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Mondesir FL, Levitan EB, Malla G, Mukerji R, Carson AP, Safford MM, Turan JM. Patient Perspectives on Factors Influencing Medication Adherence Among People with Coronary Heart Disease (CHD) and CHD Risk Factors. Patient Prefer Adherence 2019; 13:2017-2027. [PMID: 31819383 PMCID: PMC6890172 DOI: 10.2147/ppa.s222176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Few qualitative studies have explored factors influencing medication adherence among people with coronary heart disease (CHD) or CHD risk factors. We explored how factors related to the patient (e.g. self-efficacy), social/economic conditions (e.g. social support and cost of medications), therapy (e.g. side effects), health condition (e.g. comorbidities), and the healthcare system/healthcare team (e.g. support from healthcare providers and pharmacy access) influence medication adherence, based on the World Health Organization Multidimensional Adherence Model (WHO-MAM). METHODS We conducted 18 in-depth qualitative interviews from April to July 2018 with ambulatory care patients aged ≥45 years (8 black men, 5 black women, 2 white men, and 3 white women) who were using medications for diabetes, hypertension, dyslipidemia and/or CHD. We used thematic analysis to analyze the data, and sub-themes emerged within each WHO-MAM dimension. FINDINGS Patient-related factors included beliefs about medications as important for self and faith; the desire to follow the advice of family, friends, and influential others; and self-efficacy. Social/economic factors included observations of social network members and information received from them; social support for medication adherence and pharmacy utilization; and economic influences. Therapy-related barriers included side effects and medicine schedules. Only a few participants mentioned condition-related factors. Healthcare system/healthcare team-related factors included support from doctors and pharmacists; and ease of pharmacy access and utilization. CONCLUSION These results underscore the need for multidimensional interventions aimed at improving medication adherence and overall health of patients with CHD and CHD risk factors.
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Affiliation(s)
- Favel L Mondesir
- Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
- Correspondence: Favel L Mondesir Division of Cardiovascular Medicine, School of Medicine, University of Utah, Room 4A100, 30 N 1900 E, Salt Lake City, UT84132, USATel +1-801-587-9048 Email
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gargya Malla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Reshmi Mukerji
- School of Medicine, Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Neter E, Brainin E. Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions. EUROPEAN PSYCHOLOGIST 2019. [DOI: 10.1027/1016-9040/a000350] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly ( n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search ( n = 26); (3) articles on eHealth literacy and its association with health outcomes ( n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.
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Affiliation(s)
- Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Esther Brainin
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
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Jessup RL, Osborne RH, Buchbinder R, Beauchamp A. Using co-design to develop interventions to address health literacy needs in a hospitalised population. BMC Health Serv Res 2018; 18:989. [PMID: 30572887 PMCID: PMC6302392 DOI: 10.1186/s12913-018-3801-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/06/2018] [Indexed: 11/23/2022] Open
Abstract
Background Health literacy describes the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Suboptimal health literacy is common and is believed to impact up to 60% of Australians. Co-design is a participatory approach to the development of interventions that brings together to staff and patients to design local solutions to local problems. The aim of this study is to describe a staff and patient co-design process that will lead to the development of health literacy interventions in response to identified health literacy needs of hospital patients. Methods A mixed methods, two-step sequential explanatory design. Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles. Step 2: clusters presented as vignettes to patients and clinicians to co-design interventions to address needs. Results Eight health literacy clusters were identified from surveys. Seven patients attended two patient workshops and 23 staff attended two staff workshops. Three key themes were identified: organisational, provider-patient, and patient self-care. Within these, five sub-themes emerged: “Good quality communication during hospital stay”, “Social support for health”, “A good discharge”, “Care across the continuum” and “Accessing quality information when home”. Fifteen potential interventions were produced, including changes to message design and delivery, staff training in assessing for understanding, social support to improve understanding, improving communication consistency across the care continuum, and strategic dissemination of web-based resources. Conclusion This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit. This approach allows for the development of locally-driven, contextually-appropriate interventions to address health literacy needs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3801-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca L Jessup
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,Northern Health, Melbourne, Australia.
| | - Richard H Osborne
- Health Systems Improvement Unit, Deakin University, Melbourne, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison Beauchamp
- Department of Medicine-Western Health, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Victoria, Australia
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54
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Albert NM, Kozinn MJ. In-Hospital Initiation of Guideline-Directed Heart Failure Pharmacotherapy to Improve Long-Term Patient Adherence and Outcomes. Crit Care Nurse 2018; 38:16-24. [DOI: 10.4037/ccn2018669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Heart failure is a burdensome cardiovascular condition associated with high rates of morbidity and mortality. The 3-month period after hospitalization is a vulnerable phase in which patients are at high risk for mortality and rehospitalization. To reduce risk during this period, patients with heart failure and reduced ejection fraction should receive guideline-directed pharmacological therapies—the right drugs at the right doses—before hospital discharge. Optimal pharmacotherapies for these patients include agents that suppress the renin-angiotensin-aldosterone system, suppress the sympathetic nervous system, enhance vasodilation, slow heart rate when needed, and reduce excess volume. Because optimal prescription and adherence are both necessary to ensure the best clinical outcomes, nurses need to participate in interventions that optimize prescription and drug use over time. Collaboration with pharmacists and advanced practice acute care nurses may help ensure that medication selection and dosing are consistent with national guidelines. Use of a predischarge order set and electronic medical records checklist can enhance collaborative care.
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Affiliation(s)
- Nancy M. Albert
- Nancy M. Albert is associate chief nursing officer, Office of Nursing Research and Innovation, and a clinical nurse specialist, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc J. Kozinn
- Marc J. Kozinn is US cardiovascular medical director, heart failure, Amgen, Inc, Thousand Oaks, California
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Yuen EYN, Thomson M, Gardiner H. Measuring Nutrition and Food Literacy in Adults: A Systematic Review and Appraisal of Existing Measurement Tools. Health Lit Res Pract 2018; 2:e134-e160. [PMID: 31294289 PMCID: PMC6607839 DOI: 10.3928/24748307-20180625-01] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/08/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Nutrition literacy (NL) and food literacy (FL) have emerged as key components in the promotion and maintenance of healthy dietary practices. However, a critical appraisal of existing tools is required to advance the operationalization and measurement of these constructs using instruments that demonstrate sound validity and reliability. Methods: Electronic databases were searched in January and July 2016, January 2017, and March 2018 for publications detailing the development and/or testing of NL or FL instruments. Instruments' psychometric properties were assessed using a structured methodological framework. We identified 2,563 new titles and abstracts, and short-listed 524 for full review. The extent to which key domains of NL were included in each measure was examined. Key Results: Thirteen instruments assessing NL underwent full evaluation; seven from the United States, and one each from Australia, Norway, Switzerland, Italy, Hong Kong, and Japan. Measures targeted general Spanish-, Italian-, or Cantonese-speaking adults; primary care patients, parent, and populations with breast cancer. Instruments ranged from 6 to 64 items, and they predominantly assessed functional NL rather than broader domains of NL. Substantial variation in methodological rigor was observed across measures. Discussion: Multidimensional and psychometrically sound measures that capture broader domains of NL and assess FL are needed. Plain Language Summary: This review systemically compiles, and critically appraises 13 existing measures that assess nutrition literacy and food literacy in an adult population. Substantial variation in methodological rigor was found across the measures, and most tools assessed nutrition literacy rather than food literacy. Findings from this current review may be useful to guide development of future measures that comprehensively capture nutrition literacy and food literacy. [HLRP: Health Literacy Research and Practice. 2018;2(3):e134–e160.]
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Affiliation(s)
- Eva Y. N. Yuen
- Address correspondence to Eva Y. N. Yuen, PhD, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA 19122;
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Hickey KT, Masterson Creber RM, Reading M, Sciacca RR, Riga TC, Frulla AP, Casida JM. Low health literacy: Implications for managing cardiac patients in practice. Nurse Pract 2018; 43:49-55. [PMID: 30028773 PMCID: PMC6391993 DOI: 10.1097/01.npr.0000541468.54290.49] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
There are limited data on racial and ethnic disparities related to quality of life (QoL) and health literacy in adults with multiple cardiac conditions. This article evaluates the relationship between health literacy and QoL among patients with cardiac conditions in a multiethnic community in New York City.
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Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is a professor of nursing and an NP at Columbia University School of Nursing, New York, N.Y. Ruth M. Masterson Creber is an associate research scientist at Columbia University School of Nursing, New York, N.Y. Meghan Reading is a doctoral student at Columbia University School of Nursing, New York, N.Y. Robert R. Sciacca is a variable hours officer at Columbia University, New York, N.Y. Teresa C. Riga is a clinical research coordinator at Columbia University Medical Center, New York, N.Y. Ashton P. Frulla is a dermatology NP in New York, N.Y. Jesus M. Casida is an assistant professor at the University of Michigan, School of Nursing, Ann Arbor, Mich
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57
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Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
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58
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Naccarella L, Biuso C, Jennings A, Patsamanis H. Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives. AUST HEALTH REV 2018; 43:323-327. [PMID: 29807558 DOI: 10.1071/ah17270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 11/23/2022]
Abstract
Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, <30% of people participate in a program. Significant patient, hospital and health system challenges exist to improve recovery through increased heart health literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels.
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Affiliation(s)
- Lucio Naccarella
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia
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Ratanawongsa N, Quan J, Handley MA, Sarkar U, Schillinger D. Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims. BMC Health Serv Res 2018; 18:254. [PMID: 29625571 PMCID: PMC5889590 DOI: 10.1186/s12913-018-3071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. Methods As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: “In the last 7 days, how many days did you MISS taking your …” diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Results Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Conclusions Language-concordant ATSM demonstrated modest potential for assessing adherence. Studies should evaluate HIT assessments of medication beliefs and concerns in diverse populations. Trial registration NCT00683020, registered May 21, 2008. Electronic supplementary material The online version of this article (10.1186/s12913-018-3071-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
| | - Judy Quan
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Margaret A Handley
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.,Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Urmimala Sarkar
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Dean Schillinger
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
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Wu JR, Cummings DM, Li Q, Hinderliter A, Bosworth HB, Tillman J, DeWalt D. The effect of a practice-based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich) 2018; 20:757-764. [PMID: 29577574 DOI: 10.1111/jch.13265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/31/2022]
Abstract
Low adherence to anti-hypertensive medications contributes to worse outcomes. The authors conducted a secondary data analysis to examine the effects of a health-coaching intervention on medication adherence and blood pressure (BP), and to explore whether changes in medication adherence over time were associated with changes in BP longitudinally in 477 patients with hypertension. Data regarding medication adherence and BP were collected at baseline, 6, 12, 18, and 24 months. The intervention resulted in increases in medication adherence (5.75→5.94, P = .04) and decreases in diastolic BP (81.6→76.1 mm Hg, P < .001) over time. The changes in medication adherence were associated with reductions in diastolic BP longitudinally (P = .047). Patients with low medication adherence at baseline had significantly greater improvement in medication adherence and BP over time than those with high medication adherence. The intervention demonstrated improvements in medication adherence and diastolic BP and offers promise as a clinically applicable intervention in rural primary care.
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Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Alan Hinderliter
- Division of Cardiology, School of Medicine, Chapel Hill, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences at Duke University, Durham, NC, USA
| | - Jimmy Tillman
- Open Water Coaching and Consulting, LLC, Cape Carteret, NC, USA
| | - Darren DeWalt
- Department of General Internal Medicine, School of Medicine, Chapel Hill, NC, USA
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Yilmazel G, Çetinkaya F. Relation between Health Literacy Levels, Hypertension Awareness and Control among Primary-secondary School Teachers in Turkey. AIMS Public Health 2018; 4:314-325. [PMID: 29546220 PMCID: PMC5690457 DOI: 10.3934/publichealth.2017.4.314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/26/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Health literacy plays a critical role in chronic disease self-management. This study aimed to determine the relation between health literacy levels, hypertension awareness and control among primary-secondary school teachers in Turkey. Materials and Methods This descriptive and cross-sectional research was conducted among school teachers with the participation of 500 volunteer teachers of both genders. The response rate was 86.2%. To determine health literacy levels, the Newest Vital Sign Scale and Blood Pressure Concept Test were used. Results The mean scores of all individuals were 2.12 ± 1.82 over six points although this showed “limited” levels of health literacy. The mean scores obtained from the scale were 2.13 ± 1.83 in non-hypertensives, while it was 2.06 ± 1.77 in hypertensives. Nonetheless, disease knowledge and awareness were low in teachers. Adequate health literacy levels were low according to disease awareness and control. The measured health literacy levels of teachers didn't overlap with their own assessments about health literacy skills. Recommendations Limited health literacy levels in educators gave an impression that our education system was poor in terms of health education programs.
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Affiliation(s)
- Gülay Yilmazel
- Department of Public Health, School of Health, Hitit University, Çorum, Turkey
| | - Fevziye Çetinkaya
- Department of Public Health, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Surbhi S, Graetz I, Wan JY, Gatwood J, Bailey JE. The Effect of Opioid Use and Mental Illness on Chronic Disease Medication Adherence in Superutilizers. J Manag Care Spec Pharm 2018; 24:198-207. [PMID: 29485952 PMCID: PMC10397787 DOI: 10.18553/jmcp.2018.24.3.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nonadherence to essential chronic medications has been identified as a potential driver of high health care costs in superutilizers of inpatient services. Few studies, however, have documented the levels of nonadherence and factors associated with nonadherence in this high-cost, vulnerable population. OBJECTIVE To examine the factors associated with nonadherence to essential chronic medications, with special emphasis on mental illness and use of opioid medications. METHODS This study was a retrospective panel analysis of 2-year baseline data for Medicare Part D beneficiaries eligible for the SafeMed care transitions program in Memphis, Tennessee, from February 2013 to December 2014. The 2-year baseline data for each patient were divided into four, 6-month patient periods. The study included Medicare superutilizers (defined as patients with ≥ 3 hospitalizations or ≥ 2 hospitalizations with ≥ 2 emergency visits in 6 months) with continuous Part D coverage who had filled at least 1 drug class used to treat hypertension, diabetes mellitus, congestive heart failure, coronary artery disease, or chronic lung disease. The outcome included medication nonadherence assessed using proportion of days covered (PDC), with PDC < 80% defined as nonadherent, and the main exposure variables included mental illness (defined as a diagnosis of depression or anxiety or ≥ 1 anxiolytic or antidepressant fill) and opioid medication fills assessed in each 6-month period. Pooled observations from the four 6-month periods were used for multivariable analyses using the patient periods as the unit of analysis. A random effects model with robust standard errors and a binary distribution were used to examine associations between independent variables (time invariant and time variant factors) and medication nonadherence. The model included lagged effects of time variant factors measured in each period. RESULTS Overall nonadherence to essential chronic medications ranged from 39.3% to 58.4%, with the highest for chronic lung disease medications (49.1%-64.4%). Factors associated with nonadherence included ≥ 4 opioid medication fills in the previous 6-month period (adjusted odds ratio [OR] = 1.90, 95% CI = 1.32-2.73); age 22-44 and 45-64 years vs. ≥ 65 years (OR = 3.57, 95% CI = 2.07-6.16, and OR = 2.07, 95% CI = 1.49-2.88); and a higher number of unique prescribers (OR = 1.10, 95% CI = 1.04-1.17). Factors protecting against nonadherence included higher number of unique medications filled (OR = 0.95, 95% CI = 0.92-0.98) and ≥ 1 physician office visit in the previous 6-month period (OR = 0.66, 95% CI = 0.46-0.94). CONCLUSIONS This study demonstrated that high levels of opioid medication use are significantly associated with essential chronic disease medication nonadherence among superutilizers. Other risk factors for nonadherence were aged < 65 years, low-income status, and a higher number of unique prescribers. Factors protecting against nonadherence were physician office visits and filling higher number of medications. Medication management interventions targeting superutilizers should focus on supporting chronic disease medication adherence. DISCLOSURES This project was supported by Funding Opportunity Number 1C1CMS331067-01-00 from the Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. Support was also provided by the Pharmaceutical Research and Manufacturers of America Foundation. The content of this study is solely the responsibility of the authors. The authors declare no relevant conflicts of interest or financial relationships. Study concept and design were contributed by Surbhi, Bailey, and Graetz. Surbhi and Wan collected the data, and data interpretation was performed primarily by Surbhi, along with Graetz, Bailey, and Gatwood. The manuscript was primarily written by Surbhi, with assistance from Bailey and Graetz, and revised by Bailey, Graetz, Gatwood, and Surbhi. This study was presented as a poster at the Academy Health Annual Research Meeting in Boston, Massachusetts, on June 26-28, 2016.
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Affiliation(s)
- Satya Surbhi
- Center for Health System Improvement, Department of Medicine-General Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Jim Y. Wan
- Department of Medicine-General Internal Medicine and Urology, University of Tennessee Health Science Center, Memphis
| | - Justin Gatwood
- Clinical Pharmacy, University of Tennessee Health Science Center, Memphis
| | - James E. Bailey
- Departments of Medicine and Preventive Medicine, University of Tennessee Health Science Center, Memphis
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Osborn CY, Kripalani S, Goggins KM, Wallston KA. Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients. J Health Care Poor Underserved 2018; 28:499-513. [PMID: 28239015 DOI: 10.1353/hpu.2017.0036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent (p < .001), but was non-significant when adjusted for financial strain. Education, income, less financial strain, and being employed were each associated with better self-rated health (p < .001). Financial strain was associated with less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p < .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95% CI: .051 to .108]). Future research should further explore the nuanced link between SES and health behaviors and outcomes.
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Jessup RL, Osborne RH, Beauchamp A, Bourne A, Buchbinder R. Differences in health literacy profiles of patients admitted to a public and a private hospital in Melbourne, Australia. BMC Health Serv Res 2018; 18:134. [PMID: 29471836 PMCID: PMC5824469 DOI: 10.1186/s12913-018-2921-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health literacy refers to an individual's ability to find, understand and use health information in order to promote and maintain health. An individual's health literacy may also be influenced by the way health care organisations deliver care. The aim of this study was to investigate the influence of hospital service type (public versus private) on individual health literacy. METHODS Two cross-sectional surveys were conducted using the Health Literacy Questionnaire (HLQ), a multi-dimensional self-report instrument covering nine health literacy domains. Recently discharged private patients (n = 3121) were sent the survey in English, public patients (n = 384) were sent the survey in English, Arabic, Chinese, Vietnamese, Italian or Greek. Eligibility included hospitalisation ≥24 h in last 30 days, aged ≥18 years, no cognitive impairment. Odds ratios were used to assess differences between hospital sociodemographic and health related variables. ANOVA and Cohen's effect sizes compared HLQ scores between hospitals. Chi square and multiple logistic regression were used to determine whether differences between private and public hospital HLQ scores was independent of hospital population sociodemographic differences. ANOVA was used to review associations between HLQ scores and subgroups of demographic, health behaviour and health conditions and these were then compared across the two hospital populations. RESULTS Public hospital participants scored lower than private hospital participants on eight of the nine health literacy domains of the HLQ (scores for Active Appraisal did not differ between the two samples). Six domains, five of which in part measure the impact of how care is delivered on health literacy, remained lower among public hospital participants after controlling for age, education, language and income. Across both hospital populations, participants who were smokers, those who had low physical activity, those with depression and/or anxiety and those with 3 or more chronic conditions reported lower scores on some HLQ domains. CONCLUSIONS Our finding of lower health literacy among patients who had received care at a public hospital in comparison to a private hospital, even after adjustment for sociodemographic and language differences, suggests that private hospitals may possess organisational attributes (environment, structure, values, practices and/or workforce competencies) that result in improved health literacy responsiveness.
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Affiliation(s)
- Rebecca L. Jessup
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Richard H. Osborne
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Alison Beauchamp
- Health Systems Improvement Unit, Centre of Population Health Research, School of Health and Social Development, Deakin University, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allison Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Soto Mas F, Schmitt CL, Jacobson HE, Myers OB. A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum. J Community Health 2018; 43:717-724. [PMID: 29428986 DOI: 10.1007/s10900-018-0475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.
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Affiliation(s)
- Francisco Soto Mas
- College of Population Health MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Cheryl L Schmitt
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Holly E Jacobson
- Department of Linguistics, University of New Mexico, Albuquerque, NM, USA
| | - Orrin B Myers
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
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Lomper K, Chabowski M, Chudiak A, Białoszewski A, Dudek K, Jankowska-Polańska B. Psychometric evaluation of the Polish version of the Adherence to Refills and Medications Scale (ARMS) in adults with hypertension. Patient Prefer Adherence 2018; 12:2661-2670. [PMID: 30587938 PMCID: PMC6296194 DOI: 10.2147/ppa.s185305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Only 50%-75% of chronically ill patients take their medication as prescribed. The patient is found to adhere to treatment correctly and optimally if they accomplish 80% or more of the treatment plan. A questionnaire titled the Adherence to Refills and Medications Scale (ARMS) has been used in studies involving various populations and proved to be a simple instrument for measuring adherence, with good psychometric properties. OBJECTIVE The aim of this study was to develop a Polish version of the ARMS (ARMS-P), an instrument that identifies levels of adherence in the hypertensive population, and evaluate its psychometric properties. METHODS This cross-sectional study included 279 patients, including 166 females (mean age 66.5 years), hospitalized between September 2016 and March 2017 in the Department of Internal Medicine, Occupational Diseases, and Hypertension of Wrocław Medical University, Poland. The 12-item ARMS was translated from English into Polish. The 12 items included in the final questionnaire comprise two subscales: adherence to taking medications (eight items) and adherence to refilling prescriptions (four items). RESULTS Patients in the good-adherence group were younger (P=0.017; P=0.048), more likely to be professionally active (P=0.041), better educated (P=0.037), and more likely to have normal blood pressure (P<0.001). They also measured their blood pressure more often (P<0.001), and took fewer pills in a day (P<0.001). Adherent patients were also more likely to take their medication on their own (P=0.016) and read information leaflets on the medication (P<0.001). The study demonstrated that the ARMS-P questionnaire has good psychometric properties that enable its use for assessing adherence in chronically ill patients, including in particular, patients with hypertension. CONCLUSION The psychometric properties of the questionnaire are satisfactory (reliability measured by means of Cronbach's α). The ARMS-P questionnaire proved to be suitable for use in the Polish population. The use of this screening tool for the assessment of adherence to treatment is recommended in this population of hypertensive patients.
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Affiliation(s)
- Katarzyna Lomper
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Mariusz Chabowski
- Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland,
| | - Anna Chudiak
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
| | - Artur Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Warsaw Medical University, Warsaw, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Beata Jankowska-Polańska
- Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland
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Choi YJ, Smaldone AM. Factors Associated With Medication Engagement Among Older Adults With Diabetes: Systematic Review and Meta-Analysis. DIABETES EDUCATOR 2017; 44:15-30. [DOI: 10.1177/0145721717747880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this systematic review and meta-analysis is to explore the factors associated with medication engagement among older adults (≥60 years) with diabetes. Methods Five databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus) were systematically searched to identify studies examining the association between factors and medication engagement among older diabetes patients. A study met inclusion for meta-analysis if the prevalence of medication engagement or factor was reported in ≥2 studies and the frequency or strength of association was either reported or able to be computed. Quality appraisal was performed with the Downs and Black tool. Results Of 538 retrieved studies, 33 (20 cohort and 13 cross-sectional) were included for systematic review; of these, 22 met criteria for meta-analysis. Findings from meta-analysis show that women (odds ratio [OR], 0.92; 95% CI, 0.86-0.97), those with depression (OR, 0.73; 95% CI, 0.62-0.87), and those with higher out-of-pocket spending for prescription drugs (OR, 0.87; 95% CI, 0.80-0.94) were less likely to take diabetes medication when compared with men, those without depression, and those with lower out-of-pocket costs, respectively. Older age (OR, 1.13; 95% CI, 1.00-1.27) was associated with better engagement to diabetes medication. Conclusions Of 4 identified factors, 2 are modifiable. Recent policy efforts to decrease the cost burden of prescribed medication for older adults, such as Medicare Part D, may remove this barrier to medication engagement. Routine screening for depression among older adults with diabetes should be included as part of usual care to facilitate an integrated treatment approach.
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Affiliation(s)
- Yoon Jeong Choi
- Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, South Korea
| | - Arlene M. Smaldone
- School of Nursing and College of Dental Medicine, Columbia University Medical Center, New York, New York, USA
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Exploring the Barriers to and Facilitators of Using Evidence-Based Drugs in the Secondary Prevention of Cardiovascular Diseases: Findings From a Multistakeholder, Qualitative Analysis. Glob Heart 2017; 13:27-34.e17. [PMID: 29146489 DOI: 10.1016/j.gheart.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health-system barriers and facilitators associated with cardiovascular medication adherence have seldom been studied, particularly in low- and middle-income countries where uptake rates are poorest. OBJECTIVES This study sought to explore the major obstacles and facilitators to the use of evidence-supported medications for secondary prevention of cardiovascular disease using qualitative analysis in 2 diverse countries across multiple levels of their health care systems. METHODS A qualitative descriptive study approach was implemented in Hamilton, Ontario, Canada, and Delhi, India. A purposeful sample (n = 69) of 23 patients, 10 physicians, 2 nurse practitioners, 5 Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy physicians, 11 pharmacists, 3 nurses, 4 hospital administrators, 1 social worker, 3 nongovernmental organization workers, 2 pharmaceutical company representatives, and 5 policy makers participated in interviews in Hamilton, Ontario, Canada (n = 21), and Delhi, India (n = 48). All interviews were digitally recorded and transcribed followed by directed content analysis to summarize and categorize the interviews. RESULTS Themes that emerged across the stakeholder groups included: medication counseling; monitoring adherence; medication availability; medication affordability and drug coverage; time restrictions; and task shifting. The depth of verbal medication counseling provided varied substantially between countries, with prescribers in India unable to convey relevant information about drug treatments due to time constraint and high patient load. Canadian patients reported drug affordability as a common issue and very few patients were familiar with government subsidized drug programs. In India, patients purchased medications out-of-pocket from private, community pharmacies to avoid long commutes, lost wages, and unavailability of medications from hospitals formularies. Task shifting medication-refilling and titration to nonphysician health workers was accepted and supported by physicians in Canada but not in India, where many of the physicians considered a high level of clinical expertise a precondition to carry out these tasks skillfully. CONCLUSIONS Our findings reveal context-specific, health system factors that affect the patient's choice or ability to initiate and/or continue cardiovascular medication. Strategies to optimize cardiovascular drug use should be targeted and relevant to the health care system.
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Mantwill S, Schulz PJ. Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland. PATIENT EDUCATION AND COUNSELING 2017; 100:2020-2027. [PMID: 28559092 DOI: 10.1016/j.pec.2017.05.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/21/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. METHODS Data was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. RESULTS Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. CONCLUSIONS Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. PRACTICE IMPLICATIONS Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive.
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Affiliation(s)
- Sarah Mantwill
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication & Health, University of Lugano, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland.
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Fleisher JE, Dahodwala NA, Xie SX, Mayo M, Weintraub D, Chodosh J, Shea JA. Development and Validation of the Parkinson's Disease Medication Beliefs Scale (PD-Rx). JOURNAL OF PARKINSONS DISEASE 2017; 6:383-92. [PMID: 27061070 DOI: 10.3233/jpd-150765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medication non-adherence is common in Parkinson's disease (PD) and is associated with increased disability and healthcare costs. Individuals' beliefs regarding their medical conditions and treatments impact medication adherence. While instruments exist to measure patients' beliefs about medications in general, no such tool exists for PD. OBJECTIVES Create an instrument eliciting medication beliefs of persons with PD; identify demographic and clinical characteristics associated with beliefs; and examine whether beliefs are associated with dopaminergic therapy adherence. METHODS We developed the Parkinson's Disease Medication Beliefs Scale (PD-Rx) in four phases: focus groups of patients and caregivers to generate items, scale development, expert and patient revision of items, and a cross-sectional validation sample (n = 75). Adherence was calculated using two approaches incorporating self-reported medication lists. RESULTS The PD-Rx consists of 11 items covering benefits and risks of PD pharmacotherapies. The scale covers motor improvement, current adverse effects, and future concerns. Higher scores indicate more positive beliefs. Internal consistency was acceptable (Cronbach's alpha = 0.67). Test-retest reliability was 0.47. Quality of life was associated with PD-Rx scores, and lower scores were associated with non-adherence. CONCLUSIONS Negative beliefs about PD treatments are associated with lower quality of life and may be related to medication non-adherence. Further study of any causal relationship between beliefs and medication non-adherence in PD will inform the design of future patient-centered interventions to improve adherence.
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Affiliation(s)
- Jori E Fleisher
- The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, New York University School of Medicine, Departments of Neurology and Population Health, New York, NY, USA
| | - Nabila A Dahodwala
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Sharon X Xie
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology., Philadelphia, PA, USA
| | - Mark Mayo
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Daniel Weintraub
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Joshua Chodosh
- New York University School of Medicine, Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York, NY, USA
| | - Judy A Shea
- University of Pennsylvania Perelman School of Medicine, Department of Medicine, Philadelphia, PA, USA
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Massey PM, Kim MC, Dalrymple PW, Rogers ML, Hawthorne KH, Manganello JA. Visualizing Patterns and Trends of 25 Years of Published Health Literacy Research. Health Lit Res Pract 2017; 1:e182-e191. [PMID: 31294264 PMCID: PMC6607782 DOI: 10.3928/24748307-20170829-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022] Open
Abstract
Background: With an increase in the number of disciplines contributing to health literacy scholarship, we sought to explore the nature of interdisciplinary research in the field. Objective: This study sought to describe disciplines that contribute to health literacy research and to quantify how disciplines draw from and contribute to an interdisciplinary evidence base, as measured by citation networks. Methods: We conducted a literature search for health literacy articles published between 1991 and 2015 in four bibliographic databases, producing 6,229 unique bibliographic records. We employed a scientometric tool (CiteSpace [Version 4.4.R1]) to quantify patterns in published health literacy research, including a visual path from cited discipline domains to citing discipline domains. Key Results: The number of health literacy publications increased each year between 1991 and 2015. Two spikes, in 2008 and 2013, correspond to the introduction of additional subject categories, including information science and communication. Two journals have been cited more than 2,000 times—the Journal of General Internal Medicine (n = 2,432) and Patient Education and Counseling (n = 2,252). The most recently cited journal added to the top 10 list of cited journals is the Journal of Health Communication (n = 989). Three main citation paths exist in the health literacy data set. Articles from the domain “medicine, medical, clinical” heavily cite from one domain (health, nursing, medicine), whereas articles from the domain “psychology, education, health” cite from two separate domains (health, nursing, medicine and psychology, education, social). Conclusions: Recent spikes in the number of published health literacy articles have been spurred by a greater diversity of disciplines contributing to the evidence base. However, despite the diversity of disciplines, citation paths indicate the presence of a few, self-contained disciplines contributing to most of the literature, suggesting a lack of interdisciplinary research. To address complex and evolving challenges in the health literacy field, interdisciplinary team science, that is, integrating science from across multiple disciplines, should continue to grow. [Health Literacy Research and Practice. 2017;1(4):e182–e191.] Plain Language Summary: The addition of diverse disciplines conducting health literacy scholarship has spurred recent spikes in the number of publications. However, citation paths suggest that interdisciplinary research can be strengthened. Findings directly align with the increasing emphasis on team science, and support opportunities and resources that incentivize interdisciplinary health literacy research.
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Affiliation(s)
- Philip M. Massey
- Address correspondence to Philip M. Massey, PhD, MPH, Department of Community Health and Prevention, Drexel Dornsife School of Public Health, 3215 Market Street, Nesbitt Hall, Philadelphia, PA 19104;
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Dietary Patterns, Nutrition Knowledge, Lifestyle, and Health-Related Quality of Life: Associations with Anti-Hypertension Medication Adherence in a Sample of Australian Adults. High Blood Press Cardiovasc Prev 2017; 24:453-462. [PMID: 28884295 DOI: 10.1007/s40292-017-0229-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/30/2017] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Poor anti-hypertension medication (AHT) adherence can increase disease costs and adverse outcomes. Hypertensive individuals who have a better nutrition knowledge may lead a healthier lifestyle, have a better health-related quality of life (HRQoL) and greater confidence to change behaviour. On this basis, they may have better treatment adherence. AIM To explore the association between the above-mentioned variables and AHT adherence in a group of Australian adults with high blood pressure (BP) in a cross-sectional clinical and community-based study. METHODS Adults with high BP (n = 270) completed a questionnaire including: food frequency questionnaire (FFQ), nutrition knowledge, HRQoL, self-efficacy of diet and exercise, lifestyle and AHT adherence sections. Bivariate analysis and hierarchical logistic regression were used to explore the data. RESULTS Three dietary patterns were identified from the FFQ, using factor and cluster analyses (Western, Snack and Alcohol, and Balanced). We observed that following a Western dietary pattern, having lower exercise self-efficacy and shorter sleep duration were more dominant in the poor AHT adherence individuals compared to their counterparts. A positive association was observed between self-efficacy and sleep duration with AHT adherence. A Western dietary pattern was prevalent in high BP participants which slightly reduced the likelihood of good adherence. CONCLUSION A healthier dietary pattern, better exercise self-efficacy and adequate sleep (more than six hours a night) may increase the likelihood of AHT adherence in individuals with high BP. Interventions focusing on improving these variables are required to confirm the findings of this study.
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Shi D, Li J, Wang Y, Wang S, Liu K, Shi R, Zhang Q, Chen X. Association between health literacy and hypertension management in a Chinese community: a retrospective cohort study. Intern Emerg Med 2017; 12:765-776. [PMID: 28303441 DOI: 10.1007/s11739-017-1651-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/08/2017] [Indexed: 02/05/2023]
Abstract
Low health literacy is associated with poor clinical outcomes. The relationship between literacy and blood pressure (BP) has been inconsistent. We investigated the determinants of health literacy and the potential relationship between health literacy and hypertension management. We conducted a retrospective cohort trial of 360 hypertensive patients. Scale measurements, physical examination, and laboratory tests were performed based on a standard protocol. To determine factors associated with health literacy, multiple logistic regression analysis was performed and the discriminatory power of the scale score for hypertension control was assessed by the area under the receiver operating curve. After adjusting for potential confounders, our findings show that the level of education, home blood pressure measurement, regular medication, and systolic blood pressure are significantly associated with health literacy. Moreover, patients with high health literacy have better hypertension control, a lower risk of ischemic cardiovascular disease (ICVD), lower brachial ankle pulse wave velocity values, and better health-related quality of life. In addition, our study also demonstrates that we can identify the health literacy level of hypertensive patients using the Chinese Health Literacy Scale for Hypertension. At a cut-off value of 13.5, we predict that patients will achieve long-term hypertension control. Adequate health literacy is a contributing factor to better blood pressure (BP) control and better perceived quality of life in hypertensive patients. Low health literacy increases the 10-year risk of ICVD and incidence of artery stiffness in hypertensive patients. Improving health literacy should be considered an important part of the management of hypertension.
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Affiliation(s)
- Di Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiangbo Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Si Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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75
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Pantuzza LL, Ceccato MDGB, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol 2017; 73:1475-1489. [PMID: 28779460 DOI: 10.1007/s00228-017-2315-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study was to systematically review evidence regarding the association between regimen complexity and adherence. METHODS Articles were searched in MEDLINE, LILACS, Cochrane, CINAHL, PsycINFO and references of included studies. Search terms included medication regimen complexity, medication adherence and their synonyms. Randomized clinical trials, cross-sectional, cohort or case-control studies published until March 2016 in English, Portuguese or Spanish were eligible if quantitatively examined the association between complexity and adherence in patients of any age and sex, under any type of medication therapy. Complexity was defined according to the strategy used to assess it in the individual studies. All types of instruments used to assess complexity and adherence were considered. Data extraction was performed using an electronic spreadsheet. Quality assessment was conducted independently using standard scales. The data were qualitatively synthesized. RESULTS Fifty-four studies were included: 37 cross-sectional and 17 cohorts. Most were conducted in outpatient setting. Most frequently, studies were carried out with HIV-infected individuals or patients with chronic conditions. The most frequent methods used to assess complexity and adherence were complexity index (19) and self-report (27), respectively. Complexity was associated with adherence in 35 studies. Most of them (28) identified that participants with more complex regimens were less likely to adhere to pharmacotherapy; seven studies found a direct correlation. The others found inconclusive results or no association between complexity and adherence. The studies had low to moderate-methodological quality. CONCLUSION Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.
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Affiliation(s)
- Laís Lessa Pantuzza
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Luane Mendes Ribeiro Junqueira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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76
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McNaughton CD, Brown NJ, Rothman RL, Liu D, Kabagambe EK, Levy PD, Self WH, Storrow AB, Collins SP, Roumie CL. Systolic Blood Pressure and Biochemical Assessment of Adherence: A Cross-Sectional Analysis in the Emergency Department. Hypertension 2017; 70:307-314. [PMID: 28652467 PMCID: PMC5531074 DOI: 10.1161/hypertensionaha.117.09659] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 04/16/2017] [Accepted: 05/20/2017] [Indexed: 12/23/2022]
Abstract
Elevated blood pressure (BP) is common in the emergency department (ED), but the relationship between antihypertensive medication adherence and BP in the ED is unclear. This cross-sectional study tested the hypothesis that higher antihypertensive adherence is associated with lower systolic BP (SBP) in the ED among adults with hypertension who sought ED care at an academic hospital from July 2012 to April 2013. Biochemical assessment of antihypertensive adherence was performed using a mass spectrometry blood assay, and the primary outcome was average ED SBP. Analyses were stratified by number of prescribed antihypertensives (<3, ≥3) and adjusted for age, sex, race, insurance, literacy, numeracy, education, body mass index, and comorbidities. Among 85 patients prescribed ≥3 antihypertensives, mean SBP for adherent patients was 134.4 mm Hg (±26.1 mm Hg), and in adjusted analysis was -20.8 mm Hg (95% confidence interval, -34.2 to -7.4 mm Hg; P=0.003) different from nonadherent patients. Among 176 patients prescribed <3 antihypertensives, mean SBP was 135.5 mm Hg (±20.6 mm Hg) for adherent patients, with no difference by adherence in adjusted analysis (+2.9 mm Hg; 95% confidence interval, -4.7 to 10.5 mm Hg; P=0.45). Antihypertensive nonadherence identified by biochemical assessment was common and associated with higher SBP in the ED among patients who had a primary care provider and health insurance and who were prescribed ≥3 antihypertensives. Biochemical assessment of antihypertensives could help distinguish medication nonadherence from other contributors to elevated BP and identify target populations for intervention.
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Affiliation(s)
- Candace D McNaughton
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.).
| | - Nancy J Brown
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Russell L Rothman
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Dandan Liu
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Edmond K Kabagambe
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Phillip D Levy
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Wesley H Self
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Alan B Storrow
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Sean P Collins
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
| | - Christianne L Roumie
- From the Department of Emergency Medicine (C.D.M., W.H.S., A.B.S., S.P.C.), Department of Internal Medicine (N.J.B., R.L.R., C.L.R.), Department of Pediatrics (R.L.R., C.L.R.), Department of Biostatistics (D.L.), and Division of Epidemiology, Department of Medicine (E.K.K.), VUMC, Nashville, TN; Department of Emergency Medicine, Wayne State University, Detroit, MI (P.D.L.); and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville (C.L.R.)
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77
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Keenan J. Improving adherence to medication for secondary cardiovascular disease prevention. Eur J Prev Cardiol 2017; 24:29-35. [DOI: 10.1177/2047487317708145] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jan Keenan
- Oxford University Hospitals NHS Foundation Trust, UK
- Faculty of Health Sciences, University of Southampton, UK
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78
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Barnason S, White-Williams C, Rossi LP, Centeno M, Crabbe DL, Lee KS, McCabe N, Nauser J, Schulz P, Stamp K, Wood K. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/hcq.0000000000000025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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García-Donaire JA, Franch-Nadal J, Rodríguez-Fortúnez P, Labrador-Barba E, Orera-Peña ML, Rodríguez de Miguel M. Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study. Semergen 2017; 44:5-12. [PMID: 28511878 DOI: 10.1016/j.semerg.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. METHODS This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. RESULTS The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. CONCLUSION This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.
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Affiliation(s)
| | - J Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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Choudhry NK, Krumme AA, Ercole PM, Girdish C, Tong AY, Khan NF, Brennan TA, Matlin OS, Shrank WH, Franklin JM. Effect of Reminder Devices on Medication Adherence: The REMIND Randomized Clinical Trial. JAMA Intern Med 2017; 177:624-631. [PMID: 28241271 PMCID: PMC5470369 DOI: 10.1001/jamainternmed.2016.9627] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Forgetfulness is a major contributor to nonadherence to chronic disease medications and could be addressed with medication reminder devices. OBJECTIVE To compare the effect of 3 low-cost reminder devices on medication adherence. DESIGN, SETTING, AND PARTICIPANTS This 4-arm, block-randomized clinical trial involved 53 480 enrollees of CVS Caremark, a pharmacy benefit manager, across the United States. Eligible participants were aged 18 to 64 years and taking 1 to 3 oral medications for long-term use. Participants had to be suboptimally adherent to all of their prescribed therapies (with a medication possession ratio of 30% to 80%) in the 12 months before randomization. Participants were stratified on the basis of the medications they were using at randomization: medications for cardiovascular or other nondepression chronic conditions (the chronic disease stratum) and antidepressants (the antidepressant stratum). In each stratum, randomization occurred within blocks defined by whether all of the patient's targeted medications were dosed once daily. Patients were randomized to receive in the mail a pill bottle strip with toggles, digital timer cap, or standard pillbox. The control group received neither notification nor a device. Data were collected from February 12, 2013, through March 21, 2015, and data analyses were on the intention-to-treat population. MAIN OUTCOMES AND MEASURES The primary outcome was optimal adherence (medication possession ratio ≥80%) to all eligible medications among patients in the chronic disease stratum during 12 months of follow-up, ascertained using pharmacy claims data. Secondary outcomes included optimal adherence to cardiovascular medications among patients in the chronic disease stratum as well as optimal adherence to antidepressants. RESULTS Of the 53 480 participants, mean (SD) age was 45 (12) years and 56% were female. In the primary analysis, 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill bottle strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up. There was no statistically significant difference in the odds of optimal adherence between the control and any of the devices (standard pillbox: odds ratio [OR], 1.03 [95% CI, 0.95-1.13]; digital timer cap: OR, 1.00 [95% CI, 0.92-1.09]; and pill bottle strip with toggles: OR, 0.94 [95% CI, 0.85-1.04]). In direct comparisons, the odds of optimal adherence were higher with a standard pillbox than with the pill bottle strip (OR, 1.10 [95% CI, 1.00-1.21]). Secondary analyses yielded similar results. CONCLUSIONS AND RELEVANCE Low-cost reminder devices did not improve adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions. The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02015806.
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Affiliation(s)
- Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts2Center for Healthcare Delivery Science, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexis A Krumme
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts2Center for Healthcare Delivery Science, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Angela Y Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nazleen F Khan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Jessica M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Lima-Dellamora EDC, Osorio-de-Castro CGS, Madruga LGDSL, Azeredo TB. Use of pharmacy records to measure treatment adherence: a critical review of the literature. CAD SAUDE PUBLICA 2017; 33:e00136216. [PMID: 28444026 DOI: 10.1590/0102-311x00136216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/06/2017] [Indexed: 01/02/2023] Open
Abstract
The current frame of reference on adherence to pharmacotherapy includes a set of behaviors experienced by the user, with observation of the detailed and continuous history of the use of each dose of the medication. Indicators based on pharmacy records have been used to measure adherence. The current review aimed to identify and describe indicators based on pharmacy records and to discuss their adequacy and limitations for measuring adherence. An exploratory literature review was conducted in three databases using the terms "adherence", "pharmacy records/administrative data", and "measure" to compose the descriptors for the selection of 81 articles and the elaboration of a chart with the denomination, sources, methods for calculation, description, and interpretation of the operational and referential meaning of 14 indicators. Given the most recent taxonomy for adherence proposed in the literature, we concluded that the indicators can be useful for identifying patients with medication-seeking behavior-related problems and analysis of persistence. The distance between supply-related events and difficulties in treatment follow-up can influence an analysis based exclusively on the use of these indicators.
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82
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Jiang Y, Yang X, Li Z, Pan Y, Wang Y, Wang Y, Ji R, Wang C. Persistence of secondary prevention medication and related factors for acute ischemic stroke and transient ischemic attack in China. Neurol Res 2017; 39:492-497. [PMID: 28420316 DOI: 10.1080/01616412.2017.1312792] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yue Jiang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
- Department of General Practice, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Yang
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Ruijun Ji
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Chen Wang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
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83
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Self-management Following a Cardiac Event in People of Chinese Ethnicity Living in Western Countries: A Scoping Review. J Immigr Minor Health 2017; 20:744-754. [DOI: 10.1007/s10903-017-0584-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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84
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Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM. Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives. J Clin Nurs 2017; 26:4325-4334. [DOI: 10.1111/jocn.13759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Caleb Ferguson
- Centre for Cardiovascular & Chronic Care; University of Technology Sydney; Sydney Australia
| | - Sally C. Inglis
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney Australia
| | - Phillip J. Newton
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney Australia
| | - Sandy Middleton
- St Vincent's Health Australia (Sydney) & Australian Catholic University; North Sydney NSW Australia
| | - Peter S. Macdonald
- Heart Transplant Program; St Vincent's Hospital; Sydney and Victor Chang Cardiac Research Institute; Darlinghurst NSW Australia
| | - Patricia M. Davidson
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney; Sydney Australia
- School of Nursing; Johns Hopkins University; Baltimore MD USA
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Rodgers JE, Thudium EM, Beyhaghi H, Sueta CA, Alburikan KA, Kucharska-Newton AM, Chang PP, Stearns SC. Predictors of Medication Adherence in the Elderly: The Role of Mental Health. Med Care Res Rev 2017; 75:746-761. [PMID: 29148336 DOI: 10.1177/1077558717696992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aging population routinely has comorbid conditions requiring complicated medication regimens, yet nonadherence can preclude optimal outcomes. This study explored the association of adherence in the elderly with demographic, socioeconomic, and disease burden measures. Data were from the fifth visit (2011-2013) for 6,538 participants in the Atherosclerosis Risk in Communities Study, conducted in four communities. The Morisky-Green-Levine Scale measured self-reported adherence. Forty percent of respondents indicated some nonadherence, primarily due to poor memory. Logit regression showed, surprisingly, that persons with low reading ability were more likely to report being adherent. Better self-reported physical or mental health both predicted better adherence, but the magnitude of the association was greater for mental than for physical health. Compared with persons with normal or severely impaired cognition, mild cognitive impairment was associated with lower adherence. Attention to mental health measures in clinical settings could provide opportunities for improving medication adherence.
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Affiliation(s)
- Jo E Rodgers
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Emily M Thudium
- 1 Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| | - Hadi Beyhaghi
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Carla A Sueta
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Khalid A Alburikan
- 4 College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anna M Kucharska-Newton
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Patricia P Chang
- 3 School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Sally C Stearns
- 2 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
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Fernández A, Quan J, Moffet H, Parker MM, Schillinger D, Karter AJ. Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes. JAMA Intern Med 2017; 177:371-379. [PMID: 28114642 PMCID: PMC5814298 DOI: 10.1001/jamainternmed.2016.8653] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Medication adherence is essential to diabetes care. Patient-physician language barriers may affect medication adherence among Latino individuals. Objective To determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications. Design, Setting, and Participants This observational study was conducted from January 1, 2006, to December 31, 2012, at a large integrated health care delivery system with professional interpreter services. Insured patients with type 2 diabetes, including English-speaking white, English-speaking Latino, or limited English proficiency (LEP) Latino patients with newly prescribed diabetes medication. Exposures Patient race/ethnicity, preferred language, and physician self-reported Spanish-language fluency. Main Outcomes and Measures Primary nonadherence (never dispensed), early-stage nonpersistence (dispensed only once), late-stage nonpersistence (received ≥2 dispensings, but discontinued within 24 months), and inadequate overall medication adherence (>20% time without sufficient medication supply during 24 months after initial prescription). Results Participants included 21 878 white patients, 5755 English-speaking Latino patients, and 3205 LEP Latino patients with a total of 46 131 prescriptions for new diabetes medications. Among LEP Latino patients, 50.2% (n = 1610) had a primary care physician reporting high Spanish fluency. For oral medications, early adherence varied substantially: 1032 LEP Latino patients (32.2%), 1565 English-speaking Latino patients (27.2%), and 4004 white patients (18.3%) were either primary nonadherent or early nonpersistent. Inadequate overall adherence was observed in 1929 LEP Latino patients (60.2%), 2975 English-speaking Latino patients (51.7%), and 8204 white patients (37.5%). For insulin, early-stage nonpersistence was 42.8% among LEP Latino patients (n = 1372), 34.4% among English-speaking Latino patients (n = 1980), and 28.5% among white patients (n = 6235). After adjustment for patient and physician characteristics, LEP Latino patients were more likely to be nonadherent to oral medications and insulin than English-speaking Latino patients (relative risks from 1.11 [95% CI, 1.06-1.15] to 1.17 [95% CI, 1.02-1.34]; P < .05) or white patients (relative risks from 1.36 [95% CI, 1.31-1.41] to 1.49 [95% CI, 1.32-1.69]; P < .05). English-speaking Latino patients were more likely to be nonadherent compared with white patients (relative risks from 1.23 [95% CI, 1.19-1.27] to 1.30 [95% CI, 1.23-1.39]; P < .05). Patient-physician language concordance was not associated with rates of nonadherence among LEP Latinos (relative risks from 0.92 [95% CI, 0.71-1.19] to 1.04 [95% CI, 0.97-1.1]; P > .28). Conclusions and Relevance Nonadherence to newly prescribed diabetes medications is substantially greater among Latino than white patients, even among English-speaking Latino patients. Limited English proficiency Latino patients are more likely to be nonadherent than English-speaking Latino patients independent of the Spanish-language fluency of their physicians. Interventions beyond access to interpreters or patient-physician language concordance will be required to improve medication adherence among Latino patients with diabetes.
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Affiliation(s)
- Alicia Fernández
- Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California2Department of Medicine, University of California-San Francisco, San Francisco3Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Judy Quan
- Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California2Department of Medicine, University of California-San Francisco, San Francisco3Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Howard Moffet
- Division of Research, Kaiser Permanente, Oakland, California
| | | | - Dean Schillinger
- Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California2Department of Medicine, University of California-San Francisco, San Francisco3Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, California
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Sampaio HADC, Carioca AAF, Sabry MOD, Dos Santos PM, Coelho MAM, Passamai MDPB. [Health literacy in type 2 diabetics: associated factors and glycemic control]. CIENCIA & SAUDE COLETIVA 2017; 20:865-74. [PMID: 25760126 DOI: 10.1590/1413-81232015203.12392014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/24/2014] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus patients must concentrate on self-care, with complex treatments and adequate health behavior in which such habits are a key factor. Due to the complexity of this issue, the importance of literacy in health arises. The goal of the study was to analyze factors associated with literacy in health and its relation with glycemic control in diabetic patients. It involved a study with 82 type 2 diabetic patients of both sexes and aged between 19 and 59 attended in the outpatient endocrinology ward of a public hospital, who filled out an abbreviated and translated version of the Test of Functional Health Literacy in Adults (b-TOFHLA). Fasting glycaemia values and glycated hemoglobin were collected from the clinical history of the participants. Correlations, mean comparisons and linear regression models were tested. Inadequate literacy in health was encountered in 65.9% of the patients. The issues involved factors associated with the b-TOFHLA point scores were age and years of schooling. Global literacy did not explain the glycemic control, but the level of numeracy presented an association with this control. The results point to the need to improve the numeracy in health of the patients to obtain enhanced glycemic control, mainly in those with more advanced age and less years of schooling.
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Lam AY, Nguyen JK, Parks JJ, Morisky DE, Berry DL, Wolpin SE. Addressing low health literacy with "Talking Pill Bottles": A pilot study in a community pharmacy setting. J Am Pharm Assoc (2003) 2016; 57:20-29.e3. [PMID: 27777076 DOI: 10.1016/j.japh.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To test the effect of "Talking Pill Bottles" on medication self-efficacy, knowledge, adherence, and blood pressure readings among hypertensive patients with low health literacy and to assess patients' acceptance of this innovation. DESIGN Longitudinal nonblinded randomized trial with standard treatment and intervention arms. SETTING AND PARTICIPANTS Two community pharmacies serving an ethnically diverse population in the Pacific Northwest. Participants were consented patients with antihypertension prescriptions who screened positive for low health literacy based on the Test of Functional Health Literacy Short Form. Participants in the intervention arm received antihypertensive medications and recordings of pharmacists' counseling in Talking Pill Bottles at baseline. Control arm participants received antihypertensive medications and usual care instructions. MAIN OUTCOME MEASURES Comparison and score changes between baseline and day 90 for medication knowledge test, Self-Efficacy for Appropriate Medication Use Scale (SEAMS), Morisky Medication Adherence Scale (MMAS-8), blood pressure, and responses to semistructured exit interviews and Technology Acceptance Model surveys. RESULTS Of 871 patients screened for health literacy, 134 eligible participants were enrolled in the trial. The sample was elderly, ethnically diverse, of low income, and experienced regarding hypertension and medication history. In both arms, we found high baseline scores in medication knowledge test, SEAMS, and MMAS-8 and minimal changes in these measures over the 90-day study period. Blood pressure decreased significantly in the intervention arm. Acceptability scores for the Talking Pill Bottle technology were high. CONCLUSION Our results suggest that providing audio-assisted medication instructions in Talking Pill Bottles positively affected blood pressure control and was well accepted by patients with low health literacy. Further research involving newly diagnosed patients is needed to mitigate possible ceiling effects that we observed in an experienced population.
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Sonawane Deshmukh KB, Qian J, Garza KB, Wright BM, Zeng P, Ganduglia Cazaban CM, Hansen RA. Achieving Adherence After First-Line Antihypertensive Treatment: Should Fixed-Dose Combinations Receive Priority? J Clin Hypertens (Greenwich) 2016; 18:934-41. [PMID: 26917089 PMCID: PMC8031934 DOI: 10.1111/jch.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/09/2016] [Accepted: 01/17/2016] [Indexed: 11/29/2022]
Abstract
Data on the long-term outcomes of the use of fixed-dose combinations (FDCs) or free-pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008-2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score-adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first-line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.
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Affiliation(s)
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL
| | - Bradley M Wright
- Pharmacy Practice, Auburn University, Auburn, AL
- The University of Alabama at Birmingham, Huntsville, AL
| | - Peng Zeng
- Mathematics and Statistics, Auburn University, Auburn, AL
| | - Cecilia M Ganduglia Cazaban
- Management Policy and Community Health, The University of Texas Health Science Centre at Houston, Houston, TX
| | - Richard A Hansen
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL.
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Ellenburg JT, Lieberman JA, Pattanaik D. Adherence and systemic reaction rates to allergy immunotherapy among veterans. ALLERGY & RHINOLOGY 2016; 7:127-130. [PMID: 28107142 PMCID: PMC5244266 DOI: 10.2500/ar.2016.7.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Although allergen immunotherapy (AIT) is effective and safe, nonadherence is common. Limited data exist regarding adherence to AIT, factors that affect adherence, and systemic reactions associated with AIT among veteran populations. Objective: To evaluate adherence to AIT and the prevalence of reactions secondary to AIT among patients at the Veterans Affairs Medical Center, Memphis, Tennessee. Methods: A retrospective chart review was performed of veterans who received AIT at a single Veterans Affairs facility. Age, race, sex, the total number of shots, travel distance, a diagnosis of posttraumatic stress disorder (PTSD), and the number of severe adverse reactions were compared between the veterans who were adherent and veterans who were nonadherent. Results: The overall adherence rate was 60.9%. Factors associated with adherence were a chart diagnosis of PTSD (29.3% [adherent group] versus 13.6% [nonadherent group]; p = 0.03) and home residence being a further distance from the facility (21.9 miles / 35.2 kilometers [adherent group] versus 18.0 miles / 28.9 kilometers [nonadherent group]; p = 0.03). Patients who were adherent received an average of more total injections compared with patients who were nonadherent. Age, sex, race, and history of systemic reactions during AIT displayed no statistically significant differences between the groups. There were a total of 20 systemic reactions, and the systemic reaction rate was 0.2% per AIT encounter and 0.1% per injection. Conclusion: AIT adherence and systemic reaction rates among veterans at our facility was comparable with similar studies. Adherence was associated with a chart diagnosis of PTSD and home residence that was further away from the clinic.
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Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:1079-1086. [PMID: 26899632 PMCID: PMC4912447 DOI: 10.1016/j.pec.2016.01.020] [Citation(s) in RCA: 337] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To use meta-analytic techniques to assess average effect sizes in studies of: (1) the correlation between patient health literacy and both medication and non-medication adherence, and (2) the efficacy of health literacy interventions on improving health literacy and treatment adherence. METHODS PsychINFO and PubMed databases were searched (1948-2012). A total of 220 published articles met the criteria for inclusion; effect sizes were extracted and articles were coded for moderators. RESULTS Health literacy was positively associated with adherence (r=0.14), and this association was significantly higher among non-medication regimens and in samples with cardiovascular disease. Health literacy interventions increased both health literacy (r=0.22) and adherence outcomes (r=0.16). Moderator analyses revealed greater intervention efficacy when health literacy and adherence were assessed using subjective measures compared to objective measures. Health literacy interventions had a greater effect on adherence in samples of lower income and of racial-ethnic minority patients than in non-minority and higher income samples. CONCLUSION This is the first study to synthesize both correlational and intervention studies examining the relationship between health literacy and adherence to both medication and non-medication regimens. IMPLICATIONS These findings demonstrate the importance of health literacy and the efficacy of health literacy interventions especially among more vulnerable patient groups.
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Affiliation(s)
- Tricia A Miller
- University of California Riverside, Department of Psychology, 900 University Avenue, Riverside, CA 92521, United States.
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Abstract
OBJECTIVE To introduce the concept 'nutrition activation' (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities. DESIGN Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes. SETTING USA. SUBJECTS Adult participants (n 7825) in the 2007-2010 National Health and Nutrition Examination Survey. RESULTS Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger 'spike' in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d). CONCLUSIONS Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.
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93
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Relation of Health Literacy to Exceeding the Labeled Maximum Daily Dose of Acetaminophen. Am J Prev Med 2016; 50:e183-e190. [PMID: 26689980 DOI: 10.1016/j.amepre.2015.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/22/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acetaminophen is a commonly used analgesic/antipyretic; overdoses can lead to liver damage. Little is known about the relationship of health literacy to exceeding the recommended maximum daily dose (4 g). METHODS Subjects were recruited at 23 U.S. malls in 2011. Health literacy was measured by Rapid Estimate of Adult Literacy in Medicine (REALM), classified as very low (VLL, score <45); low (LL, 45-60); or adequate (AL, >60). Participants completed a 7-day acetaminophen use diary by daily telephone interview; an exit interview covered demographics, physical/mental health, medical history, medication label reading, and medication-taking knowledge/attitudes. Acetaminophen products were identified from a comprehensive list; subjects were not required to know their medications contained acetaminophen. Seven hundred fifty-six subjects aged ≥18 years had taken acetaminophen in the past 30 days and completed 7 diary days with ≥1 day of acetaminophen use, plus the exit survey. Analysis was conducted in 2012-2014. RESULTS VLL were more likely than AL individuals to exceed 4 g on ≥1 day (OR [95% CI]=3.8 [1.5, 9.6]; 4.0 [1.3, 12] after controlling for five REALM score-related factors). On usage days, VLL individuals were also more likely to exceed 4 g (3.3 [1.1, 10], by generalized estimating equations; 2.4 [0.9, 6.6], direct effect after accounting for mediation by other deviations from label recommendations). CONCLUSIONS VLL individuals exceed the recommended maximum acetaminophen dose more often than AL individuals. Other identified characteristics related to health literacy do not explain this, but it is partly mediated by increased frequency of other label deviations.
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Goedken AM, Lund BC, Cook EA, Schroeder MC, Brooks JM. Application of a framework for determining number of drugs. BMC Res Notes 2016; 9:272. [PMID: 27178197 PMCID: PMC4865986 DOI: 10.1186/s13104-016-2076-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/04/2016] [Indexed: 11/11/2022] Open
Abstract
Background There are many different methodologies used in the literature for determining the number of drugs used by a patient, and many are incompletely described. This may be attributable to the lack of a framework to help investigators choose and describe their methods and the lack of evidence on the implications of the choice. The purpose of the study was to propose a framework and illustrate how that framework can be used to create and succinctly describe various approaches to counting the number of drugs used by patients and to examine the impact of varying individual components of the framework on the resulting drug count. Methods The three component framework requires specification of scope, uniqueness, and timeframe. The framework was applied to Medicare beneficiaries admitted for acute myocardial infarction in 2008. Drug use was ascertained by Part D prescription drug event files. A default measure for drug count was established, and fourteen additional measures were created by separately altering individual components of the default to illustrate the application of the framework and understand how these changes impacted drug count. Median drug counts and the frequency distributions of beneficiaries experiencing a change in count from default were produced for each measure. Results The median drug count for the default measure was 4. Alteration of the timeframe component had the largest impact on drug counts, with a look-back period of 180 days producing a median count of 8 and changing the count by at least two for 73 % of patients. Variations of the other components had less impact. Conclusion Our framework is intended to be used by investigators to select an approach to counting number of drugs in their studies. Extending the timeframe over which fills from a pharmacy refill database could be counted toward the drug count produced the greatest changes in the number of drugs.
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Affiliation(s)
- Amber M Goedken
- Division of Health Services Research, University of Iowa College of Pharmacy, 115 S. Grand Ave, S557 PHAR, Iowa City, IA, 52242, USA.
| | - Brian C Lund
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Elizabeth A Cook
- Clinical Trials Statistical and Data Management Center, University of Iowa, Iowa City, IA, USA
| | - Mary C Schroeder
- Division of Health Services Research, University of Iowa College of Pharmacy, 115 S. Grand Ave, S557 PHAR, Iowa City, IA, 52242, USA
| | - John M Brooks
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Wu JR, Moser DK, DeWalt DA, Rayens MK, Dracup K. Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002250. [PMID: 26721913 DOI: 10.1161/circheartfailure.115.002250] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF. METHODS AND RESULTS This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation. CONCLUSIONS Health literacy mediates the relationship between age and health outcomes in adults with HF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Jia-Rong Wu
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
| | - Debra K Moser
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Darren A DeWalt
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Mary Kay Rayens
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Kathleen Dracup
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
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Geboers B, de Winter AF, Spoorenberg SLW, Wynia K, Reijneveld SA. The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators. Qual Life Res 2016; 25:2869-2877. [PMID: 27101999 PMCID: PMC5065597 DOI: 10.1007/s11136-016-1298-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Low health literacy is an important predictor of poor health outcomes and well-being among older adults. A reason may be that low health literacy decreases older adults' self-management abilities. We therefore assessed the association between health literacy and self-management abilities among adults aged 75 and older, and the impact of demographic factors, socioeconomic factors, and health status on this association. METHODS We used data of 1052 older adults, gathered for a previously conducted randomized controlled trial on Embrace, an integrated elderly care model. These data pertained to health literacy, self-management abilities, demographic background, socioeconomic situation, and health status. Health literacy was measured by the validated three-item Brief Health Literacy Screening instrument. Self-management abilities were measured by the validated Self-Management Ability Scale (SMAS-30). RESULTS After adjustment for confounders, self-management abilities were poorer in older adults with low health literacy (β = .34, p < .001). This was more pronounced in medium- to high-educated older adults than in low-educated older adults. Sex, age, living situation, income, presence of chronic illness, and mental health status did not moderate the association between health literacy and self-management abilities. CONCLUSIONS Low health literacy is associated with poor self-management abilities in a wide range of older adults. Early recognition of low health literacy among adults of 75 years and older and interventions to improve health literacy might be very beneficial for older adults.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands.
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, FA10, P.O. Box 196, 9700 AD, Groningen, The Netherlands
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Chesser AK, Keene Woods N, Smothers K, Rogers N. Health Literacy and Older Adults: A Systematic Review. Gerontol Geriatr Med 2016; 2:2333721416630492. [PMID: 28138488 PMCID: PMC5119904 DOI: 10.1177/2333721416630492] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 12/17/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022] Open
Abstract
Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults.
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Lafata JE, Karter AJ, O'Connor PJ, Morris H, Schmittdiel JA, Ratliff S, Newton KM, Raebel MA, Pathak RD, Thomas A, Butler MG, Reynolds K, Waitzfelder B, Steiner JF. Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes. J Gen Intern Med 2016; 31:188-195. [PMID: 26282954 PMCID: PMC4720651 DOI: 10.1007/s11606-015-3486-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. METHODS We identified three cohorts of black and white patients treated with oral medications and who had poor risk factor control at baseline (2009): those with glycated hemoglobin (HbA1c) >8 % (n = 37,873), low-density lipoprotein cholesterol (LDL-C) >100 mg/dl (n = 27,954), and systolic blood pressure (SBP) >130 mm Hg (n = 63,641). Subjects included insured adults with diabetes who were receiving care in one of nine U.S. integrated health systems comprising the SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) consortium. Baseline and follow-up risk factor control, sociodemographic, and clinical characteristics were obtained from electronic health records. Pharmacy-dispensing data were used to estimate medication adherence (i.e., medication refill adherence [MRA]) and treatment intensification (i.e., dose increase or addition of new medication class) between baseline and follow-up. County-level income and educational attainment were estimated via geocoding. Logistic regression models were used to test the association between race and follow-up risk factor control. Models were specified with and without medication adherence to evaluate its role as a mediator. RESULTS We observed poorer medication adherence among black patients than white patients (p < 0.01): 50.6 % of blacks versus 39.7 % of whites were not highly adherent (i.e., MRA <80 %) to HbA1c oral medication(s); 58.4 % of blacks and 46.7 % of whites were not highly adherent to lipid medication(s); and 33.4 % of blacks and 23.7 % of whites were not highly adherent to BP medication(s). Across all cardiometabolic risk factors, blacks were significantly less likely to achieve control (p < 0.01): 41.5 % of blacks and 45.8 % of whites achieved HbA1c <8 %; 52.6 % of blacks and 60.8 % of whites achieved LDL-C <100; and 45.7 % of blacks and 53.6 % of whites achieved SBP <130. Adjusting for medication adherence/treatment intensification did not alter these patterns or model fit statistics. CONCLUSIONS Medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.
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Affiliation(s)
- Jennifer Elston Lafata
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
- Henry Ford Health System, Detroit, MI, USA.
- Department of Social and Behavioral Health, Virginia Commonwealth University, PO Box 980149, Richmond, VA, 23298, USA.
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patrick J O'Connor
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | | | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Scott Ratliff
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | | | - Melissa G Butler
- Kaiser Permanente Georgia Center for Health Research- Southeast, Atlanta, GA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Beth Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research - Hawaii, Honolulu, HI, USA
| | - John F Steiner
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
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Kim H, Kim HS, Bowman JD, Cho NH. Comparing diabetic patient characteristics related to stated medication adherence in a rural vs. urban community in Korea. J Clin Pharm Ther 2015; 41:40-6. [DOI: 10.1111/jcpt.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/25/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H. Kim
- College of Pharmacy; Sookmyung Women's University; Seoul South Korea
| | - H.-S. Kim
- College of Medicine; The Catholic University of Korea; Seoul South Korea
| | - J. D. Bowman
- Rangel College of Pharmacy; Texas A&M Health Science Center; Kingsville TX USA
| | - N. H. Cho
- Department of Preventive Medicine; Ajou University School of Medicine; Suwon South Korea
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100
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Fleisher JE, Shah K, Fitts W, Dahodwala NA. Associations and implications of low health literacy in Parkinson's Disease. Mov Disord Clin Pract 2015; 3:250-256. [PMID: 27331078 DOI: 10.1002/mdc3.12272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Low health literacy (HL) indicates a limited ability to understand and use basic information to make appropriate healthcare decisions. While low HL is associated with higher morbidity, mortality, and healthcare costs in multiple chronic conditions, little is known about HL and its associations in Parkinson's disease (PD). METHODS Cross-sectional study of non-demented adults with PD participating in the National Parkinson Foundation Parkinson's Outcomes Project at the University of Pennsylvania. Subjects were administered two brief HL assessments-the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), a word-recognition test, and the Newest Vital Sign (NVS), a test of literacy, numeracy and understanding of health information-as well as demographic and clinical questionnaires. Adverse outcomes included falls in the 3 months preceding the study visit, and hospital admissions, emergency room visits, infections, or injuries in the preceding year. Caregiver burden was measured using the Multidimensional Caregiver Strain Index. RESULTS 168 subjects completed both HL screens (mean 65.8 years, 65.5% male, 65.2% Hoehn & Yahr Stage 2). Using the REALM-SF, 97.6% of subjects had adequate HL. Using the NVS, however, 29.8% had low HL, which was associated with older age, lower education, male gender, greater disease severity, and poorer cognition. Low HL was associated with hospital admission and increased caregiver burden. CONCLUSIONS Low HL is common and associated with greater caregiver burden and a higher likelihood of hospitalization in patients with PD. Since HL is associated with both disease severity and adverse outcomes, it may be an important, modifiable contributor to morbidity.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurology, New York University Langone School of Medicine, New York, New York, USA
| | - Krunal Shah
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Whitney Fitts
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nabila A Dahodwala
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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