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Nelson K, Drain N, Robinson J, Kapp J, Hebert P, Taylor L, Silverman J, Kiefer M, Lessler D, Krieger J. Peer Support for Achieving Independence in Diabetes (Peer-AID): design, methods and baseline characteristics of a randomized controlled trial of community health worker assisted diabetes self-management support. Contemp Clin Trials 2014; 38:361-9. [PMID: 24956324 DOI: 10.1016/j.cct.2014.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND & OBJECTIVES Community health workers (CHWs) may be an important mechanism to provide diabetes self-management to disadvantaged populations. We describe the design and baseline results of a trial evaluating a home-based CHW intervention. METHODS & RESEARCH DESIGN Peer Support for Achieving Independence in Diabetes (Peer-AID) is a randomized, controlled trial evaluating a home-based CHW-delivered diabetes self-management intervention versus usual care. The study recruited participants from 3 health systems. Change in A1c measured at 12 months is the primary outcome. Changes in blood pressure, lipids, health care utilization, health-related quality of life, self-efficacy and diabetes self-management behaviors at 12 months are secondary outcomes. RESULTS A total of 1438 patients were identified by a medical record review as potentially eligible, 445 patients were screened by telephone for eligibility and 287 were randomized. Groups were comparable at baseline on socio-demographic and clinical characteristics. All participants were low-income and were from diverse racial and ethnic backgrounds. The mean A1c was 8.9%, mean BMI was above the obese range, and non-adherence to diabetes medications was high. The cohort had high rates of co-morbid disease and low self-reported health status. Although one-third reported no health insurance, the mean number of visits to a physician in the past year was 5.7. Trial results are pending. CONCLUSIONS Peer-AID recruited and enrolled a diverse group of low income participants with poorly controlled type 2 diabetes and delivered a home-based diabetes self-management program. If effective, replication of the Peer-AID intervention in community based settings could contribute to improved control of diabetes in vulnerable populations.
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Affiliation(s)
- Karin Nelson
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States; University of Washington, School of Public Health, United States.
| | - Nathan Drain
- Public Health - Seattle & King County, United States
| | - June Robinson
- Public Health - Seattle & King County, United States
| | - Janet Kapp
- Public Health - Seattle & King County, United States
| | - Paul Hebert
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Leslie Taylor
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States
| | - Julie Silverman
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Meghan Kiefer
- VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, United States; University of Washington, School of Medicine, Department of Medicine, United States
| | - Dan Lessler
- University of Washington, School of Medicine, Department of Medicine, United States
| | - James Krieger
- University of Washington, School of Medicine, Department of Medicine, United States; University of Washington, School of Public Health, United States; Public Health - Seattle & King County, United States
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202
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Baig AA, Benitez A, Locklin CA, Campbell A, Schaefer CT, Heuer LJ, Lee SM, Solomon MC, Quinn MT, Burnet DL, Chin MH. Community health center provider and staff's Spanish language ability and cultural awareness. J Health Care Poor Underserved 2014; 25:527-45. [PMID: 24858866 DOI: 10.1353/hpu.2014.0086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76-100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients.
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203
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Maclennan PA, McGwin G, Heckemeyer C, Lolley VR, Hullett S, Saaddine J, Shrestha SS, Owsley C. Eye care use among a high-risk diabetic population seen in a public hospital's clinics. JAMA Ophthalmol 2014; 132:162-7. [PMID: 24310149 DOI: 10.1001/jamaophthalmol.2013.6046] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. OBJECTIVE To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics. RESULTS There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99). CONCLUSIONS AND RELEVANCE Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.
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Affiliation(s)
- Paul A Maclennan
- Department of Surgery, School of Medicine, University of Alabama at Birmingham
| | - Gerald McGwin
- Department of Surgery, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham3Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Christine Heckemeyer
- Jefferson County Health System, Cooper Green Mercy Hospital, Birmingham, Alabama
| | - Virginia R Lolley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Sandral Hullett
- Jefferson County Health System, Cooper Green Mercy Hospital, Birmingham, Alabama
| | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sundar S Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
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204
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Odulana A, Kim MM, Green M, Taylor Y, Howard DL, Godley P, Corbie-Smith G. Participating in research: attitudes within the African American church. JOURNAL OF RELIGION AND HEALTH 2014; 53:373-81. [PMID: 22886179 PMCID: PMC4419576 DOI: 10.1007/s10943-012-9637-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We assessed associations between pastor and congregant characteristics and congregant attitudes about research participation among African American churches. Respondents shared their attitudes regarding how willing, ready, and confident they were about research participation. The outcome measure, the index of research preparedness, summed responses across the domains of willingness, readiness, and confidence. Pastor age and pastor educational attainment were independently associated with a congregants' higher index of research preparedness. Young and educated pastors were significantly associated with congregant attitudes about participation preparedness, a finding that highlights the importance of the pastor regarding congregant research participation decisions.
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Affiliation(s)
- Adebowale Odulana
- Division of General Medicine & Clinical Epidemiology and Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic, CB 7100, Chapel Hill, NC, 27599, USA,
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Okosun IS, Annor F, Dawodu EA, Eriksen MP. Clustering of cardiometabolic risk factors and risk of elevated HbA1c in non-Hispanic White, non-Hispanic Black and Mexican-American adults with type 2 diabetes. Diabetes Metab Syndr 2014; 8:75-81. [PMID: 24907170 DOI: 10.1016/j.dsx.2014.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM To determine which cardiometabolic risk factors and clusters of cardiometabolic risk factors that are mostly associated with elevated HbA1c in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-American (MA) adults who have type 2 diabetes. METHODS Data (n=2910) from the United States National Health and Nutritional Examination Surveys were used in this study. Elevated HbA1c was defined as having HbA1c value was 7% or greater. Race/ethnicity-specific associations of individual and clustered (2-5 factors) cardiometabolic risk factors with elevated HbA1c were determined using prevalence odds ratio from multivariate logistic regression analyses. Statistical adjustments were made for sex, age, education, income and marital status. RESULTS Joint occurrence of abdominal obesity, high blood pressure, and elevated triglycerides and joint occurrence of high blood pressure, elevated triglycerides and low HDL were more highly associated with elevated odds of HbA1c compared to other cardiometabolic risk factors joint occurrences. Joint occurrences of abdominal obesity, high blood pressure, and elevated triglycerides was associated with 2.3 (95% CI: 1.2-3.3), 9.1 (95% CI: 2.9-28.7) and 4.8 (95% CI: 2.0-11.5) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. The corresponding values for the joint occurrence of high blood pressure, elevated triglycerides and low HDL was associated with 2.4 (95% CI: 1.2-3.7), 3.5 (95% CI: 1.1-5.5) and 2.6 (95% CI: 1.5-4.7) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. CONCLUSION This finding calls for consideration of cardiovascular risk factor clustering in deciding medical therapies to optimize glycemic control in individuals with type 2 diabetes. Interventions designed to achieve glycemic control coupled with modification of cardiometabolic risk factors may be crucial in alleviating sequelae resulting from type 2 diabetes.
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Affiliation(s)
- Ike S Okosun
- Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States.
| | - Francis Annor
- Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States
| | - Ebenezer A Dawodu
- Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States
| | - Michael P Eriksen
- Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States
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206
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Pollard SL, Zachary DA, Wingert K, Booker SS, Surkan PJ. Family and Community Influences on Diabetes-Related Dietary Change in a Low-Income Urban Neighborhood. DIABETES EDUCATOR 2014; 40:462-469. [DOI: 10.1177/0145721714527520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to explore the influence of the social environment, including family and community relationships, on diabetes-related dietary change behaviors in a low-income, predominantly African American community with limited access to healthy foods. Methods Study methods included interviews and focus groups with adults with diabetes and family members of individuals with diabetes in a low-income African American community. In this analysis, interview participants included 11 participants with diabetes, one with prediabetes, and 8 family members or close friends with diabetes. Information from 4 participants with diabetes and 6 with family members with diabetes was included from 6 focus groups. Transcripts were analyzed via thematic iterative coding influenced by social cognitive theory to understand the influence of family and community relationships on dietary change. Results Participants’ social environments strongly influenced diet-related behavioral change. Family members without diabetes provided reinforcements for dietary change for those with diabetes by preparing healthy food and monitoring intake, as well as by adopting dietary changes made by those with diabetes. Family and community members served as sources of observational learning about the potential impacts of diabetes and enhanced behavioral capability for dietary change among people with diabetes by providing dietary advice and strategies for making healthy choices. Conclusions This study demonstrates the ways in which family and community members can influence dietary change in people with diabetes. Interventions targeting diabetes management should incorporate families and communities as sources of information, learning, and support.
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Affiliation(s)
- Suzanne L. Pollard
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Drew A. Zachary
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Katherine Wingert
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Sara S. Booker
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Pamela J. Surkan
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
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207
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Kupersmith J, LaBarca D. Using comparative effectiveness research to remedy health disparities. J Comp Eff Res 2014; 3:177-84. [DOI: 10.2217/cer.14.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Health disparities are an important and continuing problem of considerable research importance. Comparative effectiveness research (CER) is an excellent vehicle to evaluate interventions to remedy disparities. We classify CER for disparities at three levels of science: basic biology, care and systems, and social and cultural context. In basic biology, genomics will delineate treatments for specific individuals and populations. Care and systems interventions are most important research areas to improve process and quality measures. However, there is evidence that correction of healthcare processes disparities will not be sufficient to improve health and that social and cultural research may be key in this regard. The methodology of CER for disparities is the same as that of other research with randomized controlled trials the gold standard and database analysis, and other observational and quasi-experimental methods important and effective. In addition, mixed methods and multilevel modeling offer promise. Community involvement in research and patient preferences among high-quality choices need to be included in planning of CER.
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Affiliation(s)
- Joel Kupersmith
- Georgetown University Medical Center, Washington, DC, USA
- Kupersmith Associates, Washington, DC, USA
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208
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Peek ME, Ferguson M, Bergeron N, Maltby D, Chin MH. Integrated community-healthcare diabetes interventions to reduce disparities. Curr Diab Rep 2014; 14:467. [PMID: 24464339 PMCID: PMC3956046 DOI: 10.1007/s11892-013-0467-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Racial and ethnic minorities suffer disproportionately from diabetes-related morbidity and mortality. With the creation of Accountable Care Organizations (ACOs) under the Affordable Care Act, healthcare organizations may have an increased motivation to implement interventions that collaborate with community resources and organizations. As a result, there will be an increasing need for evidence-based strategies that integrate healthcare and community components to reduce diabetes disparities. This paper summarizes the types of community/health system partnerships that have been implemented over the past several years to improve minority health and reduce disparities among racial/ethnic minorities and describes the components that are most commonly integrated. In addition, we provide our recommendations for creating stronger healthcare and community partnerships through enhanced community support.
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209
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Raffel KE, Goddu AP, Peek ME. "I Kept Coming for the Love": Enhancing the Retention of Urban African Americans in Diabetes Education. DIABETES EDUCATOR 2014; 40:351-360. [PMID: 24525568 DOI: 10.1177/0145721714522861] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to investigate how retention strategies employed by the Diabetes Empowerment Program (DEP) contributed to retention. METHODS An experienced moderator conducted in-depth interviews (n = 7) and 4 focus groups (n = 29) with former DEP participants. Interviews were recorded, transcribed, and coded using iteratively modified coding guidelines. Results were analyzed using Atlas.ti 4.2 software. RESULTS Participants were African American and predominantly female, low income, and with more than 1 diabetes complication. Key retention themes included: (1) educator characteristics and interpersonal skills ("The warmth of the staff . . . kept me coming back for more."), (2) accessible information ("I didn't know anything about diabetes [before]. I was just given the medicine."), (3) social support ("I realized I wasn't the only one who has diabetes."), (4) the use of narrative ("It's enlightening to talk about [my diabetes]."), and (5) the African American helping tradition ("I went not just for myself but for my husband."). CONCLUSIONS While many interventions focus on costly logistics and incentives to retain at-risk participants, study findings suggest that utilizing culturally tailored curricula and emphasizing interpersonal skills and social support may be more effective strategies to retain low-income African Americans in diabetes education programs.
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Affiliation(s)
- Katie E Raffel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois (Dr Raffel)
| | - Anna P Goddu
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek)
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois (Ms Goddu, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Ms Goddu, Dr Peek),Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, Illinois (Dr Peek)
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210
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Kenney MC, Chwa M, Atilano SR, Falatoonzadeh P, Ramirez C, Malik D, Tarek M, Del Carpio JC, Nesburn AB, Boyer DS, Kuppermann BD, Vawter MP, Jazwinski SM, Miceli MV, Wallace DC, Udar N. Molecular and bioenergetic differences between cells with African versus European inherited mitochondrial DNA haplogroups: implications for population susceptibility to diseases. BIOCHIMICA ET BIOPHYSICA ACTA 2014; 1842:208-19. [PMID: 24200652 PMCID: PMC4326177 DOI: 10.1016/j.bbadis.2013.10.016] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/18/2013] [Accepted: 10/29/2013] [Indexed: 02/08/2023]
Abstract
The geographic origins of populations can be identified by their maternally inherited mitochondrial DNA (mtDNA) haplogroups. This study compared human cybrids (cytoplasmic hybrids), which are cell lines with identical nuclei but mitochondria from different individuals with mtDNA from either the H haplogroup or L haplogroup backgrounds. The most common European haplogroup is H while individuals of maternal African origin are of the L haplogroup. Despite lower mtDNA copy numbers, L cybrids had higher expression levels for nine mtDNA-encoded respiratory complex genes, decreased ATP (adenosine triphosphate) turnover rates and lower levels of reactive oxygen species production, parameters which are consistent with more efficient oxidative phosphorylation. Surprisingly, GeneChip arrays showed that the L and H cybrids had major differences in expression of genes of the canonical complement system (5 genes), dermatan/chondroitin sulfate biosynthesis (5 genes) and CCR3 (chemokine, CC motif, receptor 3) signaling (9 genes). Quantitative nuclear gene expression studies confirmed that L cybrids had (a) lower expression levels of complement pathway and innate immunity genes and (b) increased levels of inflammation-related signaling genes, which are critical in human diseases. Our data support the hypothesis that mtDNA haplogroups representing populations from different geographic origins may play a role in differential susceptibilities to diseases.
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Affiliation(s)
- M Cristina Kenney
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA; Department of Pathology and Laboratory Medicine, Univ. of California Irvine, Irvine, CA, USA.
| | - Marilyn Chwa
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
| | - Shari R Atilano
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
| | | | - Claudio Ramirez
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
| | - Deepika Malik
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
| | - Mohamed Tarek
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
| | | | - Anthony B Nesburn
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA; Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David S Boyer
- Retina-Vitreous Associates Medical Group, Beverly Hills, CA, USA
| | | | - Marquis P Vawter
- Functional Genomics Laboratory, Department of Psychiatry and Human Behavior, Univ. of California Irvine, Irvine, CA, USA
| | | | - Michael V Miceli
- Tulane Center for Aging, Tulane University, New Orleans, LA, USA
| | | | - Nitin Udar
- Gavin Herbert Eye Institute, Univ. of California Irvine, Irvine, CA, USA
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211
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Philis-Tsimikas A, Gallo LC. Implementing community-based diabetes programs: the scripps whittier diabetes institute experience. Curr Diab Rep 2014; 14:462. [PMID: 24390404 PMCID: PMC3946451 DOI: 10.1007/s11892-013-0462-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetes affects a large and growing segment of the US population. Ethnic and racial minorities are at disproportionate risk for diabetes, with Hispanics and non-Hispanic Blacks showing a near doubling of risk relative to non-Hispanic Whites. There is an urgent need to identify low cost, effective, and easily implementable primary and secondary prevention approaches, as well as tertiary strategies that delay disease progression, complications, and associated deterioration in function in patients with diabetes. The Chronic Care Model provides a well-accepted framework for improving diabetes and chronic disease care in the community and primary care medical home. A number of community-based diabetes programs have incorporated this model into their infrastructure. Diabetes programs must offer accessible information and support throughout the community and must be delivered in a format that is understood, regardless of literacy and socioeconomic status. This article will discuss several successful, culturally competent community-based programs and the key elements needed to implement the programs at a community or health system level. Health systems together with local communities can integrate the elements of community-based programs that are effective across the continuum of the care to enhance patient-centered outcomes, enable patient acceptability and ultimately lead to improved patient engagement and satisfaction.
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Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, 9894 Genesee Ave, Suite 316, La Jolla, CA 92037, Telephone : 858-626-5628, Fax : 858-626-5680
| | - Linda C. Gallo
- San Diego State University, Department of Psychology, 9245 Sky Park Court Suite 115, San Diego, CA 92123, Telephone: (619) 594-4833, Fax: (619) 594-6780
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212
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Baig AA, Locklin CA, Wilkes AE, Oborski DD, Acevedo JC, Gorawara-Bhat R, Quinn MT, Burnet DL, Chin MH. Integrating diabetes self-management interventions for mexican-americans into the catholic church setting. JOURNAL OF RELIGION AND HEALTH 2014; 53:105-18. [PMID: 22528288 PMCID: PMC3430816 DOI: 10.1007/s10943-012-9601-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members' diabetes care.
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Affiliation(s)
- Arshiya A Baig
- Department of Medicine, University of Chicago, 5841 S. Maryland Ave. MC 2007, Chicago, IL, 60637, USA,
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213
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West JF. Public health program planning logic model for community engaged type 2 diabetes management and prevention. EVALUATION AND PROGRAM PLANNING 2014; 42:43-49. [PMID: 24211470 DOI: 10.1016/j.evalprogplan.2013.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 08/29/2013] [Accepted: 09/11/2013] [Indexed: 06/02/2023]
Abstract
Diabetes remains a growing epidemic with widening health inequity gaps in disease management, self-management knowledge, access to care and outcomes. Yet there is a paucity of evaluation tools for community engaged interventions aimed at closing the gaps and improving health. The Guide to Community Preventive Services (the Community Guide) developed by the Task Force on Community Preventive Services (the Task Force) at the Centers for Disease Control and Prevention (CDC) recommends two healthcare system level interventions, case management interventions and disease management programs, to improve glycemic control. However, as a public health resource guide for diabetes interventions a model for community engagement is a glaringly absent component of the Community Guide recommendations. In large part there are few evidence-based interventions featuring community engagement as a practice and system-level focus of chronic disease and Type 2 diabetes management. The central argument presented in this paper is that the absence of these types of interventions is due to the lack of tools for modeling and evaluating such interventions, especially among disparate and poor populations. A conceptual model emphasizing action-oriented micro-level community engagement is needed to complement the Community Guide and serve as the basis for testing and evaluation of these kinds of interventions. A unique logic model advancing the Community Guide diabetes recommendations toward measureable and sustainable community engagement for improved Type 2 diabetes outcomes is presented.
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Affiliation(s)
- Joseph F West
- Sinai Urban Health Institute (SUHI), California at 15th Street, Room NR6-137, Chicago, IL 60608, United States.
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The association of binge eating and neighbourhood fast-food restaurant availability on diet and weight status. Public Health Nutr 2014; 18:352-60. [PMID: 24476972 DOI: 10.1017/s1368980013003546] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Fast-food restaurants (FFR) are prevalent. Binge eating is common among overweight and obese women. For women prone to binge eating, neighbourhood FFR availability (i.e. the neighbourhood around one's home) may promote poor diet and overweight/obesity. The present study tested the effects of binge eating and neighbourhood FFR availability on diet (fat and total energy intake) and BMI among African American and Hispanic/Latino women. DESIGN All measures represent baseline data from the Health is Power randomized clinical trial. The numbers of FFR in participants' neighbourhoods were counted and dichotomized (0 or ≥1 neighbourhood FFR). Participants completed measures of binge eating status and diet. Weight and height were measured and BMI calculated. 2 (binge eating status) × 2 (neighbourhood FFR availability) ANCOVA tested effects on diet and BMI while controlling for demographics. SETTING Houston and Austin, TX, USA. SUBJECTS African American and Hispanic/Latino women aged 25-60 years. RESULTS Of the total sample (n 162), 48 % had 1-15 neighbourhood FFR and 29 % were binge eaters. There was an interaction effect on BMI (P = 0·05). Binge eaters with ≥1 neighbourhood FFR had higher BMI than non-binge eaters or binge eaters with no neighbourhood FFR. There were no significant interactions or neighbourhood FFR main effects on total energy or fat intake (P > 0·05). A main effect of binge eating showed that binge eaters consumed more total energy (P = 0·005) and fat (P = 0·005) than non-binge eaters. CONCLUSIONS Binge eaters represented a substantial proportion of this predominantly overweight and obese sample of African American and Hispanic/Latino women. The association between neighbourhood FFR availability and weight status is complicated by binge eating status, which is related to diet.
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Davidson MB, Duran P, Lee ML. Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos. Ethn Dis 2014; 24:195-199. [PMID: 24804366 PMCID: PMC4287403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To evaluate community screening using HbA1c levels in high risk African Americans and Latinos in those not known to have diabetes. DESIGN HbA1c levels were measured in 1542 African Americans and Latinos aged > or = 40 years with one or more of the following risk factors: family history in first degree relatives, waist circumference > or = 40 inches in males or > or = 35 inches in females, and hypertension, either treatment for or a measured BP of > or = 140/ 90 mm Hg. Oral glucose tolerance tests (OGTT) were offered to those meeting the HbA1c criterion for pre-diabetes. SETTING Churches, community health fares, senior citizen sites. PARTICIPANTS People without known diabetes. MAIN OUTCOME MEASURES Proportion of people meeting the HbA1c criteria for prediabetes (5.8-6.4%) and diabetes (> or = 6.5%). RESULTS 32% had one, 50% had two and 18% had three risk factors. By HbA1c criteria, 40% had pre-diabetes and 25% had diabetes. Increased waist circumference was the most common risk factor followed by a positive family history, and lastly, hypertension. Each individual risk factor was significantly (P < .001) and progressively more common as glycemia increased. Each additional risk factor increased the odds of pre-diabetes or diabetes by 2- to 4-fold. In individuals with pre-diabetes who underwent an OGTT, 59% were normal, 35% had pre-diabetes and only 6% had diabetes. CONCLUSIONS Community screening of high risk African Americans and Latinos with HbA1c levels identifies a large proportion of people with pre-diabetes and diabetes. Those identified with pre-diabetes are unlikely to meet the OGTT criteria for diabetes.
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216
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Baig AA, Locklin CA, Foley E, Ewigman B, Meltzer DO, Huang ES. The association of English ability and glycemic control among Latinos with diabetes. Ethn Dis 2014; 24:28-34. [PMID: 24620445 PMCID: PMC3965672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Language barriers may be significant contributors to diabetes disparities. We sought to assess the association of English speaking ability with glycemic control among Latinos with diabetes. METHODS We analyzed 167 Latinos from a cross-sectional survey of adults with type 2 diabetes. The main outcome was HbA1c > or =7.0%. The main predictor was self-reported English speaking ability. Adjusted analyses accounted for age, sex, education, annual income, health insurance status, duration of diabetes, birth in the United States, and years in the United States. RESULTS In unadjusted analyses, point estimates for the odds of having a high HbAlc revealed a U-shaped curve with English speaking ability. Those who spoke English very well (OR=2.32, 95% CI, 1.00-5.41) or not at all (OR=4.11, 95% CI 1.35-12.54) had higher odds of having an elevated HbA1c than those who spoke English well, although this was only statistically significant for those who spoke no English. In adjusted analyses, the U-shaped curve persisted with the highest odds among those who spoke English very well (OR=3.20, 95% CI 1.05-9.79) or not at all (OR 4.95, 95% CI 1.29-18.92). CONCLUSIONS The relationship between English speaking ability and diabetes management is more complex than previously described. Interventions aimed at improving diabetes outcomes may need to be tailored to specific subgroups within the Latino population.
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Personal Weight Status Classification and Health Literacy Among Supplemental Nutrition Assistance Program (SNAP) Participants. J Community Health 2013; 39:446-53. [DOI: 10.1007/s10900-013-9796-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Thirty years of disparities intervention research: what are we doing to close racial and ethnic gaps in health care? Med Care 2013; 51:1020-6. [PMID: 24128746 DOI: 10.1097/mlr.0b013e3182a97ba3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A systematic scan of the disparities intervention literature will allow researchers, providers, and policymakers to understand which interventions are being evaluated to improve minority health and which areas require further research. METHODS We systematically categorized 391 disparities intervention articles published between 1979 and 2011, covering 11 diseases. We developed a taxonomy of disparities interventions using qualitative theme analysis. We identified the tactic, or what was done to intervene; the strategy, or a group of tactics with common characteristics; and the level, or who was targeted by the effort. RESULTS The taxonomy included 44 tactics, 9 strategies, and 6 levels. Delivering education and training was the most common strategy (37%). Within education and training, the most common tactics were education about disease (14%) and self-management (11%), whereas communication skills training (3%) and decision-making aids (1%) were less frequent. The strategy of actively engaging the community through tactics such as community health workers and outreach efforts accounted for 6.5% of tactics. Interventions most commonly targeted patients (50%) and community members who were not established patients of the intervening organization (32%). Interventions targeting providers (7%), the microsystem (immediate care team) (9%), organizations (3%), and policies (0.1%) were less common. CONCLUSIONS Disparities researchers have predominantly focused on the patient as the target for change; future research should also investigate how to improve the system that serves minority patients. Areas for further study include interventions that engage the community, educational interventions that address communication barriers, and the impact of policy reform on disparities in care.
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Abstract
Health disparities in diabetes and its complications and comorbidities exist globally. A recent Endocrine Society Scientific Statement described the Health Disparities in several endocrine disorders, including type 2 diabetes. In this review, we summarize that statement and provide novel updates on race/ethnic differences in children and adults with type 1 diabetes, children with type 2 diabetes, and in Latino subpopulations. We also review race/ethnic differences in the epidemiology of diabetes, prediabetes, and diabetes complications and mortality in the United States and globally. Finally, we discuss biological, behavioral, social, environmental, and health system contributors to diabetes disparities to identify areas for future preventive interventions.
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Affiliation(s)
- Elias K. Spanakis
- Departments of Medicine, Johns Hopkins University School of Medicine
| | - Sherita Hill Golden
- Departments of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
- Corresponding author: Address correspondence and requests for reprints to: Dr. Sherita Hill Golden, Johns Hopkins University School of Medicine Division of Endocrinology and Metabolism, 1830 E. Monument Street, Suite 333 Baltimore, MD 21287 Tel: (410) 502-0993, Fax (410) 955-8172,
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220
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Dauvrin M, Lorant V. Culturally competent interventions in Type 2 diabetes mellitus management: an equity-oriented literature review. ETHNICITY & HEALTH 2013; 19:579-600. [PMID: 24266662 DOI: 10.1080/13557858.2013.857763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Although, culturally competent (CC) interventions aim to reduce health inequalities for ethnic minorities, they have been criticized on the grounds that they increase prejudice and stereotyping. It remains unclear whether CC interventions really can reduce health inequalities among ethnic minorities. The purpose of this review is to assess whether CC interventions in the management of Type 2 diabetes mellitus (T2DM) match the recommendations to reduce health inequalities. DESIGN We identified CC interventions relating to T2DM among ethnic minority patients in the literature published between 2005 and 2011. Data were analyzed according to an equity-oriented framework. Each study was given a score based on its congruence with the reduction of health inequalities amongst ethnic minorities. RESULTS We reviewed 137 papers and found 61 studies that met the inclusion criteria. Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups. Thirty-three studies had a very low average congruence score. The highest score of congruence was achieved by one study. CONCLUSION Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities. The future of CC interventions may involve going one step further and going back to basic tenets of cultural competence: the integration of difference, whatever its source, into the delivery of fair health care for patients.
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Affiliation(s)
- Marie Dauvrin
- a Institute of Health and Society IRSS , Université catholique de Louvain , Brussels , Belgium
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Beohar N, Sansing VV, Davis AM, Srinivas VS, Helmy T, Althouse AD, Thomas SB, Brooks MM. Race/ethnic disparities in risk factor control and survival in the bypass angioplasty revascularization investigation 2 diabetes (BARI 2D) trial. Am J Cardiol 2013; 112:1298-305. [PMID: 23910429 DOI: 10.1016/j.amjcard.2013.05.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023]
Abstract
This study sought to evaluate the impact of race/ethnicity on cardiovascular risk factor control and on clinical outcomes in a setting of comparable access to medical care. The BARI 2D trial enrolled 1,750 participants from the United States and Canada that self-reported either White non-Hispanic (n = 1,189), Black non-Hispanic (n = 349), or Hispanic (n = 212) race/ethnicity. Participants had type 2 diabetes and coronary artery disease and were randomized to cardiac and glycemic treatment strategies. All patients received intensive target-based medical treatment for cardiac risk factors. Average follow-up was 5.3 years. Kaplan-Meier survival curves and Cox proportional hazards regression models were constructed to assess potential differences in mortality and cardiovascular outcomes across racial/ethnic groups. Long-term risk of death and death/myocardial infarction/stroke did not vary significantly by race/ethnicity (5-year death: 11.0% Whites, 13.7% Blacks, 8.7% Hispanics, p = 0.19; adjusted hazard ratio 1.18 Black versus White, 95% confidence interval 0.84 to 1.67, p = 0.33 and 0.82 Hispanic versus White, 95% confidence interval 0.51 to 1.34, p = 0.43). Among the 1,168 patients with suboptimal risk factor control at baseline, the ability to attain better risk factor control during the trial was associated with higher 5-year survival (71%, 86% and 95% for patients with 0 or 1, 2, and 3 factors in control, respectively, p <0.001); this pattern was observed within each race/ethnic group. In conclusion, significant race/ethnic differences in cardiac risk profiles that persisted during follow-up did not translate into significant differences in 5-year death or death/MI/stroke.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami Beach, Florida
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Ricci-Cabello I, Olry de Labry–Lima A, Bolívar-Muñoz J, Pastor-Moreno G, Bermudez-Tamayo C, Ruiz-Pérez I, Quesada-Jiménez F, Moratalla-López E, Domínguez-Martín S, de los Ríos-Álvarez AM, Cruz-Vela P, Prados-Quel MA, López-De Hierro JA. Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care. BMC Health Serv Res 2013; 13:433. [PMID: 24153053 PMCID: PMC4016588 DOI: 10.1186/1472-6963-13-433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 10/10/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION Clinical Trials U.S. National Institutes of Health, NCT01849731.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Department of Primary Care Health Sciences, Health Services and Policy Research Group, NIHR School for Primary Care Research, University of Oxford, Oxford, England
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Antonio Olry de Labry–Lima
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apdo. 2070, 18080, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Julia Bolívar-Muñoz
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apdo. 2070, 18080, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Guadalupe Pastor-Moreno
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apdo. 2070, 18080, Granada, Spain
| | - Clara Bermudez-Tamayo
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apdo. 2070, 18080, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Hospital Universitario Virgen de las Nieves, Av Fuerzas Armadas, 2, 18014, Granada, Spain
| | - Isabel Ruiz-Pérez
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio 4, Apdo. 2070, 18080, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | | | | | - Pilar Cruz-Vela
- Centro de Salud Cartuja, Casería del Cerro, s/n, 18013, Granada, Spain
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Guo H, Tian X, Li R, Lin J, Jin N, Wu Z, Yu D. Reward-based, task-setting education strategy on glycemic control and self-management for low-income outpatients with type 2 diabetes. J Diabetes Investig 2013; 5:410-7. [PMID: 25411600 PMCID: PMC4210071 DOI: 10.1111/jdi.12152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/28/2013] [Accepted: 08/25/2013] [Indexed: 01/24/2023] Open
Abstract
AIMS/INTRODUCTION The purpose of the study was to determine the feasibility and effect of a reward-based, task-setting strategy for low-income outpatients with type 2 diabetes. MATERIALS AND METHODS Indigent diabetes outpatients without glucometers were eligible to participate in this trial. A total of 132 cases were randomly recruited. Participants in group B used glucometers for self-monitoring at no cost. Group A participants could keep the glucometers only if the glycosylated hemoglobin level declined compared with the baseline visit; for those not achieving a reduction in the glycosylated hemoglobin level, the glucometers would have to be returned. Group C served as the control group without self-monitoring setout. Diabetes education was provided to all groups. Metabolic indices and self-management were evaluated after 6 months of follow up. RESULTS Group A had a significant decline in the glycosylated hemoglobin level (-0.97%) and medical costs (-159 yuan) compared with the baseline visit, whereas groups B and C had a decrease in the glycosylated hemoglobin levels alone (-0.62 and -0.57%, respectively). The body mass index did not change significantly in any group. There was a statistical difference in the glycosylated hemoglobin level of group A compared with groups B and C. Self-management in group A improved the outcome relative to groups B and C. CONCLUSIONS This preliminary evidence suggests that the program is feasible, acceptable for improving patient self-management, and cost-effective in reducing the glycosylated hemoglobin level and medical costs.
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Affiliation(s)
- Honglei Guo
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Xiaoli Tian
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Rixia Li
- General Hospital of Dagang Oilfield Tianjin China
| | - Jingna Lin
- Tianjin Municipal People's Hospital Tianjin China
| | - Nana Jin
- General Hospital of Dagang Oilfield Tianjin China
| | - Zhongming Wu
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Demin Yu
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
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Cené CW, Haymore LB, Ellis D, Whitaker S, Henderson S, Lin FC, Corbie-Smith G. Implementation of the power to prevent diabetes prevention educational curriculum into rural African American communities: a feasibility study. DIABETES EDUCATOR 2013; 39:776-85. [PMID: 24129595 DOI: 10.1177/0145721713507114] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to describe the feasibility of using a community-based participatory research (CBPR) approach to implement the Power to Prevent (P2P) diabetes prevention education curriculum in rural African American (AA) settings. METHODS Trained community health workers facilitated the 12-session P2P curriculum across 3 community settings. Quantitative (based on the pre- and post-curriculum questionnaires and changes in blood glucose, blood pressure [BP], and weight at baseline and 6 months) and qualitative data (based on semi-structured interviews with facilitators) were collected. Indicators of feasibility included: demand, acceptability, implementation fidelity, and limited efficacy testing. RESULTS Across 3 counties, 104 AA participants were recruited; 43% completed ≥ 75% of the sessions. There was great demand for the program. Fifteen community health ambassadors (CHAs) were trained, and 4 served as curriculum facilitators. Content and structure of the intervention was acceptable to facilitators but there were challenges to implementing the program as designed. Improvements were seen in diabetes knowledge and the impact of healthy eating and physical activity on diabetes prevention, but there were no significant changes in blood glucose, BP, or weight. CONCLUSION While it is feasible to use a CBPR approach to recruit participants and implement the P2P curriculum in AA community settings, there are significant challenges that must be overcome.
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Affiliation(s)
- Crystal W Cené
- University of North Carolina at Chapel Hill, North Carolina (Dr Cene, Ms Haymore, Dr Lin, Dr Corbie-Smith)
| | - Laura Beth Haymore
- University of North Carolina at Chapel Hill, North Carolina (Dr Cene, Ms Haymore, Dr Lin, Dr Corbie-Smith)
| | - Danny Ellis
- Together Transforming Lives, Inc, Enfield, North Carolina (Dr Ellis, Ms Whitaker)
| | - Shaketa Whitaker
- Together Transforming Lives, Inc, Enfield, North Carolina (Dr Ellis, Ms Whitaker)
| | - Stacey Henderson
- Dynasty Health Solutions, Roanoke Rapids, North Carolina (Ms Henderson)
| | - Feng-Chang Lin
- University of North Carolina at Chapel Hill, North Carolina (Dr Cene, Ms Haymore, Dr Lin, Dr Corbie-Smith)
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, North Carolina (Dr Cene, Ms Haymore, Dr Lin, Dr Corbie-Smith)
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Kaplan SH, Billimek J, Sorkin DH, Ngo-Metzger Q, Greenfield S. Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project. J Gen Intern Med 2013; 28:1340-9. [PMID: 23645452 PMCID: PMC3785664 DOI: 10.1007/s11606-013-2452-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade. OBJECTIVE To understand potential contributors to disparities in diabetes care and glycemic control. DESIGN Cross sectional analysis. SETTING Seven outpatient clinics affiliated with an academic medical center. PATIENTS Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484). MEASUREMENTS Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment. RESULTS Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity. LIMITATIONS Generalizability to other minorities or to patients with poorer access to care may be limited. CONCLUSIONS The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.
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Affiliation(s)
- Sherrie H Kaplan
- Health Policy Research Institute and Department of Medicine, School of Medicine, University of California, Irvine, 100 Theory Suite 110, Irvine, CA, 92697, USA,
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Crisford P, Winzenberg T, Venn A, Cleland V. Understanding the physical activity promotion behaviours of podiatrists: a qualitative study. J Foot Ankle Res 2013; 6:37. [PMID: 24016671 PMCID: PMC3846794 DOI: 10.1186/1757-1146-6-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health professionals are encouraged to play a part in reducing the health risks of physical inactivity. Little is known of the physical activity promotion practice behaviours of podiatrists. METHODS We performed 20 semi-structured interviews with purposefully selected podiatrists to explore their physical activity promotion attitudes, beliefs, knowledge and practice. Transcribed interviews were coded using an iterative thematic approach to identify major themes and salient beliefs. RESULTS Overall, the participants had a positive attitude to physical activity promotion, considering it a normal part of their role. They saw their role as giving information, encouraging activity and making recommendations, however in practice they were less inclined to follow up on recommendations, monitor activity levels or document the process. Their approach was generally opportunistic, informal and unstructured and the content of assessment and promotion dependent upon the presenting patient's condition. Advice tended to be tailored to the patient's capabilities and interests. They considered there are opportunities to promote physical activity during regular consultations, however, were more likely to do so in patients with chronic diseases such as diabetes. Main barriers to physical activity promotion included unreceptive and unmotivated patients as well as a lack of time, skills and resources. CONCLUSIONS Physical activity promotion appears feasible in podiatry practice in terms of opportunity and acceptability to practitioners, but there is scope for improvement. Strategies to improve promotion need to consider the major issues, barriers and opportunities as well as provide a more structured approach to physical activity promotion by podiatrists.
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Affiliation(s)
- Paul Crisford
- Menzies Research Institute Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Tania Winzenberg
- Menzies Research Institute Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Alison Venn
- Menzies Research Institute Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Verity Cleland
- Menzies Research Institute Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
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Noble JA, Johnson J, Lane JA, Valdes AM. HLA class II genotyping of African American type 1 diabetic patients reveals associations unique to African haplotypes. Diabetes 2013; 62:3292-9. [PMID: 23801574 PMCID: PMC3749336 DOI: 10.2337/db13-0094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
HLA genotyping was performed in African American type 1 diabetic patients (n = 772) and controls (n = 1,641) in the largest study of African Americans and type 1 diabetes reported to date. Cases were from Children's Hospital and Research Center Oakland and from existing collections (Type 1 Diabetes Genetics Consortium [T1DGC], Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications [DCCT/EDIC], and Genetics of Kidneys in Diabetes [GoKinD]). Controls were from the T1DGC and from newborn bloodspot cards. The diversity of HLA DRB1-DQA1-DQB1 haplotypes and genotypes is far greater than that found in Europeans and European Americans. Association analyses replicated many type 1 diabetes risk effects of European-derived haplotypes but also revealed novel effects for African-derived haplotypes. Notably, the African-specific "DR3" haplotype DRB1*03:02-DQA1*04:01-DQB1*04:02 is protective for type 1 diabetes, in contrast to the common and highly-susceptible DR3 DRB1*03:01-DQA1*05:01-DQB1*02:01. Both DRB1*07:01 and DRB1*13:03 haplotypes are predisposing when they include DQA1*03:01-DQB1*02:01g but are protective with DQA1*02:01-DQB1*02:01g. The heterozygous DR4/DR9 genotype, containing the African-derived "DR9" haplotype DRB1*09:01-DQA1*03:01-DQB1*02:01g, exhibits extremely high risk (odds ratio = 30.88), approaching that for DR3/DR4 in European populations. Disease risk assessment for African Americans differs greatly from risk assessment in European populations. This has profound implications on risk screening programs and underscores the need for high-resolution genotyping of multiple populations for the rational design of screening programs with tests that will fairly represent the population being screened.
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Affiliation(s)
- Janelle A Noble
- Children's Hospital Oakland Research Institute, Oakland, California, USA.
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228
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McKinlay J, Piccolo R, Marceau L. An additional cause of health care disparities: the variable clinical decisions of primary care doctors. J Eval Clin Pract 2013; 19:664-73. [PMID: 23216876 PMCID: PMC3729756 DOI: 10.1111/jep.12015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2012] [Indexed: 12/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Decades of work on health disparities have culminated in identification of three contributors to variability in diagnosis and management of disease: (i) patient attributes; (ii) doctor's characteristics; and (iii) organizational factors. Understanding the relative influence of different contributors to variability in diagnosis and management of diabetes is important to improving quality and reducing disparities. This study was designed to examine the influence of patient, provider and organizational factors on the diagnosis and management of a major chronic disease - diabetes. METHOD A factorial experiment using video vignettes was conducted among n = 192 primary care doctors. Doctors were interviewed after viewing vignettes of (1) a 'patient' with symptoms strongly suggestive of diabetes and (2) an already diagnosed diabetes 'patient' with emerging peripheral neuropathy. RESULTS A total of 60.9% of doctors identified diabetes as the correct diagnosis, with significant variations depending on the patients' race/ethnicity. Many doctors offered competing diagnoses with high levels of certainty. For the 'patient' with emerging peripheral neuropathy, 42.2% of doctors would do all essential components of a foot examination, while 21.9% would do none. CONCLUSIONS That half of all diabetes in the United States remains undiagnosed is unsurprising given only 60.9% of doctors would diagnose it when the condition is strongly suggested, and nearly one-quarter suspecting diabetes would not order tests necessary to confirm it. The diagnosis of diabetes is significantly influenced by a patient's race/ethnicity, and clinical management (specifically for foot neuropathy) is influenced by patient socio-economic status (SES), doctor's gender and access to clinical guidelines.
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Affiliation(s)
- John McKinlay
- Health Services and Disparities Research, New England Research Institutes, Watertown, Massachusetts 02472, USA.
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229
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Vest BM, Kahn LS, Danzo A, Tumiel-Berhalter L, Schuster RC, Karl R, Taylor R, Glaser K, Danakas A, Fox CH. Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system. Chronic Illn 2013; 9:145-55. [PMID: 23585634 PMCID: PMC3895933 DOI: 10.1177/1742395313475674] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. METHODS Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. RESULTS Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. DISCUSSION Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management.
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Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY 14203, USA.
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Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chronic Dis 2013; 10:E26. [PMID: 23428085 PMCID: PMC3604796 DOI: 10.5888/pcd10.120180] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.
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Paksin-Hall A, Dent ML, Dong F, Ablah E. Factors contributing to diabetes patients not receiving annual dilated eye examinations. Ophthalmic Epidemiol 2013; 20:281-7. [PMID: 23662945 DOI: 10.3109/09286586.2013.789531] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Early detection of diabetic eye disease by dilated eye exam can limit potential vision loss from diabetic retinopathy. The purpose of this study was to examine what variables contribute to diabetes patients not receiving annual dilated eye examinations. METHODS This study used national 2009 Behavioral Risk Factor Surveillance System survey data. Variables used in the analysis included sociodemographics, insurance status, mentally unhealthy days, receipt of annual dilated eye exams, insulin dependence, a history of diabetes education classes, timely annual diabetic foot exams, and history of cardiovascular disease. Survey proportions were calculated, and survey logistic regression was performed with the consideration of survey strata and weight to correct for biases. RESULTS The likelihood of receiving annual dilated eye exams was correlated with eight statistically significant variables. These variables included age category, income level, education level, health insurance status, mentally unhealthy days within the past month, insulin dependence, a history of diabetic education classes, and timeliness of annual diabetic foot examinations. CONCLUSIONS This study provides a snapshot of variables that may have a bearing on diabetes patients seeking annual dilated retinal examinations. Eight variables were statistically significant in affecting the timeliness of diabetic eye examinations. Thus, resolutions for these factors could be implemented for future improvement of comprehensive health care provided to those with diabetes.
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Abstract
BACKGROUND Factors contributing to patient-reported experiences of diabetes self-management support are not understood well, particularly over time. OBJECTIVES The aim of the study was to identify the contribution of patient characteristics to patient-reported quality of SMS. METHODS Using secondary data from a prospective clinical trial (n = 339) comparing three approaches of providing diabetes self-management support (Group Medical Visits, Automated Telephone Support, and Usual Care) in a diverse, underserved population, the influence of patient characteristics (e.g., age, gender, income, and health status) was examined on Patient Assessment of Chronic Illness Care ratings. RESULTS At baseline, older age (p = .014), being female (p = .038), and having lower income (p = .001) were associated with lower ratings. Income and interactions involving income combined explained 12% of the variance in baseline ratings. Compared with White patients, African American and Asian patients tended to have higher baseline ratings (p = .076 and p = .045, respectively). Race or ethnicity influenced perceptions throughout the trial, explaining 5% of the variance at baseline and 2% of the variance in 1-year changes in Patient Assessment of Chronic Illness Care ratings. As expected, over 1 year, ratings increased more for patients in both intervention groups compared with the control group (p < .001). DISCUSSION Ratings of healthcare quality are influenced by patient characteristics independent of the nature of the care provided. Understanding more precisely how these differences are associated with differences in clinical processes will be particularly important for efforts aiming to integrate patient-reported measures into assessments of healthcare quality during routine clinical care and clinical trials.
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233
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Arnaoutakis DJ, Propper BW, Black JH, Schneider EB, Lum YW, Freischlag JA, Perler BA, Abularrage CJ. Racial and ethnic disparities in the treatment of unruptured thoracoabdominal aortic aneurysms in the United States. J Surg Res 2013; 184:651-7. [PMID: 23545407 DOI: 10.1016/j.jss.2013.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Previous studies have found increased mortality in minority patients undergoing abdominal aortic aneurysm repair. The goal of this study was to identify racial and ethnic disparities in patients undergoing thoracoabdominal aortic aneurysm repair. MATERIALS AND METHODS We queried the Nationwide Inpatient Sample (2005-2009) using International Classification of Diseases, Ninth Revision, Clinical Modification codes for repair of unruptured thoracoabdominal aneurysms. The primary outcome was death. Secondary outcomes included postoperative complications. We performed multivariate analysis adjusting for age, gender, race, comorbidities (Charlson index), insurance type, and surgeon and hospital operative volumes and characteristics. RESULTS Overall, 1541 white, 207 black, and 117 Hispanic patients underwent thoracoabdominal aortic aneurysm repair. White patients tended to be older (P = 0.003), whereas black patients had a higher incidence of diabetes mellitus (P = 0.04). Black and Hispanic patients were less likely to have an elective admission (P < 0.001) and more likely to have repair performed at a hospital with a lower average annual surgical volume (P = 0.04). Postoperative complications were similar among the groups (P = 0.31). On multivariate analysis, increased mortality was independently associated with Hispanic ethnicity (relative ratio [RR], 2.57; 95% confidence interval [CI], 1.25-5.25; P = 0.01), cerebrovascular disease (RR, 1.88; 95% CI, 1.10-3.23; P = 0.02), and age (RR, 1.04; 95% CI, 1.01-1.07; P = 0.004). CONCLUSIONS Hispanic ethnicity is independently associated with increased mortality after repair of unruptured thoracoabdominal aneurysms. This finding was independent of preoperative comorbidities, postoperative complications, and surgeon and hospital operative volumes. Further studies are necessary to determine whether this mortality difference persists after the index hospitalization.
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Affiliation(s)
- Dean J Arnaoutakis
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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234
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SHRINE: enabling nationally scalable multi-site disease studies. PLoS One 2013; 8:e55811. [PMID: 23533569 PMCID: PMC3591385 DOI: 10.1371/journal.pone.0055811] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 01/04/2013] [Indexed: 11/19/2022] Open
Abstract
Results of medical research studies are often contradictory or cannot be reproduced. One reason is that there may not be enough patient subjects available for observation for a long enough time period. Another reason is that patient populations may vary considerably with respect to geographic and demographic boundaries thus limiting how broadly the results apply. Even when similar patient populations are pooled together from multiple locations, differences in medical treatment and record systems can limit which outcome measures can be commonly analyzed. In total, these differences in medical research settings can lead to differing conclusions or can even prevent some studies from starting. We thus sought to create a patient research system that could aggregate as many patient observations as possible from a large number of hospitals in a uniform way. We call this system the ‘Shared Health Research Information Network’, with the following properties: (1) reuse electronic health data from everyday clinical care for research purposes, (2) respect patient privacy and hospital autonomy, (3) aggregate patient populations across many hospitals to achieve statistically significant sample sizes that can be validated independently of a single research setting, (4) harmonize the observation facts recorded at each institution such that queries can be made across many hospitals in parallel, (5) scale to regional and national collaborations. The purpose of this report is to provide open source software for multi-site clinical studies and to report on early uses of this application. At this time SHRINE implementations have been used for multi-site studies of autism co-morbidity, juvenile idiopathic arthritis, peripartum cardiomyopathy, colorectal cancer, diabetes, and others. The wide range of study objectives and growing adoption suggest that SHRINE may be applicable beyond the research uses and participating hospitals named in this report.
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235
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Umar-Kamara M, Tufts KA. Impact of a quality improvement intervention on provider adherence to recommended standards of care for adults with type 2 diabetes mellitus. J Am Assoc Nurse Pract 2013; 25:527-534. [PMID: 24170484 DOI: 10.1111/1745-7599.12018] [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] [Indexed: 11/28/2022]
Abstract
PURPOSE To report provider adherence to standards of care for adults with type 2 diabetes before and after a quality improvement (QI) intervention. DATA SOURCES Pre- and post intervention data were abstracted from 50 medical records of patients with type 2 diabetes in a small primary care practice. CONCLUSION There was a significant increase in the rates of foot and urine microalbumin screenings, documentation for dilated eye exams were not statistically significant. These findings demonstrated the effectiveness of using simple practice aids to reinforce adherence to the standards of care in diabetes. The failure to see a corresponding improvement in glycemic and blood pressure control is consistent with prior research and the need for more research in this area remain critical. IMPLICATIONS FOR PRACTICE Ethnic minorities are more likely to have worse control of their diabetes and more likely to receive all their care in the primary care setting, QI interventions targeting primary care providers have the potential to reduce disparities in diabetes care. Future research to determine whether cultural tailoring of diabetes QI interventions will produce additional benefits above those of generic diabetes QI interventions are needed.
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Affiliation(s)
- Marie Umar-Kamara
- (Assistant Professor), South University, Richmond, Virginia, (Assistant Professor), Minuteclinic, Richmond, Virginia, (Associate Professor), School of Nursing College of Health Sciences, Old Dominion University, Norfolk, Virginia
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Ricci-Cabello I, Ruiz-Pérez I, Nevot-Cordero A, Rodríguez-Barranco M, Sordo L, Gonçalves DC. Health care interventions to improve the quality of diabetes care in African Americans: a systematic review and meta-analysis. Diabetes Care 2013; 36:760-8. [PMID: 23431094 PMCID: PMC3579329 DOI: 10.2337/dc12-1057] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ignacio Ricci-Cabello
- Health Services and Policy Research Group, National Institute for Health Research School for Primary Care Research, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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237
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Wilson DS, Dapic V, Sultan DH, August EM, Green BL, Roetzheim R, Rivers B. Establishing the infrastructure to conduct comparative effectiveness research toward the elimination of disparities: a community-based participatory research framework. Health Promot Pract 2013; 14:893-900. [PMID: 23431128 DOI: 10.1177/1524839913475451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with "usual care" for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED's goal of providing evidence to eliminate cancer health disparities.
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238
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Jones CA, Nanji A, Mawani S, Davachi S, Ross L, Vollman A, Aggarwal S, King-Shier K, Campbell N. Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP). BMC Public Health 2013; 13:160. [PMID: 23432996 PMCID: PMC3614427 DOI: 10.1186/1471-2458-13-160] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 02/19/2013] [Indexed: 01/05/2023] Open
Abstract
Background South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. Methods South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures). Results Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. Conclusions SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.
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Affiliation(s)
- Charlotte A Jones
- Department of Medicine, University of Calgary, Libin Cardiovascular Institute, TRW Building GE89, 3280 Hospital Drive NW, Calgary, AB, Canada.
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239
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"It's up to you and God": understanding health behavior change in older African American survivors of colorectal cancer. Transl Behav Med 2013; 3:94-103. [PMID: 23646096 DOI: 10.1007/s13142-012-0188-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors' perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.
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240
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Sulaiman N, Hadj E, Hussein A, Young D. Peer-supported diabetes prevention program for Turkish- and arabic-speaking communities in australia. ISRN FAMILY MEDICINE 2013; 2013:735359. [PMID: 24959573 PMCID: PMC4041252 DOI: 10.5402/2013/735359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022]
Abstract
In Australia, type 2 diabetes and prediabetes are more prevalent in culturally and linguistically diverse (CALD) communities than mainstream Australians. Purpose. To develop, implement, and evaluate culturally sensitive peer-supported diabetes education program for the prevention of type 2 diabetes in high-risk middle-aged Turkish- and Arabic-speaking people. Methods. A two-day training program was developed. Ten bilingual peer leaders were recruited from existing health and social networks in Melbourne and were trained by diabetes educators. Each leader recruited 10 high-risk people for developing diabetes. Questionnaires were administered, and height, weight, and waist circumference were measured at baseline and three months after the intervention. The intervention comprised two 2-hour group sessions and 30 minutes reinforcement and support telephone calls. Results. 94 individuals (73% women) completed the program. Three months after the program, the participants' mean body weight (before = 78.1 kg, after = 77.3; Z score = -3.415, P = 0.001) and waist circumference (Z = -2.569, P = 0.004) were reduced, their diabetes knowledge was enhanced, and lifestyle behaviours were significantly improved. Conclusions. A short diabetes prevention program delivered by bilingual peers was associated with improved diabetes awareness, changed lifestyle behaviour, and reduction in body weight 3 months after intervention. The findings are encouraging and should stimulate a larger control-designed study.
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Affiliation(s)
- Nabil Sulaiman
- Department of Family and Community Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE ; Department of GP, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
| | - Elaine Hadj
- Dianella Community Health, Broadmeadows, Melbourne, VIC 3047, Australia
| | - Amal Hussein
- Department of Family and Community Medicine and Behavioural Sciences, College of Medicine, University of Sharjah, P.O. Box 27272, Sharjah, UAE
| | - Doris Young
- Department of GP, The University of Melbourne, Carlton, Melbourne, VIC 3053, Australia
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241
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Lorenzo L. Partnering with patients to promote holistic diabetes management: Changing paradigms. J Am Assoc Nurse Pract 2013; 25:351-61. [DOI: 10.1111/1745-7599.12004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nundy S, Dick JJ, Solomon MC, Peek ME. Developing a behavioral model for mobile phone-based diabetes interventions. PATIENT EDUCATION AND COUNSELING 2013; 90:125-132. [PMID: 23063349 PMCID: PMC3785373 DOI: 10.1016/j.pec.2012.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 09/04/2012] [Accepted: 09/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Behavioral models for mobile phone-based diabetes interventions are lacking. This study explores the potential mechanisms by which a text message-based diabetes program affected self-management among African-Americans. METHODS We conducted in-depth, individual interviews among 18 African-American patients with type 2 diabetes who completed a 4-week text message-based diabetes program. Each interview was audio-taped, transcribed verbatim, and imported into Atlas.ti software. Coding was done iteratively. Emergent themes were mapped onto existing behavioral constructs and then used to develop a novel behavioral model for mobile phone-based diabetes self-management programs. RESULTS The effects of the text message-based program went beyond automated reminders. The constant, daily communications reduced denial of diabetes and reinforced the importance of self-management (Rosenstock Health Belief Model). Responding positively to questions about self-management increased mastery experience (Bandura Self-Efficacy). Most surprisingly, participants perceived the automated program as a "friend" and "support group" that monitored and supported their self-management behaviors (Barrera Social Support). CONCLUSIONS A mobile phone-based diabetes program affected self-management through multiple behavioral constructs including health beliefs, self-efficacy, and social support. PRACTICE IMPLICATIONS Disease management programs that utilize mobile technologies should be designed to leverage existing models of behavior change and can address barriers to self-management associated with health disparities.
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Affiliation(s)
- Shantanu Nundy
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Glasgow T, Cheek L, Tabet N. Efficacy of non-pharmacological interventions in controlling type 2 diabetes in patients of African descent: A systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.65a007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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244
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Ryan JG, Jennings T, Vittoria I, Fedders M. Short and Long-Term Outcomes from a Multisession Diabetes Education Program Targeting Low-Income Minority Patients: A Six-Month Follow Up. Clin Ther 2013; 35:A43-53. [DOI: 10.1016/j.clinthera.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. HEALTH COMMUNICATION 2013; 28:616-23. [PMID: 23050731 PMCID: PMC3766485 DOI: 10.1080/10410236.2012.710873] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study explores patient trust in physicians and its relationship to shared decision-making (SDM) among African-Americans with diabetes (types 1 and 2). We conducted a series of focus groups (n = 27) and in-depth interviews (n = 24). Topic guides were developed utilizing theoretical constructs. Each interview was audiotaped and transcribed verbatim. Each transcript was independently coded by two randomly assigned members of the research team; codes and themes were identified in an iterative fashion utilizing Atlas.ti software. The mean age of study participants was 62 years and 85% were female. We found that (1) race as a social construct has the potential to influence key domains of patient trust (interpersonal/relationship aspects and medical skills/technical competence), (2) the relationship between patient trust and shared decision-making is bidirectional in nature, and (3) enhancing patient trust may potentially increase or decrease SDM among African-Americans with diabetes. Mistrust of physicians among African-Americans with diabetes may partially be addressed through (1) patient education efforts, (2) physician training in interpersonal skills and cultural competence, and (3) physician efforts to engage patients in SDM. To help enhance patient outcomes among African-Americans with diabetes, physicians might consider incorporating strategies to simultaneously engender their patients' trust and encourage shared decision-making.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, Diabetes Research and Training Center, Center for Health and the Social Sciences & Center for the Study of Race, Politics, and Culture, University of Chicago, Chicago, IL 60637, USA
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Abstract
Racial and ethnic minorities in the US have a higher prevalence, as well as suffer from more complications, lower quality care, and poorer outcomes for diabetes than their counterparts. Given the US health care system is in the midst of drastic transformation, with the passage of health care reform, and efforts in payment reform, and value-based purchasing, there is now support to provide more intensive, team-based care for those conditions that are complex, costly, and highly prevalent. Addressing and improving diabetes disparities, given they are prevalent and costly, will be an important area of focus in the years to come. The latest research demonstrates that community-based efforts, multifactorial approaches, and the deployment of health information technology can be successful in addressing diabetes disparities, and require support, attention, resources, and continued evaluation. Ultimately, these efforts should improve the quality of care for all persons with diabetes, especially those who are most vulnerable.
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Affiliation(s)
- Joseph R Betancourt
- The Disparities Solutions Center, Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Suite 901, Boston, MA 02114, USA.
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Naranjo D, Hessler DM, Deol R, Chesla CA. Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities. Curr Diab Rep 2012; 12:729-38. [PMID: 22961116 DOI: 10.1007/s11892-012-0319-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.
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Affiliation(s)
- Diana Naranjo
- Department of Pediatrics, University of California San Francisco, 400 Parnassus Avenue, 4th Floor, UCSF, MailBox 0318, San Francisco, CA 94143-0318, USA.
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248
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Jyun-You L, Chia-Fen M, Chao-Yu H. Medical appointment no-shows associated with poor glycaemic control among Taiwanese aborigines. Aust J Rural Health 2012. [DOI: 10.1111/j.1440-1584.2012.01310.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Liou Jyun-You
- Department of Pediatrics; National Taiwan University Hospital; Taipei; Taiwan
| | - Mu Chia-Fen
- Department of Community Medicine; Puli Christian Hospital; Puli; Taiwan
| | - Hsu Chao-Yu
- Department of Community Medicine; Puli Christian Hospital; Puli; Taiwan
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Impact of a pay for performance program to improve diabetes care in the safety net. Prev Med 2012; 55 Suppl:S80-5. [PMID: 23046985 DOI: 10.1016/j.ypmed.2012.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 03/06/2012] [Accepted: 05/03/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the impact of a "piece-rate" pay for performance (P4P) program aimed at improving diabetes care processes, outcomes and related healthcare utilization for patients enrolled in a not-for-profit Medicaid-focused managed care plan. METHODS To evaluate Hudson Health Plan's P4P program in New York (2003-2007), we conducted: (1) a case-comparison difference-in-difference study using plan-level administrative data; (2) a patient-level claims data analysis; and (3) a cross-sectional survey. RESULTS The case-comparison study found that diabetes care processes (e.g., HbA1c, lipid, and dilated eye exam rates) and outcomes (e.g., LDL-C<100mg/dL) did not improve significantly over the study period. Claims analysis showed that younger adults had significantly increased odds (OR 3.50-3.56, p<0.001) of using emergency and hospital-based services and similarly decreased odds of receiving recommended care process (OR 0.22-0.36, p<0.01-0.001). Survey study indicated that practices lack fundamental quality improvement infrastructures and training. CONCLUSIONS Recent health legislation mandates the use of P4P incentives in government programs that disproportionately care for patients with lower socioeconomic or minority backgrounds (e.g., Medicaid, Veterans Health Administration, and Tricare). More research is needed in order to understand how to tailor P4P programs for vulnerable care settings.
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Mwendwa DT, Ali MK, Sims RC, Madhere S, Levy SA, Callender CO, Campbell AL. Psychometric properties of the Cook Medley hostility scale and its association with inflammatory markers in African Americans. PSYCHOL HEALTH MED 2012; 18:431-44. [PMID: 23116190 DOI: 10.1080/13548506.2012.736623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dispositional hostility as measured by the Cook Medley Hostility (Ho) Scale has been associated with inflammation and cardiovascular disease (CVD) risk. There is evidence that suggests that factors of hostility are more useful in predicting poor cardiovascular health outcomes than a single hostility construct. The purpose of this study was to investigate the latent factors of hostility and their association with inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) in an African-American community sample. This racial/ethnic group has been largely excluded from this line of research despite their disproportionate burden of CVD and its risk factors. Blood samples for plasma IL-6 and CRP were collected on the same day the Ho Scale was administered. Plasma IL-6 and CRP levels were determined using enzymatic-linked immunosorbent assay. Confirmatory factor analysis revealed three latent main factors of hostility: Neuroticism, Manichaeism and Moral Primitiveness, and seven intermediary subfactors. Of the subfactors, hostile affect was significantly associated with greater CRP levels and predatory self interest was significantly associated with greater IL-6 levels. Findings suggest that African Americans have a unique pattern of hostility and two latent subfactors are associated with a marker of CVD. Based on the findings, future studies should aim to further delineate how hostility influences health outcomes in African Americans.
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Affiliation(s)
- Denee T Mwendwa
- Department of Psychology, Howard University, Washington, DC, USA.
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