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Liddon N, Pampati S, Steiner RJ, Hensel DJ, Beckmeyer J, Herbenick D. Truth Be Told: Adolescents' Disclosure of Sexual Activity to Healthcare Providers. J Adolesc Health 2021; 68:623-625. [PMID: 32807593 PMCID: PMC9119426 DOI: 10.1016/j.jadohealth.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services. METHODS Data from the 2018 National Survey of Sexual Health and Behavior were used to describe self-reported disclsoure of sexually active 14- to 24-year-olds who had a health care visit in the previous year where a sexual history was taken (n = 196). We examined bivariate associations between disclosure and age, race/ethnicity, sex, sexual identity, and receipt of sexual health services. RESULTS Most (88%) respondents reported telling their provider the truth about sexual activity. A higher proportion of the younger adolescents (14- to 17-year-olds) did not disclose compared with the 18- to 24-year-old respondents (25.4% vs 3.9%; p < .001). A higher proportion of patients who disclosed reported having a sexually transmitted disease test (69.6% vs 26.7%; p < .001); being offered a sexually transmitted disease test (44.3% vs 4.5%; p < .001); and being asked by providers about number of partners (54.3% vs 15.4%; p < .01). CONCLUSIONS Most young patients disclose their sexual history to their provider, but younger patients might be less likely to do so. Positive patient-provider relationships may encourage disclosure of sexual activity and support receipt of indicated sexual and reproductive health services.
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Affiliation(s)
- Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education (ORISE), Atlanta, Georgia
| | - Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Devon J Hensel
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Sociology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Jonathon Beckmeyer
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
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Knight J, Wachira J, Kafu C, Braitstein P, Wilson IB, Harrison A, Owino R, Akinyi J, Koech B, Genberg B. The Role of Gender in Patient-Provider Relationships: A Qualitative Analysis of HIV Care Providers in Western Kenya with Implications for Retention in Care. AIDS Behav 2019; 23:395-405. [PMID: 30168005 DOI: 10.1007/s10461-018-2265-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/25/2022]
Abstract
The disproportionate burden of HIV among women in sub-Saharan Africa reflects underlying gender inequities, which also impact patient-provider relationships, a key component to retention in HIV care. This study explored how gender shaped the patient-provider relationship and consequently, retention in HIV care in western Kenya. We recruited and consented 60 HIV care providers from three facilities in western Kenya affiliated with the Academic Model Providing Access to Healthcare (AMPATH). Trained research assistants conducted and audio recorded 1-h interviews in English or Swahili. Data were transcribed and analyzed in NVivo using inductive thematic analysis. Gender constructs, as culturally defined, emerged as an important barrier negatively impacting the patient-provider relationship through three main domains: (1) challenges establishing clear roles and sharing power due to conflicting gender versus patient/provider identities, (2) provider frustration over suboptimal patient adherence resulting from gender-influenced contextual barriers, and (3) negative provider perceptions shaped by differing male and female approaches to communication. Programmatic components addressing gender inequities in the health care setting are urgently needed to effectively leverage the patient-provider relationship and fully promote long-term adherence and retention in HIV care.
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Affiliation(s)
- Jennifer Knight
- Brown University School of Public Health, Providence, RI, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Juddy Wachira
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Catherine Kafu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ira B Wilson
- Brown University School of Public Health, Providence, RI, USA
| | | | - Regina Owino
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jacqueline Akinyi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Beatrice Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Becky Genberg
- Brown University School of Public Health, Providence, RI, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Siembida EJ, Moss K, Kadan-Lottick N, Bellizzi KM. The Patient-Provider Relationship in Adolescent Oncology: AnExploratory Factor Analysis of a Thirteen-Item Self-Report Measure. J Adolesc Health 2018; 63:509-512. [PMID: 30131286 DOI: 10.1016/j.jadohealth.2018.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/14/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The patient-provider relationship has been understudied in adolescents with cancer. The currentstudy describes an exploratory factor analysis of a patient-provider relationship self-report measure developed for use in adolescent oncology. METHODS A self-report measure was included in an iPad/tablet survey delivered to 102 adolescent cancer patients (diagnosed between the ages of 10 and 20). Principal factor analysis with promax rotation and a three-factor structure was specified. RESULTS The final solution identified three underlying dimensions of the patient-provider relationship-SupportingIndependence (69.7% variance explained; Cronbach's α = .89), Family-Centered Communication (50.0% variance explained; Cronbach's α = .73), and Respectful Relationships (40.1% variance; Cronbach's α = .66). DISCUSSION The current measure highlights the unique developmental place of adolescent cancer patients in their preference for aspects of both patient-centered and family-centered care. The current analysis begins to fill the need for adolescent-tailored measurement to assess the patient-provider relationship in this population.
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Affiliation(s)
- Elizabeth J Siembida
- Department of Human Development of Family Studies, University of Connecticut, U-1058 Storrs, Connecticut.
| | - Kerry Moss
- Connecticut Children's Medical Center, Hartford, Connecticut; University of Connecticut's School of Medicine, Farmington, Connecticut
| | - Nina Kadan-Lottick
- Section of Pediatric Hematology-Oncology, Yale University School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | - Keith M Bellizzi
- Department of Human Development of Family Studies, University of Connecticut, U-1058 Storrs, Connecticut
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Berghoff CR, Gratz KL, Portz KJ, Pinkston M, Naifeh JA, Evans SD, Konkle-Parker DJ, Tull MT. The Role of Emotional Avoidance, the Patient-Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals. AIDS Behav 2018; 22:929-38. [PMID: 28265805 DOI: 10.1007/s10461-017-1745-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adherence to antiretroviral therapy (ART) is associated with positive health outcomes among HIV+ patients. However, non-adherence remains high. Though factors that account for non-adherence remain unclear, social support has been consistently associated with ART adherence. As such, identifying malleable factors that hinder patients' ability to form supportive relationships may have consequence for improving ART adherence. Emotional avoidance (EA) may be one such factor given that it has been linked to difficulties in social situations. The present study examined relations among EA, the patient-provider relationship, other sources of social support, and ART adherence within a sample of HIV+ ART-prescribed patients. High EA was related to poor adherence and patient-provider relationships. EA was indirectly related to poor adherence through poorer patient-provider interactions. The indirect relation of EA to ART adherence through other sources of social support was not significant. Implications for developing targeted behavioral interventions focused on improving ART adherence are discussed.
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Abstract
Placebo effects are beneficial clinical outcomes that emerge as a result of nonspecific contextual factors, transmitted primarily by the treating physician and the social, physical, and behavioral cues he or she displays. The patient-provider therapeutic alliance is critical for determining placebo effects and health outcomes. In this chapter, we review the recent literature, suggesting that provider social characteristics modulate placebo and clinical outcomes. We highlight the importance of studying not only the provider but also the patient's perception of the provider, which is subject to the influence of the patient's psychosocial orientation, such as their psychosocial motivations and perceptions of their interpersonal relationships broadly. We argue that psychosocial orientation can exaggerate the influence of the patient-provider relationship on placebo effects and can directly affect the likelihood of placebo effects emerging by modulating the underlying biological systems that support them. Here, we examine patient loneliness, or perceived social isolation, as a case example for understanding how patients' psychosocial orientation may affect placebo effects across diseases. We propose psychosocial mechanisms by which loneliness might modulate placebo effects across medical outcomes, and focus in particular on how loneliness might specifically alter behaviorally conditioned immune responses and placebo analgesia. Future studies should directly measure social factors to formally test the effects of social isolation on placebo effects and better elucidate the role of psychosocial and interpersonal factors in placebo effects and clinical outcomes.
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Affiliation(s)
- Elizabeth A Necka
- Section on Affective Neuroscience and Pain, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States.
| | - Lauren Y Atlas
- Section on Affective Neuroscience and Pain, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States; National Institute on Drug Abuse, NIH, Bethesda, MD, United States
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Mattingly TJ, Tom SE, Stuart B, Onukwugha E. Examining patient-provider relationship (PPR) quality and patient activation in the Medicare population. Aging Clin Exp Res 2017; 29:543-548. [PMID: 27324691 DOI: 10.1007/s40520-016-0600-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient activation describes an individual's willingness and ability to take actions to independently manage health. Additional qualities of the relationship between a patient and provider may play a role in patient decision-making and motivation. AIMS (1) To describe patient characteristics for groups who perceive different quality levels of PPR. (2) To examine the association and determine the effect of PPR on patient activation. METHODS The Medicare Current Beneficiary Surveys was used to gather information on patient confidence, information seeking behaviors, and PPR. Scores for each variable set were categorized and described. Odds ratios were calculated using multinomial logistic regression models adjusting for sociodemographic variables. RESULTS The study included 15,185 beneficiaries, 4198 (27.6 %) were categorized as low PPR, 6752 (44.5 %) were moderate PPR, and 4235 (27.9 %) high PPR. Adjusting for covariates, patients with moderate PPR and high PPR were more likely to have higher confidence when making healthcare decisions and exhibit information seeking behaviors compared to low PPR beneficiaries. DISCUSSION This study supports the notion that patients with stronger relationships with their providers are also more active in healthcare decisions. After adjusting for gender, race, age, education, and income, high-quality PPR was still found to be associated with increased levels of activation in the Medicare population. CONCLUSIONS High-quality patient-provider relationships are associated with improved patient confidence and information seeking behaviors. Provider-centered strategies to improve patients' connections to their physicians may motivate patients to engage in the healthcare process.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 North Pine Street, N415, Baltimore, MD, 21201, USA.
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA.
| | - Sarah E Tom
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA
| | - Bruce Stuart
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA
| | - Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA
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Greco CM, Yu L, Johnston KL, Dodds NE, Morone NE, Glick RM, Schneider MJ, Klem ML, McFarland CE, Lawrence S, Colditz J, Maihoefer CC, Jonas WB, Ryan ND, Pilkonis PA. Measuring nonspecific factors in treatment: item banks that assess the healthcare experience and attitudes from the patient's perspective. Qual Life Res 2015; 25:1625-34. [PMID: 26563249 DOI: 10.1007/s11136-015-1178-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/02/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Nonspecific factors that accompany healthcare treatments, such as patients' attitudes and expectations, are important parts of the experience of care and can influence outcomes. However, no precise, concise, and generalizable instruments to measure these factors exist. We report on the development and calibration of new item banks, titled the Healing Encounters and Attitudes Lists (HEAL), that assess nonspecific factors across a broad range of treatments and conditions. METHODS The instrument development methodology of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) was used. Patient focus groups and clinician interviews informed our HEAL conceptual model. Literature searches of eight databases yielded over 500 instruments and resulted in an initial item pool of several thousand items. After qualitative item analysis, including cognitive interviewing, 296 items were included in field testing. The calibration sample included 1657 respondents, 1400 obtained through an Internet panel and 257 from conventional and integrative medicine clinics. Following exploratory and confirmatory factor analyses, the HEAL item banks were calibrated using item response theory. RESULTS The final HEAL item banks were Patient-Provider Connection (57 items), Healthcare Environment (25 items), Treatment Expectancy (27 items), Positive Outlook (27 items), and Spirituality (26 items). Short forms were also developed from each item bank. A six-item short form, Attitudes toward Complementary and Alternative Medicine (CAM), was also created. CONCLUSIONS HEAL item banks provided substantial information across a broad range of each construct. HEAL item banks showed initial evidence of predictive and concurrent validity, suggesting that they are suitable for measuring nonspecific factors in treatment.
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Affiliation(s)
- Carol M Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA.
| | - Lan Yu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly L Johnston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nathan E Dodds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Natalia E Morone
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald M Glick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine E McFarland
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jason Colditz
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Catherine C Maihoefer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Eliassen AH. Power Relations and Health Care Communication in Older Adulthood: Educating Recipients and Providers. Gerontologist 2015; 56:990-996. [PMID: 26491035 DOI: 10.1093/geront/gnv095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/04/2015] [Indexed: 01/17/2023] Open
Abstract
Unequal power relations lie just below the surface in much of today's discourse on health care communication with older adults. Focusing on pathologies or deficits tends to reinforce stereotypes of frailty and dependency, thus framing elders as a vulnerable group requiring special assistance. Implicit stereotyping frequently colors interactions of health care personnel with older clients and their families-interactions likely to affect elders' perceptions and health outcomes. Health care providers need to be attuned to the vast and growing diversity in today's older population, wherein many older adults are exemplars of what it takes to marshal resources and cope with multifaceted challenges. Thus, elders have the potential to teach medical personnel through narratives of resilience as well as tribulation. This potential can be fully realized, however, only in contexts where communication patterns characterized by paternalism, consumerism, and collaboration are mutually recognized and selectively challenged or implemented. Promising interventions to facilitate health care communication in older adulthood might well be directed toward (a) educating both recipients and providers to become more mindful of cues that evoke stereotypical thinking, (b) promoting an institutional culture that normalizes situationally appropriate assertive responses to stereotyping, and (c) formally ratifying older adults' life experience in the training of health care personnel.
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Affiliation(s)
- A Henry Eliassen
- Department of Social Sciences, University of Houston-Downtown, Texas.
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Bennett WL, Wang NY, Gudzune KA, Dalcin AT, Bleich SN, Appel LJ, Clark JM. Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial. Patient Educ Couns 2015; 98:1099-105. [PMID: 26026649 PMCID: PMC4546866 DOI: 10.1016/j.pec.2015.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 04/30/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the association between the patient-provider relationship, satisfaction with primary care provider's (PCP) involvement and weight loss in a practice-based weight loss trial. METHODS POWER was a practice-based randomized controlled behavioral weight loss trial. Participants completed questionnaires about patient-provider relationship and satisfaction with their PCPs' involvement in the trial. PCPs completed a demographics and practice survey. The main outcome was the mean weight change from baseline to 24 months. We created mixed-effect models, accounting for the random effects of patients clustering with the PCP and the repeated outcome assessments within patient over time, and adjusted for randomization assignment, age, gender, race and clinical site. RESULTS 347 (of 415) were included. Mean age was 54.8 years, mean BMI was 36.3 kg/m(2). Participants reported high quality patient-provider relationships (mean summary score=29.1 [range 14-32]). Patient-provider relationship quality was not associated weight loss in either the intervention or control groups. Among intervention participants, higher ratings of the helpfulness of the PCPs' involvement was associated with greater weight loss (p=0.005). CONCLUSION Patient-provider relationship quality was not associated with weight loss in a practice-based weight loss trial but rating PCPs as helpful in the intervention was associated with weight loss. PRACTICE IMPLICATIONS Partnering with PCPs to deliver weight loss programs may promote greater participant satisfaction and weight loss.
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Affiliation(s)
- Wendy L Bennett
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Arlene T Dalcin
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sara N Bleich
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jeanne M Clark
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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