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Liu T, Meng W, Wang W, Sun G, Chen X, Lu Y, Qin W, Wang Y, Zhang L, Zheng S. A cross-sectional study of predictive factors of health literacy among rheumatoid arthritis patients in China. Front Psychol 2024; 15:1390442. [PMID: 38993349 PMCID: PMC11236717 DOI: 10.3389/fpsyg.2024.1390442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To investigate the factors that influence health literacy (HL) among Chinese patients with rheumatoid arthritis (RA) and furnish theoretical underpinnings for the development of intervention strategies aimed at enhancing patients' quality of life. Methods From May 2022 to December 2022, a comprehensive survey was conducted among both outpatients and inpatients diagnosed with (RA) in a tertiary hospital in China. The survey utilized various instruments, including a general information questionnaire, a chronic disease patient health literacy scale, the Health Assessment Questionnaire-Disability Index (HAQ-DI), the Chinese-translated Rheumatoid Arthritis Self-Efficacy Scale, the Chinese-translated Rheumatoid Arthritis Stigma Scale, and the Chinese-translated Compliance Questionnaire for Rheumatology Treatments. Results The average scores of HL, self-efficacy, medication adherence, and disability index were 83.54 ± 17.43, 84.91 ± 14.37, 70.16 ± 11.24, and 0.26 ± 0.44, respectively. HL in Chinese RA patients was negatively correlated with age, erythrocyte sedimentation rate (ESR), number of tender joints, number of swollen joints, and disease activity, while positively correlated with self-efficacy and medication adherence. Age, disease activity, disability index, self-efficacy, and medication adherence are predictive factors of HL, and a predictive model has been initially constructed. Conclusion In the management of RA, healthcare professionals should develop and implement effective intervention measures by focusing on improving medication adherence, enhancing patients' self-efficacy, improving patients' physical function, and reducing disease activity. This will help enhance the health literacy and promote clinical outcomes in RA patients.
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Affiliation(s)
- Ting Liu
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Weifen Meng
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Wenlong Wang
- Department of Rheumatology, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Guomin Sun
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xi Chen
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yan Lu
- Department of Rheumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, China
| | - Weiping Qin
- Department of Rheumatology, Changzhou Community Health Service Center, Changzhou, Jiangsu, China
| | - Yan Wang
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Lu Zhang
- Department of Rheumatology, Changzhou Community Health Service Center, Changzhou, Jiangsu, China
| | - SuHua Zheng
- Department of Rheumatology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Joseph D, Hu R, Min R, Jolly M, Hassan S. Use and Utility of Patient After-Visit Instructions at a University Rheumatology Outpatient Clinic: Status and Randomized Prospective Pilot Intervention Study. ACR Open Rheumatol 2024; 6:321-329. [PMID: 38387613 PMCID: PMC11089441 DOI: 10.1002/acr2.11659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the use of after-visit instructions (AVIs) in an academic rheumatology clinic and assess the impact of standardized AVIs (sAVIs) and teach-back (TB) on comprehension of health information. METHODS A retrospective review of adult patients seen between October 1 and 8, 2021, at the rheumatology clinic collected data on patient demographics, clinical features, and the presence, content, and readability of AVIs. During a subsequent prospective proof-of-concept study, routinely scheduled patients seen at the rheumatology clinic were randomized into three groups: control (received standard of care), received sAVIs only, and received sAVIs plus TB. Patients completed a health literacy questionnaire, satisfaction survey, and a one- to two-week postvisit telephone survey to assess AVI comprehension. RESULTS Out of 316 retrospective patient visits, 82 (25.9%) received AVIs. Among 210 of 316 patients (66.5%) with management changes, 76 (36.1%) received AVI, with 74.2% of the instructions considered concordant with the provider's note. Use of AVIs was higher with management changes, new patient visits, and medical trainee/teaching clinics. AVIs were written at a median 6.8 grade level. A total of 75 patients completed the prospective study: 31 (41.3%) were in the control group, 19 (25.3%) were in the group that received sAVIs only, and 25 (33.3%) were in the group that received AVIs with TB. There were no differences in overall postvisit survey comprehension/retention scores among the three patient groups evaluated. CONCLUSION Although a lack of AVI use was identified, implementation of sAVIs did not appear to impact patient retention or comprehension of discharge health information.
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Affiliation(s)
- Dijo Joseph
- Rush University Medical CenterChicagoIllinois
| | - Rong Hu
- Rush University Medical CenterChicagoIllinois
| | - Robert Min
- Rush University Medical CenterChicagoIllinois
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3
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Dela Cruz R, Galbreath J, Butel J, Yamanaka AB, Wilkens LR, Aflague T, Coleman P, Shallcross L, McFall P, Novotny R. Social determinants of health literacy among parents and caregivers in the US-Affiliated Pacific. Health Promot Int 2024; 39:daae002. [PMID: 38294036 PMCID: PMC10828926 DOI: 10.1093/heapro/daae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators-acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)-and their relationship to health literacy among 1305 parents/caregivers of young children ages 2-8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity.
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Affiliation(s)
- Rica Dela Cruz
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Jennifer Galbreath
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Jean Butel
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Ashley B Yamanaka
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
| | - Lynne R Wilkens
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, 701 Ilalo St, Honolulu, HI 96813, USA
| | - Tanisha Aflague
- College of Natural and Applied Sciences, University of Guam, 303 University Drive, UOG Station, Mangilao, GU 96923, USA
| | - Patricia Coleman
- Cooperative Research, Extension and Education Services, Northern Marianas College, PO Box 501250, Saipan, MP 96950, USA
| | - Leslie Shallcross
- Cooperative Extension Service, University of Alaska Fairbanks, 1000 University Avenue, Fairbanks, AK 99709, USA
| | - Pauline McFall
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
- Agriculture, Community, and Natural Resources, American Samoa Community College, PO Box 2609, Pago Pago, AS 96799, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, 1955 East-West Rd, Honolulu, HI 96822, USA
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4
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Gorter A, Bakker MM, ten Klooster PM, Boonen A, Vonkeman HE. The impact of health literacy: associations with disease activity and medication prescription in patients with rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:3409-3415. [PMID: 36825825 PMCID: PMC10547512 DOI: 10.1093/rheumatology/kead094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the longitudinal associations between health literacy profiles and disease activity and medication prescription in patients with RA. METHODS Patients with RA who previously completed the Health Literacy Questionnaire (HLQ) and were assigned 1 of 10 distinct health literacy profiles based on cluster analysis were further aggregated into three groups: 'several health literacy limitations', 'some health literacy limitations' and 'good health literacy'. Linear mixed modelling (LMM) was used to analyse the association between health literacy groups and disease activity over the course of 1 year. Chi-squared tests and logistic regression analyses were used to compare medication prescriptions between the groups. RESULTS A total of 108 patients with RA were included. LMM showed a significant effect of health literacy group on disease activity over time (P = 0.010). Patients with 'good health literacy' had significantly lower disease activity over time [28-joint DAS with ESR (DAS28-ESR) = 2.4] than patients with 'several health literacy limitations' (DAS28-ESR = 3.1), independent of age, gender and education level. Patients with 'good health literacy' were most often prescribed a biologic DMARD (50%), whereas patients with 'some health literacy limitations' more commonly received a conventional synthetic DMARD only [72.7%; odds ratio (OR) 4.24], and patients with 'several health literacy limitations' were more often prescribed prednisolone (52.4%; OR 3.56). CONCLUSION Significant differences in longitudinal disease activity and medication prescription were observed between groups with different health literacy levels. These results stress the importance of insights into the role of health literacy in treatment and outcomes in patients with RA.
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Affiliation(s)
- Anne Gorter
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mark M Bakker
- Department of Internal Medicine, Rheumatology Division, Maastricht University Medical Center+, Maastricht, The Netherlands
- Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter M ten Klooster
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Rheumatology Division, Maastricht University Medical Center+, Maastricht, The Netherlands
- Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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5
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Gwinnutt JM, Norton S, Hyrich KL, Lunt M, Combe B, Rincheval N, Ruyssen‐Witrand A, Fautrel B, McWilliams DF, Walsh DA, Nikiphorou E, Kiely PDW, Young A, Chipping JR, MacGregor A, Verstappen SMM. Influence of Social Support, Financial Status, and Lifestyle on the Disparity Between Inflammation and Disability in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:1026-1035. [PMID: 36576238 PMCID: PMC10952173 DOI: 10.1002/acr.24996] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate how social support, financial status, and lifestyle influence the development of excess disability in rheumatoid arthritis (RA). METHODS Data were obtained from the Étude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort study of people with RA. A previous analysis identified groups with similar inflammation trajectories but markedly different disability over 10 years; those in the higher disability trajectory groups were defined as having "excess disability." Self-reported data regarding contextual factors (social support, financial situation, lifestyle) were obtained from participants, and they completed patient-reported outcome measures (pain, fatigue, anxiety, depression) at baseline. The direct effect of the contextual factors on excess disability and the effect mediated by patient-reported outcome measures were assessed using structural equation models. Findings were validated in 2 independent data sets (Norfolk Arthritis Register [NOAR], Early Rheumatoid Arthritis Network [ERAN]). RESULTS Of 538 included ESPOIR participants (mean age ± SD 48.3 ± 12.2 years; 79.2% women), 200 participants (37.2%) were in the excess disability group. Less social support (β = 0.17 [95% confidence interval (95% CI) 0.08, 0.26]), worse financial situation (β = 0.24 [95% CI 0.14, 0.34]), less exercise (β = 0.17 [95% CI 0.09-0.25]), and less education (β = 0.15 [95% CI 0.06, 0.23]) were associated with excess disability group membership; smoking, alcohol consumption, and body mass index were not. Fatigue and depression mediated a small proportion of these effects. Similar results were seen in NOAR and ERAN. CONCLUSION Greater emphasis is needed on the economic and social contexts of individuals with RA at presentation; these factors might influence disability over the following decade.
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Affiliation(s)
| | | | - Kimme L. Hyrich
- University of Manchester and Manchester University NHS Foundation TrustManchesterUK
| | - Mark Lunt
- University of ManchesterManchesterUK
| | | | | | | | - Bruno Fautrel
- Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitie Salpetriere Hospital, and Pierre Louis Institute of Epidemiology and Public HealthParisFrance
| | - Daniel F. McWilliams
- University of Nottingham and NIHR Nottingham Biomedical Research CentreNottinghamUK
| | - David A. Walsh
- University of Nottingham and NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Sherwood Forest Hospitals NHS Foundation TrustSutton‐in‐AshfieldUK
| | | | - Patrick D. W. Kiely
- St. George's University Hospitals NHS Foundation Trust and St. George's University of LondonLondonUK
| | | | - Jacqueline R. Chipping
- University of East Anglia and Norfolk and Norwich University Hospitals NHS TrustNorwichUK
| | - Alex MacGregor
- University of East Anglia and Norfolk and Norwich University Hospitals NHS TrustNorwichUK
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6
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Bakker MM, Putrik P, Dikovec C, Rademakers J, Vonkeman HE, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Exploring discordance between Health Literacy Questionnaire scores of people with RMDs and assessment by treating health professionals. Rheumatology (Oxford) 2022; 62:52-64. [PMID: 35438147 PMCID: PMC9788830 DOI: 10.1093/rheumatology/keac248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We studied discordance between health literacy of people with rheumatic and musculoskeletal diseases (RMDs) and assessment of health literacy by their treating health professionals, and explored whether discordance is associated with the patients' socioeconomic background. METHODS Patients with RA, spondyloarthritis (SpA) or gout from three Dutch outpatient rheumatology clinics completed the nine-domain Health Literacy Questionnaire (HLQ). Treating health professionals assessed their patients on each HLQ domain. Discordance per domain was defined as a ≥2-point difference on a 0-10 scale (except if both scores were below three or above seven), leading to three categories: 'negative discordance' (i.e. professional scored lower), 'probably the same' or 'positive discordance' (i.e. professional scored higher). We used multivariable multilevel multinomial regression models with patients clustered by health professionals to test associations with socioeconomic factors (age, gender, education level, migration background, employment, disability for work, living alone). RESULTS We observed considerable discordance (21-40% of patients) across HLQ domains. Most discordance occurred for 'Critically appraising information' (40.5%, domain 5). Comparatively, positive discordance occurred more frequently. Negative discordance was more frequently and strongly associated with socioeconomic factors, specifically lower education level and non-Western migration background (for five HLQ domains). Associations between socioeconomic factors and positive discordance were less consistent. CONCLUSION Frequent discordance between patients' scores and professionals' estimations indicates there may be hidden challenges in communication and care, which differ between socioeconomic groups. Successfully addressing patients' health literacy needs cannot solely depend on health professionals' estimations but will require measurement and dialogue. VIDEO ABSTRACT A video abstract of this article can be found at https://www.youtube.com/watch?v=ggnB1rATdQ4.
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Affiliation(s)
- Mark M Bakker
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
| | - Cédric Dikovec
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC
| | - Jany Rademakers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht.,Nivel Netherlands Institute for Health Services Research, Utrecht
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, Enschede.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Arthritis Center Twente, Enschede
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden UMC, Leiden.,Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Maarten de Wit
- Tools2Use Patient Association, Amsterdam, The Netherlands
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University.,Monash Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht UMC.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht
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7
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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8
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Poureslami I, FitzGerald JM, Tregobov N, Goldstein RS, Lougheed MD, Gupta S. Health literacy in asthma and chronic obstructive pulmonary disease (COPD) care: a narrative review and future directions. Respir Res 2022; 23:361. [PMID: 36529734 PMCID: PMC9760543 DOI: 10.1186/s12931-022-02290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Respiratory self-care places considerable demands on patients with chronic airways disease (AD), as they must obtain, understand and apply information required to follow their complex treatment plans. If clinical and lifestyle information overwhelms patients' HL capacities, it reduces their ability to self-manage. This review outlines important societal, individual, and healthcare system factors that influence disease management and outcomes among patients with asthma and chronic obstructive pulmonary disease (COPD)-the two most common ADs. For this review, we undertook a comprehensive literature search, conducted reference list searches from prior HL-related publications, and added insights from international researchers and scientists with an interest in HL. We identified methodological limitations in currently available HL measurement tools in respiratory care. We also summarized the issues contributing to low HL and system-level cultural incompetency that continue to be under-recognized in AD management and contribute to suboptimal patient outcomes. Given that impaired HL is not commonly recognized as an important factor in AD care, we propose a three-level patient-centered model (strategies) designed to integrate HL considerations, with the goal of enabling health systems to enhance service delivery to meet the needs of all AD patients.
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Affiliation(s)
- Iraj Poureslami
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,Canadian Multicultural Health Promotion Society (CMHPS), Vancouver, BC Canada
| | - J. Mark FitzGerald
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Noah Tregobov
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, Vancouver-Fraser Medical Program, University of British Columbia, Vancouver, BC Canada
| | - Roger S. Goldstein
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,Respiratory Medicine, Westpark Healthcare Centre, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.410356.50000 0004 1936 8331Asthma Research Unit, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - Samir Gupta
- grid.415502.7Unity Health, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON Canada
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9
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Tam K, Hazlewood GS, Barber CEH. Effect of Training on Patient Self-Assessment of Joint Counts in Rheumatoid Arthritis: A Systematic Review. ACR Open Rheumatol 2021; 3:860-869. [PMID: 34535968 PMCID: PMC8672172 DOI: 10.1002/acr2.11344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
Objective Patient self‐assessed joint counts, if accurate and reliable, could potentially serve as a useful clinical assessment tool in rheumatoid arthritis (RA). This systematic review examines the effect of patient training on the inter‐rater reliability of joint counts between patients and clinicians. Methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was performed in PubMed, Embase, Cochrane Library, and CINAHL for articles that incorporated patient training and measured the reliability of patient self‐assessed joint counts in RA. Articles were included if they reported on the inter‐rater reliability between patient and clinician joint counts in both trained and untrained patients with RA. Data were extracted on characteristics of patients, structure and components of the training interventions, joint count reliability of patients with and without training, and patient feedback on training interventions. The relevant data were summarized and described. Results Multiple training methods have been studied (n = 5), including in‐person sessions run by rheumatologists and instructional videos on the joint examination. Overall, training improved the reliability of patient self–joint counts, with more marked improvement in reliability of swollen joint counts than tender joint counts. Patients had positive feedback when surveyed on their experiences with training. Conclusion Various training modalities (in‐person and video‐based) may be effective at improving reliability of patient self–joint counts. More research is needed on this topic, with potential areas for future research including 1) comparison between the efficacy of different modalities of training, and 2) impact of patient factors (education level and disease severity) on the efficacy of training.
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Affiliation(s)
- Keith Tam
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen S Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Claire E H Barber
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
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10
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Zhang W, Radhakrishnan K, Becker H, Acton GJ, Holahan CK. Self-Regulation Strategies Among Community-Dwelling People Aging With Arthritis and Multimorbidity. J Gerontol Nurs 2021; 47:35-45. [PMID: 33377983 DOI: 10.3928/00989134-20201209-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022]
Abstract
Self-regulation strategies of selection, optimization, and compensation (SR-SOC) have been found to predict arthritis self-efficacy and quality of life among community-dwelling people aging with arthritis and multimorbidity. The current study aimed to describe the health resources and chronic disabling symptom characteristics of community-dwelling people aging with arthritis and multimorbidity and investigate how these characteristics influence and predict SR-SOC strategies in managing arthritis multimorbidity after controlling for demographics and comorbidities. One hundred forty individuals aged >50 years completed surveys on demographics, comorbidities, health resources, symptoms, and SR-SOC strategy use frequencies. Descriptive statistics were used to describe sample characteristics. Correlations and multivariate hierarchical stepwise regressions were used to examine the associated characteristics and predictors for SR-SOC strategy use frequency. Lower health literacy, health care provider communication quality, and smaller social network were reported less often than arthritis in general. Significant predictors of SR-SOC strategy use were physical symptoms, health care provider communication quality, and age (p < 0.05). Better symptom management and health care provider communication quality could help promote self-regulation. [Journal of Gerontological Nursing, 47(1), 35-45.].
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11
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Patil U, Kostareva U, Hadley M, Manganello JA, Okan O, Dadaczynski K, Massey PM, Agner J, Sentell T. Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3301. [PMID: 33806763 PMCID: PMC8004744 DOI: 10.3390/ijerph18063301] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 01/24/2023]
Abstract
The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4-5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.
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Affiliation(s)
- Uday Patil
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, 1960 East West Road, Honolulu, HI 96822, USA;
| | - Uliana Kostareva
- School of Nursing and Dental Hygiene, University of Hawai‘i at Mānoa, 2528 McCarthy Mall, Honolulu, HI 96822, USA;
| | - Molly Hadley
- School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA; (M.H.); (J.A.M.)
| | - Jennifer A. Manganello
- School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA; (M.H.); (J.A.M.)
| | - Orkan Okan
- Interdisciplinary Centre for Health Literacy, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany;
| | - Kevin Dadaczynski
- Department of Nursing and Health Science, Fulda University of Applied Sciences, Leipziger Straße 123, 36037 Fulda, Germany;
- Center for Applied Health Science, Leuphana University of Lueneburg, Wilschenbrucher Weg 84a, 21335 Lüneburg, Germany
| | - Philip M. Massey
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA;
| | - Joy Agner
- Department of Psychology, University of Hawai‘i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96822, USA;
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, 1960 East West Road, Honolulu, HI 96822, USA;
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12
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Oliveira IV, do Nascimento MMG, Kakehasi AM, de Morais Neves C, Silva HM, Gonçalves TS, de Moura Aredes R, de Oliveira DR. Association between Health Literacy, Patient Activation, and Functional Capacity in Individuals with Rheumatoid Arthritis. Open Rheumatol J 2021. [DOI: 10.2174/1874312902115010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives:
To describe health literacy, patient activation, and functional capacity in individuals with rheumatoid arthritis and to evaluate the associations of health literacy and activation level with functional capacity.
Methods:
A cross-sectional study involving patients with rheumatoid arthritis was carried out at the rheumatology service of a teaching hospital. Health literacy was assessed by applying the short version of the Test of Functional Health Literacy in Adults. Patient Activation was measured by using the summarized version of the Patient Activation Measure. The Health Assessment Questionnaire was applied to evaluate functional capacity. Sociodemographic and clinical variables were also collected to carried out univariate and multivariate analyses by using logistic regression.
Results:
The sample was composed of 179 patients, of whom 90.5% (n = 162) were women. The participants’ average age was 58.3 ± 11.4 years. The prevalence of patients with inadequate or marginal health literacy was high (67%). In contrast, 74% of the patients showed high activation levels. The average score on the Health Assessment Questionnaire was 1.08 ± 0.7. Adequate health literacy was negatively associated with higher Health Assessment Questionnaire scores (OR = 0.42; 95% CI 0.20 – 0.86; p = 0.018), and high activation levels were negatively associated with moderate to severe functional limitation (level 3/moderate activation level – OR = 0.24; 95% CI 0.10 – 0.56; p = 0.001; level 4/high activation level – OR = 0.22; 95% CI 0.08 – 0.50; p = 0.000).
Conclusion:
Health professionals must be aware of health literacy and activation levels of patients with rheumatoid arthritis, given that interventions to improve them represent an opportunity to increase functional capacity.
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13
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Bakker MM, Putrik P, Rademakers J, van de Laar M, Vonkeman H, Kok MR, Voorneveld-Nieuwenhuis H, Ramiro S, de Wit M, Buchbinder R, Batterham R, Osborne RH, Boonen A. Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals? Arthritis Care Res (Hoboken) 2021; 73:100-109. [PMID: 33026713 PMCID: PMC7839720 DOI: 10.1002/acr.24480] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022]
Abstract
Objective To identify and describe health literacy profiles of patients with rheumatic diseases and explore whether the identified health literacy profiles can be generalized to a broader rheumatology context. Methods Patients with rheumatoid arthritis, spondyloarthritis, and gout from 3 hospitals in different regions in The Netherlands completed the Health Literacy Questionnaire (HLQ). Hierarchical cluster analysis was used to identify patients’ health literacy profiles based on 9 HLQ domains. A multinomial regression model with the identified health literacy profiles as the dependent variable was fitted to assess whether patients with a given disease type or attending a given hospital were more likely to belong to a specific profile. Results Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for “critical appraisal,” “navigating the health system,” and “finding good health information.” The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7–10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease. Conclusion Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.
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Affiliation(s)
- Mark M Bakker
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Polina Putrik
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jany Rademakers
- Nivel Netherlands Institute for Health Services Research, Utrecht, and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mart van de Laar
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Harald Vonkeman
- Medisch Spectrum Twente, Arthritis Center Twente and University of Twente, Enschede, The Netherlands
| | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sofia Ramiro
- Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands
| | - Maarten de Wit
- Tools2use patient association, Amsterdam, The Netherlands
| | | | - Roy Batterham
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia, and Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Swinburne University of Technology, Centre for Global Health and Equity, Melbourne, Victoria, Australia
| | - Annelies Boonen
- Maastricht UMC+ and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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14
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Katz P, Dall’Era M, Trupin L, Rush S, Murphy LB, Lanata C, Criswell LA, Yazdany J. Impact of Limited Health Literacy on Patient-Reported Outcomes in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2021; 73:110-119. [PMID: 32741118 PMCID: PMC7775267 DOI: 10.1002/acr.24361] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Health disparities in patient-reported outcomes by income and education are well documented; however, the impact of health literacy on patient-reported outcomes has received less attention. We examined independent effects of income, education, and health literacy on patient-reported outcomes in systemic lupus erythematosus (SLE). METHODS Data from the California Lupus Epidemiology Study (n = 323 participants) were used. Health literacy was assessed with a validated 3-item measure (ability to understand written information, reliance on others to understand written information, confidence in completing written forms). Patient-reported outcomes were administered by interview in English, Spanish, Cantonese, or Mandarin. Generic and disease-specific patient-reported outcomes were examined using the following: 10 Patient-Reported Outcomes Measurement Information System (PROMIS) short forms; the 8 Short Form 36 (SF-36) health survey subscales; and 3 patient-reported SLE disease activity and damage measures. We conducted 2 sets of multivariable analyses: the first examined education, income, or health literacy individually; the second included all 3 simultaneously. All multivariable models included age, sex, race/ethnicity, language, disease duration, and physician-assessed disease activity and damage. RESULTS More than one-third of participants (38%) had limited health literacy (LHL), including >25% with greater than high school education. In multivariable analyses simultaneously considering education, income, and health literacy, LHL was associated with significantly worse scores on all patient-reported outcomes except disease damage. In contrast, disparities by income were seen in only 3 PROMIS scales, 3 SF-36 subscales, and 1 disease activity measure. No disparities by education level were noted. CONCLUSION We found significantly worse patient-reported outcome scores among individuals with LHL, even after controlling for disease activity and damage. Whether disparities are due to actual differences in health or measurement issues requires further study.
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15
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Self-Management of Rheumatoid Arthritis: Mobile Applications. Curr Rheumatol Rep 2020; 23:2. [DOI: 10.1007/s11926-020-00968-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
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16
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Carvajal Bedoya G, Davis LA, Hirsh JM. Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:738-749. [PMID: 33091257 DOI: 10.1002/acr.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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17
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Liu LH, Garrett SB, Li J, Ragouzeos D, Berrean B, Dohan D, Katz PP, Barton JL, Yazdany J, Schmajuk G. Patient and clinician perspectives on a patient-facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis. Health Expect 2020; 23:846-859. [PMID: 32270591 PMCID: PMC7495065 DOI: 10.1111/hex.13057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/20/2020] [Accepted: 03/12/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Poor patient-clinician communication around patient-reported outcomes (PROs) is a barrier to the effective management of rheumatoid arthritis (RA). We aimed to develop an RA 'dashboard' that could facilitate conversations about PROs and that would be acceptable to a wide range of patients, including English and Spanish speakers and patients with adequate or limited health literacy. METHODS A diverse group of RA patients along with clinicians from two academic rheumatology clinics joined separate focus groups. We solicited feedback and made iterative changes to mock-ups of an RA dashboard that visualized PROs using a human-centred design process. We used the thematic analysis method to identify and characterize themes from the focus groups and used these insights to refine the dashboard. RESULTS We conducted six focus groups involving 25 RA patients and three groups with 11 clinicians. Patients and clinicians agreed that the dashboard could enhance communication about PROs and RA disease activity and could promote patient self-management. Patients varied in their (a) comprehension, (b) preferences for the display and features of the dashboard, and (c) desired uses for the dashboard. Clinicians expressed significant concerns about the logistics of using the dashboard in clinical practice. CONCLUSION Using principles of human-centred design, we created an RA dashboard that was well-accepted among patients and clinicians. The ability to customize the data display is important for tailoring the dashboard to patients with diverse needs and preferences. Special attention should be given to feasibility concerns voiced by clinicians.
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Affiliation(s)
- Lucy H. Liu
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- San Francisco VA Medical CenterSan FranciscoCalifornia
| | - Sarah B. Garrett
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Jing Li
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
| | - Dana Ragouzeos
- School of Medicine Technology Unit (SOMTech)University of California ‐ San FranciscoSan FranciscoCalifornia
| | - Beth Berrean
- School of Medicine Technology Unit (SOMTech)University of California ‐ San FranciscoSan FranciscoCalifornia
| | - Daniel Dohan
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Patricia P. Katz
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Jennifer L. Barton
- VA Portland Health Care SystemOregon Health Sciences UniversityPortlandOregon
| | - Jinoos Yazdany
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
| | - Gabriela Schmajuk
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- San Francisco VA Medical CenterSan FranciscoCalifornia
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
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18
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Slavin V, Creedy DK, Gamble J. Single Item Measure of Social Supports: Evaluation of construct validity during pregnancy. J Affect Disord 2020; 272:91-97. [PMID: 32379626 DOI: 10.1016/j.jad.2020.03.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/02/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lack of social support during pregnancy is associated with psychosocial vulnerability. The Single Item Measure of Social Supports (SIMSS) is included in a core outcome set to facilitate case-adjustment based on social support. Validity of the SIMSS has not been evaluated in childbearing women. We aimed to evaluate the construct validity of the SIMSS during pregnancy. Secondary aim was to evaluate an alternative short-measure of social support. METHODS Recruited women (n = 309) attending antenatal care were invited to complete the SIMSS, Multidimensional Scale of Perceived Social Support (MSPSS), Antenatal Risk Questionnaire (ANRQ), and Edinburgh Postnatal Depression Scale (EPDS). Convergent validity of SIMSS with MSPSS and hypothesis testing for psychosocial risk and depressive symptoms were conducted. RESULTS Correlations were moderate between the SIMSS and MSPSS (rs = .35), but weak between the SIMSS and EPDS (rs = -.18); and SIMSS and ANRQ (rs = -.22). In contrast, correlations were moderate between the MSPSS and EPDS (rs = -.39) and ANRQ (rs = -.45). A shortened 3-item version of the MSPSS showed good psychometric properties and internal consistency reliability (a = .86). LIMITATIONS Findings relate to one Australian birthing sample during pregnancy. Replication of this study in larger, diverse maternity populations, including postpartum is recommended. CONCLUSIONS The SIMSS is a poor measure of social support during pregnancy with poor predictive ability to detect maternal vulnerability including depression and psychosocial risk. A revised 3-item version of the MSPSS was found to be a valid and reliable measure of social support.
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Affiliation(s)
- Valerie Slavin
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia; Women, Newborn & Children's Services, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld, 4215, Australia..
| | - Debra K Creedy
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, 4131, Australia
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19
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Hirsh J, Wood P, Keniston A, Boyle D, Quinzanos I, Caplan L, Davis L. Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients. ACR Open Rheumatol 2020; 2:110-118. [PMID: 31957348 PMCID: PMC7011426 DOI: 10.1002/acr2.11108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. METHODS Data collected during a 6-month prospective quality assurance intervention was compared with data from a prior 6-month period. Interventions included 1) encouraging questions, 2) teach-back communication, and 3) brown-bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. RESULTS During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach-back communication was performed in more than 90% of visits. Brown-bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology-related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach-back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). CONCLUSION Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety-net clinic, with particularly strong effects seen with teach-back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real-world setting.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Dennis Boyle
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Itziar Quinzanos
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
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20
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Hirsh J, Wood P, Keniston A, Peng M, Ramaswami S, Caplan L, Davis L. Limited Health Literacy and Patient Confusion About Rheumatoid Arthritis Patient Global Assessments and Model Disease States. Arthritis Care Res (Hoboken) 2019; 71:611-619. [PMID: 29953748 DOI: 10.1002/acr.23692] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/26/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patient global assessment visual analog scales (PGA-VAS) are widely used in rheumatoid arthritis (RA) practice and research, and low PGA-VAS scores are required for remission. Vulnerable patients with RA may have difficulty completing the PGA-VAS. There is limited information about both patients' perceptions of PGA-VAS and how patients score VAS model disease states. The objective of this study was to understand the perspectives of vulnerable patients regarding PGA-VAS and model disease states. METHODS We enrolled patients with RA at Denver Health (n = 300). Subjects completed the PGA-VAS in the Disease Activity Score in 28 joints and the Multidimensional Health Assessment Questionnaire and completed a questionnaire regarding these PGA-VAS. Subjects also scored remission, mild, moderate, and severe model disease states by VAS. We performed analyses by linear and logistic regression and by using summary statistics. Outcomes included whether subjects found the PGA-VAS confusing, whether subjects' responses to the model disease states followed a natural progression (remission <mild <moderate <severe), and whether responses to the remission model would meet Boolean and Simplified Disease Activity Index-based remission criteria. RESULTS Approximately 40% of subjects found the PGA-VAS confusing; lower health literacy and depressive symptoms were associated with finding them confusing. Less than 25% of subjects ranked the model disease states with natural progression and ranked the remission model at the threshold for remission; higher health literacy and income were associated with accomplishing these objectives. CONCLUSION Vulnerable patients perceive difficulty with PGA-VAS and do not reliably rate a model disease state VAS. These patients are potentially at risk for disease activity misclassification because of literacy and other barriers in completing VAS.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority Denver, Colorado and University of Colorado Medical School, Denver, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, and University of Colorado Medical School, Denver, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority Denver, Colorado and University of Colorado Medical School, Denver, Colorado
| | - Mandy Peng
- University of Colorado Medical School, Denver
| | - Sai Ramaswami
- Denver Health and Hospital Authority, Denver, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, and University of Colorado Medical School, Denver, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority Denver, Colorado and University of Colorado Medical School, Denver, Colorado
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21
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Betancourt BY, Biehl A, Katz JD, Subedi A. Pharmacotherapy Pearls in Rheumatology for the Care of Older Adult Patients: Focus on Oral Disease-Modifying Antirheumatic Drugs and the Newest Small Molecule Inhibitors. Rheum Dis Clin North Am 2018; 44:371-391. [PMID: 30001781 DOI: 10.1016/j.rdc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Providing safe and effective pharmacotherapy to geriatric patients with rheumatologic disorders is challenging. Multidisciplinary care involving rheumatologists, primary care physicians, and other specialties can optimize benefit and reduce adverse outcomes. Oral disease-modifying antirheumatic drugs, including methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, and the small molecule inhibitors tofacitinib and apremilast have distinctive monitoring requirements and specific adverse reaction profiles. This article provides clinically relevant pearls for use of these interventions in older patients.
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Affiliation(s)
- Blas Y Betancourt
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA.
| | - Ann Biehl
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, FDA, 10001 New Hampshire Avenue, Hillandale Building, 4th Floor Silver Spring, MD 20993, USA
| | - James D Katz
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA
| | - Ananta Subedi
- National Institutes of Arthritis and Musculoskeletal and Skin Disease, National Institutes of Health Clinical Center, Bethesda, MD 20814, Maryland, USA
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22
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Katz PP, Barton J, Trupin L, Schmajuk G, Yazdany J, Ruiz PJ, Yelin E. Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:621-8. [PMID: 26414775 DOI: 10.1002/acr.22748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite advances in therapies, disparities in outcomes have been documented for rheumatoid arthritis (RA) patients for both ethnicity and English language proficiency. The goals of these analyses were to compare differences in RA patient-reported outcomes, by both self-identification of ethnicity and English language proficiency, and to identify factors that might explain differences among groups. METHODS Data were collected through structured telephone interviews of a longitudinal cohort with physician-diagnosed RA (n = 438); only women were included (n = 335). Three groups were defined based on self-reported ethnicity and English proficiency: white/English (n = 219), Hispanic/English (n = 39), and Hispanic/Spanish (n = 77). Outcomes examined were patient-reported physical functioning, pain, and presence of moderate or severe fatigue. Multivariate regression analyses compared outcomes among groups, adjusting for sociodemographic characteristics, health and disease factors, and depression. RESULTS Hispanic/Spanish women had worse function, pain, and fatigue than either English-proficient group. Depression was associated with all outcomes (P < 0.0001), and accounted for greater differentials in scores than ethnicity/language proficiency. In interaction analyses, differences between women who were and were not depressed were greater for Hispanic/English than for Hispanic/Spanish. Nondepressed Hispanic/Spanish scores were significantly worse than nondepressed Hispanic/English, i.e., the impact of depression was less for Hispanic/Spanish women because both depressed and nondepressed women in this group reported worse outcomes. After adjustment for sociodemographic factors and depression, language remained significantly associated with outcomes. CONCLUSION Disparities in patient-reported outcomes may be driven less by ethnicity than by sociodemographic or psychological factors. Measurement instruments that are not culturally appropriate and equivalent may also hamper meaningful analyses of disparities.
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Affiliation(s)
| | | | | | | | | | - Pedro J Ruiz
- California Pacific Medical Center, San Francisco, California
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Barton JL, Trupin L, Schillinger D, Evans-Young G, Imboden J, Montori VM, Yelin E. Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study. Arthritis Care Res (Hoboken) 2017; 68:889-98. [PMID: 26605752 DOI: 10.1002/acr.22801] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence; however, few tools support SDM in RA. Our objective was to pilot a low-literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications. METHODS RA patients were consecutively enrolled into 1 of 3 arms: 1) control; patients received existing medication guide prior to clinic visit, 2) adapted guide prior to visit, and 3) adapted guide prior to plus decision aid during visit. Outcomes were collected immediately postvisit, at 1-week, and at 3- and 6-month interviews. Eligible adults had to have failed at least 1 disease-modifying antirheumatic drug and fulfill 1 of the following: age >65 years, immigrant, non-English speaker, less than high school education, limited health literacy, and racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions. RESULTS The majority of 166 patients were immigrants (66%), non-English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge postvisit in arm 3 was higher (78%) than arm 1 (53%; adjusted odds ratio 2.7, 95% confidence interval 1.2, 6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (P = 0.03). There were no significant differences in acceptability. CONCLUSION A low-literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with RA patients' values and preferences.
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Affiliation(s)
- Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
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Biehl AJ, Katz JD. Pharmacotherapy Pearls for the Geriatrician: Focus on Oral Disease-Modifying Antirheumatic Drugs Including Newer Agents. Clin Geriatr Med 2016; 33:1-15. [PMID: 27886691 DOI: 10.1016/j.cger.2016.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Providing safe and effective pharmacotherapy to the geriatric patients with rheumatological disorders is an ongoing struggle for the rheumatologist and geriatrician alike. Cohesive communication and partnership can improve the care of these patients and subvert adverse outcomes. Disease-modifying antirheumatic drugs, including methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, and the newest oral agent for treatment of rheumatoid arthritis, tofacitinib, have distinctive monitoring and adverse effect profiles. This article provides the general practitioner or geriatrician with clinically relevant pearls regarding the use of these interventions in older patients.
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Affiliation(s)
- Ann J Biehl
- Department of Pharmacy, National Institutes of Health Clinical Center, 10 Center Drive, Room 1C240, Bethesda, MD 20892-1196, USA.
| | - James D Katz
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 6N-216F, Building 10, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Wong PKK. Medication adherence in patients with rheumatoid arthritis: why do patients not take what we prescribe? Rheumatol Int 2016; 36:1535-1542. [PMID: 27665289 DOI: 10.1007/s00296-016-3566-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which results in extensive articular and extra-articular morbidity and increased mortality from cardiovascular disease. Despite an increasing range of non-biological and biological disease-modifying agents, poor patient adherence with medication is a significant barrier to effective control of the inflammation associated with RA. This review seeks to identify factors that affect patient adherence with medication, examine the effectiveness of interventions to address this issue and offer practical suggestions to improve medication adherence. The impact of health literacy on medication adherence and the novel role of musculoskeletal ultrasound as an educational intervention will also be discussed.
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Affiliation(s)
- Peter K K Wong
- Mid-North Coast Arthritis Clinic, PO Box 6307, Coffs Harbour, NSW, 2450, Australia.
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW, Australia.
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26
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Health literacy screening of patients attending a student-led osteopathy clinic: A pilot investigation. Complement Ther Clin Pract 2016; 24:41-4. [PMID: 27502799 DOI: 10.1016/j.ctcp.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022]
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Hirsh JM. The Challenge and Opportunity of Capturing Patient Reported Measures of Rheumatoid Arthritis Disease Activity in Vulnerable Populations with Limited Health Literacy and Limited English Proficiency. Rheum Dis Clin North Am 2016; 42:347-62. [DOI: 10.1016/j.rdc.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:745-51. [PMID: 26595554 DOI: 10.1097/mib.0000000000000622] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Health literacy (HL) is the extent to which individuals have the capacity to obtain, process, and understand basic health information that is needed to make appropriate health decisions. As adults with inflammatory bowel disease engage in complex health decisions throughout their lives, attention is needed regarding the influence of HL on the lives of people with inflammatory bowel disease. About one-third of adults in the United States have limited HL. Limited HL is a potentially modifiable risk factor that has been associated with barriers to patient-provider communication and worse health outcomes for people with a range of chronic diseases. Gastroenterologists must recognize the role of HL in their practice. Limited HL can affect a patient's ability to understand the purpose of a screening test for colorectal cancer, understand the concept of an asymptomatic yet chronic disease, ask questions in an office visit and engage in shared decision making. Gastroenterologists must approach each patient as potentially having limited HL and use clear communication strategies in all encounters. Currently, there is a lack of training, education, and support for health care providers to meet the needs of patients with limited HL. More research is needed in inflammatory bowel disease to understand the impact of limited health literacy on health outcomes in this population and develop effective systems-based interventions to reduce the health literacy burden on patients.
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A Systematic Review of Factors Associated with Non-Adherence to Treatment for Immune-Mediated Inflammatory Diseases. Adv Ther 2015; 32:983-1028. [PMID: 26547912 PMCID: PMC4662720 DOI: 10.1007/s12325-015-0256-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-adherence impacts negatively on patient health outcomes and has associated economic costs. Understanding drivers of treatment adherence in immune-mediated inflammatory diseases is key for the development of effective strategies to tackle non-adherence. OBJECTIVE To identify factors associated with treatment non-adherence across diseases in three clinical areas: rheumatology, gastroenterology, and dermatology. DESIGN Systematic review. DATA SOURCES Articles published in PubMed, Science Direct, PsychINFO and the Cochrane Library from January 1, 1980 to February 14, 2014. STUDY SELECTION Studies were eligible if they included patients with a diagnosis of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or psoriasis and included statistics to examine associations of factors with non-adherence. DATA EXTRACTION Data were extracted by the first reviewer using a standardized 23-item form and verified by a second/third reviewer. Quality assessment was carried out for each study using a 16-item quality checklist. RESULTS 73 studies were identified for inclusion in the review. Demographic or clinical factors were not consistently associated with non-adherence. Limited evidence was found for an association between non-adherence and treatment factors such as dosing frequency. Consistent associations with adherence were found for psychosocial factors, with the strongest evidence for the impact of the healthcare professional-patient relationship, perceptions of treatment concerns and depression, lower treatment self-efficacy and necessity beliefs, and practical barriers to treatment. CONCLUSIONS While examined in only a minority of studies, the strongest evidence found for non-adherence were psychosocial factors. Interventions designed to address these factors may be most effective in tackling treatment non-adherence.
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Gong Z, Haig SL, Pope JE, Rohekar S, Rohekar G, LeRiche NGH, Thompson AE. Health Literacy Rates in a Population of Patients with Rheumatoid Arthritis in Southwestern Ontario. J Rheumatol 2015; 42:1610-5. [PMID: 26233510 DOI: 10.3899/jrheum.141509] [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] [Accepted: 05/06/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the rate of low health literacy in the rheumatoid arthritis (RA) population in southwestern Ontario. METHODS For the study, 432 patients with RA were contacted, and 311 completed the assessment. The health literacy levels of the participants were estimated using 4 assessment tools administered in the following order: the Single Item Literacy Screener (SILS), the Medical Term Recognition Test (METER), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Shortened Test of Functional Health Literacy in Adults (STOFHLA). RESULTS The rates of low literacy as estimated by STOFHLA, REALM, METER, and SILS were 14.5%, 14.8%, 14.1%, and 18.6%, respectively. All 4 assessment tools were statistically significantly correlated. STOFHLA, REALM, and METER were strongly correlated with each other (r = 0.59-0.79), while SILS only demonstrated moderate correlations with the other assessment tools (r = 0.33-0.45). Multiple linear regression and binary logistic regression analyses revealed that low levels of education and a lack of daily reading activity were common predictors of low health literacy. Using a non-English primary language at home was found to be a strong predictor of low health literacy in STOFHLA, REALM, and METER. Male sex was found to be a significant predictor of poor performance in REALM and METER, but not STOFHLA. CONCLUSION Low health literacy is an important issue in the southwestern Ontario RA population. About 1 in 7 patients with RA may not have the necessary skills to become involved in making decisions regarding their personal health. Rheumatologists should be aware of the low health literacy levels of patients with RA and should consider identifying patients at risk of low health literacy.
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Affiliation(s)
- Zhaowei Gong
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Sara L Haig
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Janet E Pope
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Sherry Rohekar
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Gina Rohekar
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Nicole G H LeRiche
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care
| | - Andrew E Thompson
- From the Department of Medicine, Division of Rheumatology, Western University, and the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada.Z. Gong, MD, Medical Student; S.L. Haig, MD, Adjunct Professor of Medicine; J.E. Pope, MD, Professor of Medicine; S. Rohekar, MD, Associate Professor of Medicine; G. Rohekar, MD, Assistant Professor of Medicine; N.G. LeRiche, MD, Associate Professor of Medicine; A.E. Thompson, MD, MHPE, FRCPC, Associate Professor of Medicine, Western University, Rheumatology Centre, St. Joseph's Health Care.
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Putrik P, Ramiro S, Chorus AM, Keszei AP, Boonen A. Socioeconomic inequities in perceived health among patients with musculoskeletal disorders compared with other chronic disorders: results from a cross-sectional Dutch study. RMD Open 2015; 1:e000045. [PMID: 26535136 PMCID: PMC4612684 DOI: 10.1136/rmdopen-2014-000045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore the impact of socioeconomic factors on physical and mental health of patients with musculoskeletal disorders (MSKDs) and compare it across patients with other disorders. METHODS A representative sample of the Dutch population (n=8904) completed a survey on sociodemographics, physician-diagnosed (co-) morbidities, and physical (physical component summary, PCS) and mental (mental component summary, MCS) subscales of SF-12 (outcome variables). Regression models were computed first in the total group of patients with MSKDs, with education, age, gender, origin and place of residence as independent variables, and, second, in individuals expected to have paid work, adding a variable on social status. Models were repeated for five other subgroups of chronic disorders (cardiovascular (CVD), diabetes, cancer, mental and respiratory) and for healthy individuals. RESULTS MSKDs confirmed by a physician were reported by 1766 (20%) participants (mean age 59 years, 38% male), 547 (6%) respondents reported to have diabetes, 1855 (21%) CVD, 270 (3%) cancer, 526 (6%) mental disorders, 679 (8%) respiratory disorders and 4525 (51%) did not report any disease. In patients with MSKDs, (primary school vs university education (-5.3 (PCS) and -3.3 (MCS)) and having a state subsidy vs paid work (-5.3 (PCS) and -4.7 (MCS)) were consistently associated with worse physical and mental health. Gender was only relevant for PCS (female vs male -2.1). Comparable differences in health by education and social status were observed in the other diseases, except for cancer. CONCLUSIONS Education and social status in MSKD have the same strong and independent association with health as in other chronic diseases. These health gradients are unfair and partly avoidable, and require consorted attention and action in and outside healthcare.
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Affiliation(s)
- P Putrik
- Department of Rheumatology, Maastricht University Medical Center, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
- Department of Health Promotion, Maastricht University, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
| | - S Ramiro
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Portugal
| | - A M Chorus
- Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - A P Keszei
- Department of Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany
| | - A Boonen
- Department of Rheumatology, Maastricht University Medical Center, CAPHRI School for Public Health and Primary care, Maastricht, The Netherlands
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Joplin S, van der Zwan R, Joshua F, Wong PKK. Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BIOMED RESEARCH INTERNATIONAL 2015; 2015:150658. [PMID: 26060812 PMCID: PMC4427825 DOI: 10.1155/2015/150658] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. OBJECTIVE The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. METHODS Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. RESULTS Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. CONCLUSION Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.
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Affiliation(s)
- Samantha Joplin
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Rick van der Zwan
- Department of Psychology, Southern Cross University, Coffs Harbour, NSW 2450, Australia
| | - Fredrick Joshua
- Department of Rheumatology, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia
- Prince of Wales Hospital Clinical School, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
| | - Peter K. K. Wong
- Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW 2450, Australia
- Rural Clinical School, University of New South Wales, Coffs Harbour, NSW 2450, Australia
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Barton JL, Koenig CJ, Evans-Young G, Trupin L, Anderson J, Ragouzeos D, Breslin M, Morse T, Schillinger D, Montori VM, Yelin EH. The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter. BMC Med Inform Decis Mak 2014; 14:104. [PMID: 25649726 PMCID: PMC4363399 DOI: 10.1186/s12911-014-0104-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles. METHODS Based on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development. RESULTS Three iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians. CONCLUSIONS The process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.
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Affiliation(s)
- Jennifer L Barton
- Department of Medicine, University of California, San Francisco, CA, USA. .,Division of Hospital & Specialty Medicine, Portland Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | | | - Gina Evans-Young
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | - Laura Trupin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | | | | | | | | | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Edward H Yelin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
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Hirsh JM. Can shared decision making help eliminate disparities in rheumatoid arthritis outcomes? J Rheumatol Suppl 2014; 41:1257-9. [PMID: 24986961 DOI: 10.3899/jrheum.140479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Joel M Hirsh
- Denver Health and Hospital Authority, 777 Bannock St., Mail Code 4000, Denver, Colorado 80204, USA.
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Barton JL, Trupin L, Tonner C, Imboden J, Katz P, Schillinger D, Yelin EH. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol 2014; 41:1290-7. [PMID: 24931952 PMCID: PMC4286372 DOI: 10.3899/jrheum.131350] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA. METHODS Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. RESULTS Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort. CONCLUSION This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.
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Affiliation(s)
| | | | | | | | | | - Dean Schillinger
- University of California, San Francisco
- UCSF Center for Vulnerable Populations, San Francisco General Hospital
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Katz SJ, Leung S. Teaching methotrexate self-injection with a web-based video maintains patient care while reducing healthcare resources: a pilot study. Rheumatol Int 2014; 35:93-6. [DOI: 10.1007/s00296-014-3076-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/12/2014] [Indexed: 11/30/2022]
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