1
|
Resciniti NV, Hong Y, McDermott S. Factors contributing to antihypertensive medication adherence among adults with intellectual and developmental disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:137-148. [PMID: 33140659 DOI: 10.1177/1744629520961958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adults with intellectual or developmental disabilities often have hypertension and mental illness, and are prescribed medications for treatment. This study examined psychotropic medication adherence as a mediator between the association of residence type and antihypertensive medication adherence for adults with intellectual or developmental disabilities. We used Medicaid data of adults with intellectual or developmental disabilities who had hypertension and prescribed antihypertensive medication (N = 1,201) to measure the direct effect, indirect effect, and total effect of residence type (home vs. supervised setting) and antihypertensive medication adherence, with a mediator of psychotropic medication adherence. The indirect effect of psychotropic medication adherence on antihypertensive medication adherence was 1.26 (OR = 1.26, CI: 1.08-1.52), holding residency constant. The direct effect of residential type on antihypertensive medication adherence was 3.75 (OR = 3.75, CI: 1.61-8.75). This association may be due to some features of having a mental illness or maybe the result of being prescribed more than one medication.
Collapse
|
2
|
Salzberg D, Zhang W, Moran M, Hardin J, McDermott S, Okoro C, Hollis N. Helpers help people with intellectual and developmental disabilities and hypertension to understand their condition and the need to adhere to anti-hypertensive medication. Disabil Health J 2021; 15:101219. [PMID: 34625396 DOI: 10.1016/j.dhjo.2021.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent evidence suggests that many adults with intellectual and developmental disabilities (IDD) do not adequately manage hypertension (HTN) medication. Known risk factors for insufficient prescription filling include age, residential placement, and lack of caregiver support. This is a first report of a randomized intervention trial designed to analyze the relationship of a brief educational intervention with increased knowledge about HTN and improvement in prescription filling for anti-hypertensive medication. OBJECTIVE/HYPOTHESIS The objective was to test whether an educational flyer and regular messages about HTN and the importance of refilling medication would improve scores on knowledge surveys. Participants were Medicaid members with HTN and IDD (Member) or caregivers (Helpers) who chose to participate on behalf of a Member. METHODS Recruitment letters explained that either the Member or their Helper could participate (not both). Participants were randomly assigned to the Case or Comparison group, and both were comprised of Members and Helpers. Only Case participants received a flyer and monthly HTN education messages for one year, but all participants completed knowledge surveys at baseline, six, and 12 months. Linear regression and log-binomial models were used to compare responses between groups. RESULTS Case Helpers had statistically significant improvements on HTN knowledge from baseline through the first year, compared to Comparison Members and Comparison Helpers. Regardless of group assignment, Helpers scored better on surveys than did Members. CONCLUSIONS This study suggests that it is beneficial to explicitly include Helpers in health care instruction and in management of chronic disease for adults with IDD.
Collapse
Affiliation(s)
- Deborah Salzberg
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA.
| | - Wanfang Zhang
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - Madeline Moran
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - James Hardin
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - Suzanne McDermott
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Catherine Okoro
- National Center on Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - NaTasha Hollis
- National Center on Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, USA
| |
Collapse
|
3
|
Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
Collapse
Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
4
|
O’Brien F, McCallion P, Carroll R, O’Dwyer M, Burke E, McCarron M. The prevalence, awareness, treatment, and control of hypertension in older adults with an intellectual disability in Ireland: a cross sectional study. Eur J Cardiovasc Nurs 2021; 20:315-323. [DOI: 10.1093/eurjcn/zvaa019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Hypertension is a leading risk factor for cardiovascular disease, accounting for almost 50% of ischaemic heart disease mortality. This study aims to identify the prevalence, awareness, treatment, and control of hypertension and their predictors in older adults with an intellectual disability (ID).
Methods and results
This cross-sectional study utilized data from the ID Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants were drawn from the nationally representative sample and included those who completed the self/informant report measures, in addition to objective blood pressure (BP) measurement. From the 551 individuals with ID, aged ≥40 years, hypertension prevalence was 35.2% [95% confidence interval (CI) 31.2–39.2%]. Of those with hypertension, 44.3% (95% CI 37.1–51.5%) were aware of their hypertensive status, and 64.2% (95% CI 57.3–71.1) were taking antihypertensive medication. Among those on treatment, 70.8% (95% CI 61.8–78.2%) had their BP controlled to below 140/90 mmHg. Significant predictors of awareness were age (P = 0.036) and level of ID (P = 0.004), predictors of treatment were age (P = 0.002), level of ID (P = 0.019), and diabetes (P = 0.001). Both diabetes and female gender were predictors of control of hypertension (P = 0.013 and P = 0.037, respectively).
Conclusion
The prevalence of hypertension in older adults with ID was lower than reports for the general Irish population, with overall levels of treatment and control, when identified, higher in the ID population. There was under-treatment and lower levels of awareness among those with more severe ID, which requires addressing. The finding, that when diagnosed, people with ID respond well to treatment should encourage addressing the under-treatment found here.
Collapse
Affiliation(s)
- Frances O’Brien
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Philip McCallion
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
- School of Social Work, Temple University, Philadelphia, PA 19122-6091, USA
| | - Rachael Carroll
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Máire O’Dwyer
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, DO2 PN40, Ireland
| | - Eilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin 2, D02 T283, Ireland
- IDS-TILDA, Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, DO2 PN40, Ireland
| |
Collapse
|
5
|
Cyrus AC, Royer J, Carroll DD, Courtney-Long EA, McDermott S, Turk MA. Anti-Hypertensive Medication Use and Factors Related to Adherence Among Adults With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:248-262. [PMID: 31026202 PMCID: PMC6554647 DOI: 10.1352/1944-7558-124.3.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adults with intellectual and developmental disabilities (IDD) are known to experience significant health disparities; however, few studies have described anti-hypertensive medication adherence in this population. Using administrative data from South Carolina from 2000-2014, we evaluated the odds of adherence to anti-hypertensive medication among a cohort of adults with IDD and hypertension. Approximately half (49.5%) of the study cohort were adherent to anti-hypertensive medication. Those who lived in a supervised residence, had a Medicaid waiver, and had more frequent contact with a primary care provider were more likely to be adherent. Organizations that serve people with IDD have an opportunity to increase adherence by educating these individuals, their family members, and caregivers about the importance of adherence to anti-hypertensive medication.
Collapse
Affiliation(s)
- Alissa C Cyrus
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Julie Royer
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Dianna D Carroll
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Elizabeth A Courtney-Long
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Suzanne McDermott
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| | - Margaret A Turk
- Alissa C. Cyrus, Centers for Disease Control and Prevention, Division of Human Development and Disability; Julie Royer, South Carolina Revenue and Fiscal Affairs Office; Dianna D. Carrol and Elizabeth A. Courtney-Long, Centers for Disease Control and Prevention, Division of Human Development and Disability; Suzanne McDermott, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; Margaret A. Turk, Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University
| |
Collapse
|
6
|
Salgado TM, Fedrigon A, Riccio Omichinski D, Meade MA, Farris KB. Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study. JMIR Mhealth Uhealth 2018; 6:e129. [PMID: 29792292 PMCID: PMC5990856 DOI: 10.2196/mhealth.9527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals.
Collapse
Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States
| | - Alexa Fedrigon
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Donna Riccio Omichinski
- Department of Physical Medicine & Rehabilitation, University of Michigan Rehabilitation Engineering Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Michelle A Meade
- Department of Physical Medicine & Rehabilitation, University of Michigan Rehabilitation Engineering Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
7
|
Williamson HJ, Contreras GM, Rodriguez ES, Smith JM, Perkins EA. Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:227-236. [PMID: 28703641 DOI: 10.1177/1539449217714148] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
Collapse
|
8
|
Dunkley AJ, Tyrer F, Spong R, Gray LJ, Gillett M, Doherty Y, Martin-Stacey L, Patel N, Yates T, Bhaumik S, Chalk T, Chudasama Y, Thomas C, Sadler S, Cooper SA, Gangadharan SK, Davies MJ, Khunti K. Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Alison J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca Spong
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mike Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabyasachi Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Thomas Chalk
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Susannah Sadler
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
9
|
Erickson SR, Kornexl K. Blood Pressure Screening, Control, and Treatment for Patients With Developmental Disabilities in General Medicine Practices. J Pharm Technol 2016. [DOI: 10.1177/8755122516663219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different ( P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.
Collapse
Affiliation(s)
| | - Kayla Kornexl
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
- University of Michigan Health System Pharmacy Services, Ann Arbor, MI, USA
| |
Collapse
|
10
|
Patel I, Erickson SR, Caldwell CH, Woolford SJ, Bagozzi RP, Chang J, Balkrishnan R. Predictors of medication adherence and persistence in Medicaid enrollees with developmental disabilities and type 2 diabetes. Res Social Adm Pharm 2015; 12:592-603. [PMID: 26522400 DOI: 10.1016/j.sapharm.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of diabetes mellitus is high among patients with developmental disabilities (cerebral palsy, autism, Down's syndrome and cognitive disabilities). OBJECTIVES The purpose of this study was to examine the racial health disparities in medication adherence and medication persistence in developmentally disabled adults with type 2 diabetes enrolled in Medicaid. METHODS This was a retrospective cohort study using the MarketScan(®) Multi-State Medicaid Database. Adults aged 18-64 years with a prior diagnosis of a developmental disability (cerebral palsy/autism/down's/cognitive disabilities) and a new diagnosis of type 2 diabetes enrolled in Medicaid from January 1, 2004 and December 31, 2006, were included. Adults were included if they had a continuous enrollment for at least 12 months and were excluded if they were dual eligible. Anti-diabetes medication adherence and diabetes medication persistence were measured using multivariate logistic regression and the Cox-proportional hazard regression, respectively. RESULTS The study population comprised of 1529 patients. Although overall diabetes medication adherence in this population was optimal, African Americans had significantly lower odds (25%) of adhering to anti-diabetes medications compared to Caucasians (OR = 0.75, 95% CI = 0.58-0.97, P < 0.05). Also, after controlling for other covariates, the rate of discontinuation was higher in African Americans compared to Caucasians (hazard ratio = 1.03, 95% CI = 0.91-1.18, P < 0.629). CONCLUSION In this study, racial disparities were found in anti-diabetes medication adherence among Medicaid enrollees with developmental disabilities (DD). Studies conducted in the future should examine predictors that impact access to care, availability of primary and specialized care, social support as well as beliefs of racial minority populations with developmental disabilities and chronic conditions like diabetes to optimize medication use outcomes in this especially vulnerable population.
Collapse
Affiliation(s)
- Isha Patel
- Bernard Dunn School of Pharmacy, Shenandoah University, Winchester, VA, USA
| | | | | | | | | | - Jongwha Chang
- McWhorter College of Pharmacy, Samford University, Birmingham, AL, USA
| | | |
Collapse
|
11
|
Karve S, Markowitz M, Fu DJ, Lindenmayer JP, Wang CC, Candrilli SD, Alphs L. Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:335-346. [PMID: 24756319 PMCID: PMC4026676 DOI: 10.1007/s40258-014-0095-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. OBJECTIVE Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. METHODS From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. RESULTS We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p < 0.001), with rehospitalization (36%) and pharmacy (40%) accounting for over three-fourths of the initial 60-day period costs. Compared with the initial 60-day post-discharge period, both all-cause and schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). CONCLUSIONS We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication adherence likely are important characteristics to examine among patients with schizoaffective disorder and help provide a more holistic view of patients' adherence patterns. Furthermore, we observed a high rate of rehospitalization and greater healthcare costs during the initial 60-day period post-discharge among patients with schizoaffective disorder. Further research is required to better understand and manage transitional care after discharge (e.g., monitor adherence), which may help reduce the likelihood of rehospitalization and the associated downstream costs.
Collapse
|