems, University of California, USA
| | - Ofelia Villero
- University of California, San Francisco School of Nursing, USA
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21
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Park LG, Dracup K, Whooley MA, McCulloch C, Lai S, Howie-Esquivel J. Sedentary lifestyle associated with mortality in rural patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:318-324. [PMID: 30663898 DOI: 10.1177/1474515118822967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/08/2023]
Abstract
BACKGROUND The incidence of mortality five years after the onset of symptomatic heart failure is about 50%. Lifestyle behaviors differ substantially and likely lead to prognostic differences. AIMS We sought to determine the factors associated with all-cause mortality in patients with heart failure, particularly the impact of a sedentary lifestyle on mortality. METHODS This is a secondary analysis of a randomized controlled trial (REMOTE-HF) to improve self-care through education and counseling ( N=602). We conducted an unadjusted Cox proportional hazards regression analysis with sedentary lifestyle as a predictor of mortality, then added depressive symptoms as a confounder. A Kaplan-Meier survival analysis assessed time to event comparing sedentary lifestyle. Cox models included variables of clinical relevance as well as all significant variables from baseline characteristics associated with all-cause mortality. RESULTS The mean ± SD age was 66 ± 12.4 years, 41% were women, and 90% were of white race. There were 125 all-cause deaths over 24 months. Sedentary lifestyle was associated with a 75% increase in the expected hazard of all-cause mortality (hazards ratio 1.75; p = 0.003; 95% CI 1.21-2.54) after adjusting for moderate to severe depressive symptoms. Two Cox models showed an 89 and 95% increase, respectively, in all-cause mortality in sedentary participants holding all other variables constant. CONCLUSIONS Sedentary lifestyle is strongly associated with all-cause mortality, independent of having moderate to severe depressive symptoms. Clinicians and researchers have an important role in promoting sustained and safe physical activity to improve survival. Other important modifiable targets to improve survival include depressive symptoms, low literacy, and low body mass index. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique Identifier: NCT00415545.
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Affiliation(s)
- Linda G Park
- 1 Department of Community Health Systems, University of California, San Francisco, School of Nursing, San Francisco Veterans Affairs Medical Center, USA
| | - Kathleen Dracup
- 2 University of California, San Francisco, School of Nursing, USA
| | - Mary A Whooley
- 3 Department of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco Veterans Affairs Medical Center, USA
| | - Charles McCulloch
- 4 Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Sonia Lai
- 2 University of California, San Francisco, School of Nursing, USA
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22
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Bender MS, Cooper BA, Park LG, Padash S, Arai S. Correction: A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial. JMIR Diabetes 2018; 3:e12784. [PMID: 30578184 PMCID: PMC6307694 DOI: 10.2196/12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melinda S Bender
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Bruce A Cooper
- Office of the Dean and Administration, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Linda G Park
- Community Health Services, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Sara Padash
- School of Nursing, University of San Francisco, San Francisco, CA, United States
| | - Shoshana Arai
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
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23
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Howie-Esquivel J, Dracup K, Whooley MA, McCulloch C, Jin C, Moser DK, Clark RA, Pelter MM, Biddle M, Park LG. Rapid 5 lb weight gain is not associated with readmission in patients with heart failure. ESC Heart Fail 2018; 6:131-137. [PMID: 30353706 PMCID: PMC6351885 DOI: 10.1002/ehf2.12370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/16/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022] Open
Abstract
Aims Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients. Methods and results This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries >50% over 24 months (N = 119). Mean age was 69 ± 11 years; 77% (65) were male, and 67% completed diaries. A weight gain of 5 lb over 7 days was associated with a greater risk for ED visits but not hospital admission [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.04, 1.08; P < 0.0001 vs. HR 1.01, 95% CI 0.88, 1.16; P = 0.79]. Increased dyspnoea over 7 days was associated with a greater risk of ED visits and hospital admissions (HR 9.64, 95% CI 3.68, 25.22; P < 0.0001 vs. HR 5.89, 95% CI 1.73, 20.04; P = 0.01). Higher diary adherence was associated with older age, non‐sedentary behaviour, lower depression, and HF knowledge. Conclusions Heart failure patients are counselled to observe for body‐weight gain. Our data do not support that a 5 lb weight gain was associated with hospital admission. Dyspnoea was a better predictor of ED visits and hospital admissions. Daily tracking of dyspnoea symptoms may be an important adjunct to daily weight to prevent hospitalization.
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Affiliation(s)
| | - Kathleen Dracup
- San Francisco School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Mary A Whooley
- Department of Medicine and Epidemiology and Biostatistics, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Charles McCulloch
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Chengshi Jin
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Debra K Moser
- University of Kentucky School of Nursing, Lexington, KY, USA
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Michele M Pelter
- San Francisco School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Martha Biddle
- University of Kentucky School of Nursing, Lexington, KY, USA
| | - Linda G Park
- San Francisco School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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Nicosia FM, Park LG, Gray CP, Yakir MJ, Hung DY. Nurses' Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency. Glob Qual Nurs Res 2018; 5:2333393618810658. [PMID: 30480041 PMCID: PMC6249655 DOI: 10.1177/2333393618810658] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022] Open
Abstract
As hospitals around the world increasingly face pressure to improve efficiency, "Lean" process improvement has become a popular approach to improving patient flow. In this article, we examine nurses' perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) "wasting time" to save time; and (d) the "real" work of providing clinical care versus the "Lean" work of process improvement. Our findings highlight the importance of soliciting hospital nurses' perspectives when implementing Lean process improvements to improve efficiency and patient flow.
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Affiliation(s)
- Francesca M. Nicosia
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | - Linda G. Park
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | | | - Maayan J. Yakir
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
| | - Dorothy Y. Hung
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
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Bender MS, Cooper BA, Park LG, Padash S, Arai S. A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial. JMIR Diabetes 2017; 2:e30. [PMID: 30291068 PMCID: PMC6238885 DOI: 10.2196/diabetes.8156] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 06/07/2017] [Revised: 10/02/2017] [Accepted: 10/29/2017] [Indexed: 01/05/2023] Open
Abstract
Background Filipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D. Objective The objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D. Methods This was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ≥18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps. Results A total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, −2.6% (−3.9 to −1.4) and −3.3% (−1.8 to −4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18% (4/22) of the intervention group achieved a 5% weight loss, whereas 82% (18/22) maintained or lost 2% to 5% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed. Conclusions The PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations. Trial Registration Clinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp)
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Affiliation(s)
- Melinda S Bender
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Bruce A Cooper
- Office of the Dean and Administration, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Linda G Park
- Community Health Services, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Sara Padash
- School of Nursing, University of San Francisco, San Francisco, CA, United States
| | - Shoshana Arai
- Family Health Care Nursing Department, School of Nursing, University of California San Francisco, San Francisco, CA, United States
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Park LG, Dracup K, Whooley MA, McCulloch C, Jin C, Moser DK, Clark RA, Pelter MM, Biddle M, Howie Esquivel J. Symptom Diary Use and Improved Survival for Patients With Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.003874. [PMID: 29158435 DOI: 10.1161/circheartfailure.117.003874] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 01/12/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. METHODS AND RESULTS This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model. CONCLUSIONS In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.
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Affiliation(s)
- Linda G Park
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.).
| | - Kathleen Dracup
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Mary A Whooley
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Charles McCulloch
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Chengshi Jin
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Debra K Moser
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Robyn A Clark
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Michele M Pelter
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Martha Biddle
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Jill Howie Esquivel
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
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Park LG, Collins EG, Shim JK, Whooley MA. Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans With Coronary Heart Disease (Mobile4Meds): Protocol for a Mixed-Methods Study. JMIR Res Protoc 2017; 6:e134. [PMID: 28720557 PMCID: PMC5539386 DOI: 10.2196/resprot.7327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to antiplatelet medications is critical to prevent life threatening complications (ie, stent thrombosis) after percutaneous coronary interventions (PCIs), yet rates of nonadherence range from 21-57% by 12 months. Mobile interventions delivered via text messaging or mobile apps represent a practical and inexpensive strategy to promote behavior change and enhance medication adherence. Objective The Mobile4Meds study seeks to determine whether text messaging or a mobile app, compared with an educational website control provided to all Veterans, can improve adherence to antiplatelet therapy among patients following acute coronary syndrome (ACS) or PCI. The three aims of the study are to: (1) determine preferences for content and frequency of text messaging to promote medication adherence through focus groups; (2) identify the most patient-centered app that promotes adherence, through a content analysis of all commercially available apps for medication adherence and focus groups centered on usability; and (3) compare adherence to antiplatelet medications in Veterans after ACS/PCI via a randomized clinical trial (RCT). Methods We will utilize a mixed-methods design that uses focus groups to achieve the first and second aims (N=32). Patients will be followed for 12 months after being randomly assigned to one of three arms: (1) customized text messaging, (2) mobile app, or (3) website-control groups (N=225). Medication adherence will be measured with electronic monitoring devices, pharmacy records, and self-reports. Results Enrollment for the focus groups is currently in progress. We expect to enroll patients for the RCT in the beginning of 2018. Conclusions Determining the efficacy of mobile technology using a Veteran-designed protocol to promote medication adherence will have a significant impact on Veteran health and public health, particularly for individuals with chronic diseases that require strict medication adherence. Trial Registration ClinicalTrials.gov NCT03022669
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Affiliation(s)
- Linda G Park
- Department of Veterans Affairs, Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
| | - Eileen G Collins
- Edward Hines Jr., VA Hospital, Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Janet K Shim
- University of California, San Francisco, Social and Behavioral Sciences, San Francisco, CA, United States
| | - Mary A Whooley
- Department of Veterans Affairs, Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Park LG, Beatty A, Stafford Z, Whooley MA. Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease. Prog Cardiovasc Dis 2016; 58:639-50. [PMID: 27001245 DOI: 10.1016/j.pcad.2016.03.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 01/04/2023]
Abstract
Mobile health in the form of text messaging and mobile applications provides an innovative and effective approach to promote prevention and management of cardiovascular disease (CVD); however, the magnitude of these effects is unclear. Through a comprehensive search of databases from 2002-2016, we conducted a quantitative systematic review. The selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. A large majority of studies (22 of 28, 79%) demonstrated text messaging, mobile applications, and telemonitoring via mobile phones were effective in improving outcomes. Some key factors associated with successful interventions included personalized messages with tailored advice, greater engagement (2-way text messaging, higher frequency of messages), and use of multiple modalities. Overall, text messaging appears more effective than smartphone-based interventions. Incorporating principles of behavioral activation will help promote and sustain healthy lifestyle behaviors in patients with CVD that result in improved clinical outcomes.
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Affiliation(s)
- Linda G Park
- Department of Community Health Systems, University of California, San Francisco.
| | - Alexis Beatty
- Veterans Affairs Puget Sound Medical Center, Cardiology Section, Seattle, WA; University of Washington, Department of Medicine.
| | - Zoey Stafford
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA.
| | - Mary A Whooley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; San Francisco Veterans Affairs Medical Center, Department of Medicine.
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Park LG, Howie-Esquivel J, Whooley MA, Dracup K. Psychosocial factors and medication adherence among patients with coronary heart disease: A text messaging intervention. Eur J Cardiovasc Nurs 2014; 14:264-73. [PMID: 24853566 DOI: 10.1177/1474515114537024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 12/29/2013] [Accepted: 04/29/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Medication adherence is a complex behavior that is influenced by numerous factors. Applying self-efficacy theory, the primary aim of this randomized controlled trial was to compare medication self-efficacy among patients with coronary heart disease who received: (a) text messages (TMs) for medication reminders and education, (b) TMs for education, or (c) no TMs. The second aim was to identify the personal (sociodemographic and clinical characteristics) and psychosocial factors that were associated with and predicted medication adherence. METHODS Customized TMs were delivered over 30 days. Repeated measures analysis of variance was used to analyze medication self-efficacy. A multiple regression analysis was performed at baseline and follow-up to determine variables that were associated with and predicted self-reported medication adherence. RESULTS Among 90 subjects with mean age 59.2 years (standard deviation (SD) 9.4, range 35-83), total scores for medication self-efficacy improved over 30 days; however, there was no significant difference in this improvement as a function of the different treatment groups (p=0.64). Controlling for other variables in the model (age, education, depression, and social support), less depression (p=0.004) and higher social support (p=0.02) positively predicted higher medication adherence in the final model. CONCLUSIONS TM medication reminders and/or health education did not improve medication self-efficacy. Further theory testing of current and future models and interventions are required to understand variables related to self-efficacy and medication adherence. Addressing psychosocial factors such as depression and social support should be a priority to improve medication adherence among patients with coronary heart disease.
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Affiliation(s)
- Linda G Park
- Veterans Affairs Medical Center, University of California, San Francisco, USA
| | - Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, USA
| | - Mary A Whooley
- Veterans Affairs Medical Center, University of California, San Francisco, USA Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kathleen Dracup
- Department of Physiological Nursing, University of California, San Francisco, USA
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Park LG, Mahar D, Shaw RE, Dracup K. The impact of a heart failure educational program for physicians varies based upon physician specialty. J Clin Med Res 2014; 6:173-83. [PMID: 24734143 PMCID: PMC3985559 DOI: 10.14740/jocmr1790w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 03/13/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Beta blocker (BB) doses are often suboptimal in heart failure (HF) management. Differences in BB management patterns may exist between physicians in family medicine (FM) and internal medicine (IM). The aims of this study were to compare: 1) BB doses and prescription patterns; and 2) health care utilization rates in patients cared for by all primary care physicians compared to an historical control group after an educational program on HF management. A subgroup analysis was performed between patients cared for by FM and IM physicians. A secondary aim was to assess physician knowledge scores and satisfaction. METHODS A historically controlled study was conducted among low-income, underserved HF patients (mean age 54.1 ± 13.1, males 70%, mean ejection fraction 28.2 ± 9.8%). Statistical methods included linear mixed models and Fisher's exact tests to assess prescription patterns of BB dosing and health care utilization rates (all cause and HF related hospitalizations, emergency department use and clinic visits). RESULTS Among 135 patients (experimental N = 81 and control N = 54), a linear mixed model test of group by time interaction showed no difference in BB dosage (t = -0.12, P = 0.91). FM physicians prescribed significant changes in BB doses compared to IM physicians (P = 0.04), had higher numbers of clinic visits (P = 0.03) and reported greater satisfaction with the program. CONCLUSIONS There was no difference in BB titration rates following an HF training intervention for physicians compared to historical controls. However, FM physicians had a greater change in prescribing practices compared to IM physicians. Educational programs targeting FM physicians may benefit HF patients and could potentially lead to greater adherence to clinical guidelines related to BB use and address gaps in providing HF care.
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Affiliation(s)
- Linda G Park
- San Francisco VA Medical Center, 4150 Clement Street 181G, San Francisco, CA 94121, USA
| | - Denis Mahar
- Contra Costa Regional Medical Center, 2500 Alhambra Ave, Martinez, CA 94553, USA
| | - Richard E Shaw
- California Pacific Medical Center, 2200 Webster St, San Francisco, CA 94115, USA
| | - Kathleen Dracup
- Department of Physiological Nursing, University of California, 2 Koret Way, N611, San Francisco, CA 94143, USA
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Park LG, Howie-Esquivel J, Dracup K. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. J Adv Nurs 2014; 70:1932-1953. [PMID: 24689978 DOI: 10.1111/jan.12400] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. BACKGROUND Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. DESIGN Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. DATA SOURCES A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. REVIEW METHODS A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. RESULTS The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. CONCLUSION While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence.
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Affiliation(s)
- Linda G Park
- Division of Geriatrics, University of California, San Francisco VA Medical Center, California, USA
| | | | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California, USA
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Abstract
The measurement of medication adherence is important in both clinical practice and research settings to offer effective medical therapy, improve clinical outcomes, and determine the efficacy of therapy. The aims of this article are to (a) present an overview of current and developing electronic methods of medication measurement, (b) explore the advantages and disadvantages to each approach, and (c) discuss the implications of using electronic monitoring devices for clinical practice and research. A comprehensive review of electronic forms of medication measurement was performed. A description of each method is presented including oral medication monitors, personal electronic devices, electronic blisters, wirelessly observed therapy, inhaled medication monitors, mobile phones, video/photo-assisted observation, and electronic health records. Familiarity with using electronic devices and advances in technology will continue to develop and influence the measurement of medication adherence.
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Affiliation(s)
- Linda G. Park
- San Francisco VA Medical Center, San Francisco, USA
- University of California, San Francisco, USA
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Park LG, Howie-Esquivel J, Chung ML, Dracup K. A text messaging intervention to promote medication adherence for patients with coronary heart disease: a randomized controlled trial. Patient Educ Couns 2014; 94:261-268. [PMID: 24321403 DOI: 10.1016/j.pec.2013.10.027] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [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: 07/09/2013] [Revised: 10/24/2013] [Accepted: 10/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Pharmacologic treatment for secondary prevention of coronary heart disease (CHD) is critical to prevent adverse clinical outcomes. In a randomized controlled trial, we compared antiplatelet and statin adherence among patients with CHD who received: (1) text messages (TM) for medication reminders and education, (2) educational TM only, or (3) No TM. METHODS A mobile health intervention delivered customized TM for 30 days. We assessed and analyzed medication adherence with electronic monitoring devices [Medication Event Monitoring System (MEMS)] by one-way ANOVA and Welch tests, two-way TM response rates by t-tests, and self-reported adherence (Morisky Medication Adherence Scale) by Repeated Measures ANOVA. RESULTS Among 90 patients (76% male, mean age 59.2 years), MEMS revealed patients who received TM for antiplatelets had a higher percentage of correct doses taken (p=0.02), percentage number of doses taken (p=0.01), and percentage of prescribed doses taken on schedule (p=0.01). TM response rates were higher for antiplatelets than statins (p=0.005). Self-reported adherence revealed no significant differences among groups. CONCLUSION TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses. PRACTICE IMPLICATIONS Feasibility and high satisfaction were established. Mobile health interventions show promise in promoting medication adherence.
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Affiliation(s)
- Linda G Park
- San Francisco VA Medical Center, Division of Geriatrics, Palliative and Extended Care, USA.
| | - Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, USA
| | | | - Kathleen Dracup
- Department of Physiological Nursing, University of California, San Francisco, USA
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Park LG, Mahar D, Shaw R, Dracup K. Abstract 180: The Effectiveness of a HF Training Program among Primary Care Physicians. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Heart failure (HF) guidelines recommend beta-blockers (BB) to reduce morbidity and mortality. BB doses are often suboptimal, which do not provide maximum benefit for HF patients. Differences in BB management patterns may exist between family practice (FP) and internal medicine (IM) physicians due to differences in specialty interest and training.
Objectives:
1) To determine the effectiveness of a one-day training intervention for primary care physicians (PCPs) designed to optimize BB titration for patients with systolic HF. 2) To compare BB titration rates of FP and IM physicians. We hypothesized the intervention would result in increased PCP BB titration rates for experimental patients, with a more significant benefit in the FP group.
Methods:
A prospective cohort study was conducted at a county hospital with low-income, underserved HF patients (mean age 54.1±13.1, males 70%, mean ejection fraction 28.2±9.8, mean serum creatinine 1.5±1.0) for up to 7 clinic visits. Twelve participating PCPs, including 5 FP and 7 IM physicians, received a one-day training intervention on HF management with a focus on BB titration. Medical records of control patients who received care 2 years prior to the intervention (n=54) were compared to experimental patients after the intervention (n=81). A linear mixed model examined differences in BB dose between the experimental and control groups and the FP and IM physicians.
Results:
No sociodemographic or clinical differences were noted between HF patients treated before or after the intervention or between IM and FP physicians (p>0.05). The test of the group by time interaction showed no difference between the experimental and control groups in linear change trajectories for BB dose change (t= -0.12, p=0.91). However, FP physicians showed a significant change in BB titration rates for experimental patients (p=0.04) when compared to IM physicians.
Conclusions:
There was no difference in BB titration rates between the experimental and control groups following a HF training intervention for PCPs, although the clinical reasons for restricting maximal dosage were not explored. Teaching interventions targeting FP physicians may benefit HF patients in achieving higher BB doses and should be examined further.
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Affiliation(s)
- Linda G Park
- Univ of California, San Francisco, Walnut Creek, CA,
| | - Denis Mahar
- Contra Costa Regional Med Cntr, Martinez, CA,
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