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Hsieh YP, Yen CF, Wu CF, Wang PW. Nonattendance at Scheduled Appointments in Outpatient Clinics Due to COVID-19 and Related Factors in Taiwan: A Health Belief Model Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4445. [PMID: 33922171 PMCID: PMC8122706 DOI: 10.3390/ijerph18094445] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
During the COVID-19 pandemic, the number of hospital visits and attendance at scheduled appointments have dropped significantly. We used the health belief model (in three dimensions) to examine the determinants of non-attendance of scheduled appointments in outpatient clinics due to the COVID-19 pandemic. Participants in Taiwan (n = 1954) completed an online survey from 10 April 10 to 23 April 2020, which assessed how people perceived and responded to the outbreak of a fast-spreading infectious disease. We performed both univariate and multivariate logistic regression to examine the roles of cognitive, affective, and behavioral health belief constructs in nonattendance at scheduled appointments. The results indicated that individuals who perceived high confidence in coping with COVID-19 were less likely to miss or cancel their doctor's appointments, whereas individuals who reported high anxiety and practiced more preventive health behaviors, including avoiding crowded places, washing hands more often, and wearing a mask more often, were more likely to miss or cancel their appointments due to the COVID-19 pandemic. Non-heterosexual participants had a lower rate of nonattendance at scheduled appointments compared with heterosexual ones. The study results increase our understanding of the patients' cognitive health beliefs, psychological distress, and health behaviors when assessing adherence to medical appointments during a pandemic.
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Affiliation(s)
- Yi-Ping Hsieh
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chia-Fen Wu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
| | - Peng-Wei Wang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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Baillie L, Sell D. Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique. Cleft Palate Craniofac J 2020; 57:1197-1215. [DOI: 10.1177/1055665620923925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
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Affiliation(s)
- Lauren Baillie
- Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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Ghasemi S, Pirzadeh A. Effectiveness of Educational Physical Activity Intervention for Preventive of Musculoskeletal Disorders in Bus Drivers. Int J Prev Med 2019; 10:132. [PMID: 31516673 PMCID: PMC6710914 DOI: 10.4103/ijpvm.ijpvm_339_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 03/16/2019] [Indexed: 11/04/2022] Open
Abstract
Background Driving is a challenging job. Drivers always face the high risk of musculoskeletal disorders (MSDs). Educational interventions could be effective in preventing and controlling these disorders. The present study aims to assess the effectiveness of an educational physical activity intervention in preventing MSDs among bus drivers in Isfahan, Iran. Methods This quasi-experimental study was conducted on 60 urban bus drivers, who were selected using multistage sampling. They were evaluated at two time points, namely before and three months after the intervention. The intervention was conducted in three 90-minute sessions. The HBM-based educational content was delivered through lectures, PowerPoint presentations, videos, practical demonstrations of corrective exercises, and educational pamphlets. Data were analysed using the SPSS program, version 20, the paired t-test, and the independent t-test. Results Before the intervention, there was no significant difference between the two groups with respect to the mean scores of the HBM constructs. However, later on, the mean scores of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and behaviour increased significantly in the intervention group, compared with those in the control group. (P < 0.001). Conclusions The results showed that the physical activity as an HBM-based educational intervention had a positive effect on the prevention of MSDs in urban bus drivers.
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Affiliation(s)
- Safiyeh Ghasemi
- Department of Environmental Manangment, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Asiyeh Pirzadeh
- Department of Environmental Manangment, Najafabad Branch, Islamic Azad University, Najafabad, Iran.,Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Costedoat‐Chalumeau N, Houssiau F, Izmirly P, Guern VL, Navarra S, Jolly M, Ruiz‐Irastorza G, Baron G, Hachulla E, Agmon‐Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard J, Pineau C, Galicier L, Vollenhoven RV, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette J, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring
SLE
: Assessment by Drug Levels and Self‐Administered Questionnaires. Clin Pharmacol Ther 2018; 106:374-382. [DOI: 10.1002/cpt.1194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Nathalie Costedoat‐Chalumeau
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | - Frédéric Houssiau
- Service de RhumatologieCliniques Universitaires Saint‐LucPôle de Pathologies Rhumatismales Inflammatoires et SystémiquesUniversité catholique de Louvain Brussels Belgium
| | - Peter Izmirly
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Véronique Le Guern
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | - Meenakshi Jolly
- Rush University Medical CenterRush Lupus Clinic Chicago Illinois USA
| | - Guillermo Ruiz‐Irastorza
- Autoimmune Diseases Research UnitDepartment of Internal MedicineBioCruces Health Research InstituteHospital Universitario CrucesUniversity of the Basque Country Barakaldo Spain
| | - Gabriel Baron
- Centre d'Epidémiologie CliniqueAP‐HPHôpitalHôtel‐DieuUniversité Paris Descartes‐Sorbonne Paris Cité Paris France
| | - Eric Hachulla
- Claude Huriez HospitalInternal Medicine DepartmentCentre de Référence Maladies Auto‐immunes et Systémiques raresUniversité de Lille Lille France
| | - Nancy Agmon‐Levin
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Yehuda Shoenfeld
- Sheba Medical CenterZabludowicz Center for Autoimmune Diseases Tel‐Hashomer Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Jill Buyon
- Division of RheumatologyDepartment of MedicineNew York University School of Medicine New York New York USA
| | - Christophe Deligny
- Internal Medicine DepartmentPierre‐Zobda‐Quitman Hospital Martinique France
| | - Ricard Cervera
- Department of Autoimmune DiseasesHospital Clínic de Barcelona Barcelona Spain
| | | | - Holy Bezanahary
- Internal Medicine DepartmentDupuytren Hospital Limoges France
| | - Gaëlle Leroux
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Nathalie Morel
- Internal Medicine DepartmentCentre de Référence Maladies Auto‐Immunes et Systémiques RaresAP‐HPCochin Hospital Paris France
- Université Paris Descartes‐Sorbonne Paris Cité Paris France
- Center for Epidemiology and StatisticsINSERM U 1153Sorbonne Paris Cité (CRESS) Paris France
| | | | | | - Lionel Galicier
- Clinical Immunology DepartmentAP‐HPSt Louis Hospital Paris France
| | - Ronald Van Vollenhoven
- Department of MedicineUnit for Clinical Research TherapyInflammatory DiseasesKarolinska University Hospital Stockholm Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology UnitSpedali Civili and Department of Clinical and Experimental ScienceUniversity of Brescia Brescia Italy
| | - Hanh Nguyen
- Centre for RheumatologyUniversity College London London UK
| | | | - Noel Zahr
- Pharmacology DepartmentAP‐HPHopital Pitié‐Salpêtrière Paris France
| | - Jacques Pouchot
- Internal Medicine DepartmentEuropean Georges Pompidou Hospital Paris France
| | - Jean‐Charles Piette
- Internal Medicine DepartmentAP‐HPPitié‐Salpêtrière HospitalUniversité Pierre et Marie Curie Paris France
| | - Michelle Petri
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - David Isenberg
- Centre for RheumatologyUniversity College London London UK
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Costedoat-Chalumeau N, Houssiau F, Izmirly P, Le Guern V, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard JF, Pineau C, Galicier L, Van Vollenhoven R, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette JC, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires. Clin Pharmacol Ther 2017; 103:1074-1082. [PMID: 28925027 DOI: 10.1002/cpt.885] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023]
Abstract
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Frédéric Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université catholique de Louvain, Brussels, Belgium
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | - Meenakshi Jolly
- Rush University Medical Center, Rush Lupus Clinic, Chicago, Illinois, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Gabriel Baron
- AP-HP, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Eric Hachulla
- Claude Huriez Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques rares, Université de Lille, Lille, France
| | - Nancy Agmon-Levin
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Christophe Deligny
- Pierre-Zobda-Quitman Hospital, Internal Medicine Department, Martinique, France
| | - Ricard Cervera
- Hospital Clínic de Barcelona, Department of Autoimmune Diseases, Barcelona, Spain
| | - Estibaliz Lazaro
- Haut Lévêque Hospital, Internal Medicine Department, Pessac, France
| | - Holy Bezanahary
- Dupuytren Hospital, Internal Medicine Department, Limoges, France
| | - Gaëlle Leroux
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | | | - Lionel Galicier
- AP-HP, St Louis Hospital, Clinical Immunology Department, Paris, France
| | - Ronald Van Vollenhoven
- Karolinska University Hospital, Department of Medicine, Unit for Clinical Research Therapy, Inflammatory Diseases, Stockholm, Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Hanh Nguyen
- University College London, Centre for Rheumatology, London, UK
| | | | - Noel Zahr
- AP-HP, Hopital Pitié-Salpêtrière, Pharmacology Department, Paris, France
| | - Jacques Pouchot
- European Georges Pompidou Hospital, Internal Medicine Department, Paris, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Isenberg
- University College London, Centre for Rheumatology, London, UK
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Williams EM, Egede L, Faith T, Oates J. Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring. Am J Med Sci 2017; 353:580-592. [PMID: 28641721 PMCID: PMC6249683 DOI: 10.1016/j.amjms.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - James Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Mendel A, Chow S. Impact of health portal enrolment with email reminders at an academic rheumatology clinic. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu214811.w5926. [PMID: 28321302 PMCID: PMC5348589 DOI: 10.1136/bmjquality.u214811.w5926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Indexed: 11/12/2022]
Abstract
Missed appointments reduce the quality, safety and efficiency of healthcare delivery. ‘No-Shows’ (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%). Patients were encouraged to enroll in the hospital's electronic patient portal, MyChart, and email reminders were implemented at one clinic for portal users. A detailed follow-up card was also given to patients. Process measures included portal enrolment, email reminder receipt, and call volumes. Outcome measures were NS and patient and staff satisfaction. During the intervention, 120/274 (44%) surveyed patients had MyChart accounts. Of these, 73 (61%) received the e-mail reminder and 72 (99%) found the e-mail helpful. Twenty-two patients knew about their appointment from the e-mail reminder alone. Improvement in attendance was seen after 3.5 months, but it was not sustained thereafter. Prior to this intervention there was no appointment reminder system at this clinic, and the email reminder demonstrated high patient satisfaction. Low portal enrolment, technical difficulties, and the inability of the intervention to reach new patients were possible reasons why the intervention was unsuccessful at reducing NS.
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Affiliation(s)
- Arielle Mendel
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
| | - Shirley Chow
- Division of rheumatology, Sunnybrook Health Sciences Center, Canada
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8
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Williams EM, Lorig K, Glover S, Kamen D, Back S, Merchant A, Zhang J, Oates JC. Intervention to Improve Quality of life for African-AmericaN lupus patients (IQAN): study protocol for a randomized controlled trial of a unique a la carte intervention approach to self-management of lupus in African Americans. BMC Health Serv Res 2016; 16:339. [PMID: 27485509 PMCID: PMC4971708 DOI: 10.1186/s12913-016-1580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina. METHODS/DESIGN In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered 'a-la-carte' approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a 'set menu' approach and usual care. This unique 'a-la-carte' self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1-4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A 'set menu' control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines). DISCUSSION Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no "gold standard" self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions. TRIAL REGISTRATION NCT01837875 ; April 18, 2013.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Department of Medicine, Division of Rheumatology, Core Investigator, MUSC Center for Health Disparities Research, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC835, Charleston, SC 29425 USA
| | - Kate Lorig
- Department of Medicine, Stanford University, 291 Campus Drive, Room LK3C02, Stanford, CA 94305 USA
| | - Saundra Glover
- Institute of Health Disparities, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210 USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 912, Charleston, SC 29425 USA
| | - Sudie Back
- Department of Psychiatry/Behavioral Science, Division of Clinical Neuroscience, Medical University of South Carolina, 67 President Street, Charleston, SC 29425 USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Room 211, Columbia, SC 29208 USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - James C. Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, 114 Doughty Street, Room 425-C, Charleston, SC 29414 USA
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Uribe AG, Ho KT, Agee B, McGwin G, Fessler BJ, Bastian HM, Reveille JD, Alarcón GS. Relationship between adherence to study and clinic visits in systemic lupus erythematosus patients: data from the LUMINA cohort. Lupus 2016; 13:561-8. [PMID: 15462484 DOI: 10.1191/0961203304lu1061oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to examine the relationship between nonadherence with study visits and with regularly scheduled clinic visits after adjusting for other patient and disease characteristics. One hundred and forty-one LUMINA patients with appointment data in the institutions’ computerized systems (UAB and UTH) were studied. ‘No shows’ were assessed as the percentage of appointments not attended for either rheumatology, other clinics and LUMINA visits (from zero to 100%). Eighty-nine percent of the patients were women, 40% were Caucasians, 55% African-Americans and 5% Hispanics. ‘No shows’ to rheumatology were associated with non-Caucasian ethnicity, younger age, single marital status, lack of home ownership, ‘no shows’ to other clinics and to the LUMINA study, greater disease activity and to some disease manifestations (serositis, renal involvement, positive anti-dsDNA antibodies). In multivariable analyses, features predictive of rheumatology ‘no shows’ were lack of home ownership, ‘no shows’ to LUMINA study visits, renal involvement and serosal manifestations. Nonadherence with study visits and with regularly scheduled care at rheumatology clinics were associated. Other factors predictive of nonadherence to recommended care were lack of home ownership (a measurement of low socioeconomic status) and the presence of disease manifestations (i.e., renal or serosal involvement). These data should be considered when caring for patients with SLE.
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Affiliation(s)
- A G Uribe
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, AL 35294, USA
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Sullivan K, Waugh D. Toward the Development of the Cerebrovascular Attitudes and Beliefs Scale (CABS): A Measure of Stroke-Related Health Beliefs. Top Stroke Rehabil 2014; 14:41-51. [PMID: 17573311 DOI: 10.1310/tsr1403-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a measure of stroke-related health beliefs, derived from the Health Belief Model (HBM) and a measure of stroke risk factor behavior change. METHOD The Cerebrovascular Attitudes and Beliefs Scale (CABS) was devised to assess survivors' beliefs and attitudes about their susceptibility to future stroke, the perceived seriousness of stroke, and the likely benefits and barriers associated with undertaking behaviors to reduce stroke risk. A second measure, the Stroke Behavior Change Inventory (SBCI), as well as a version developed for relatives (SBCI-R), was devised to assess participants' pre- and poststroke risk factor behavior. RESULTS Forty-two stroke/transient ischemic attack (TIA) survivors accurately described behavior changes they had undertaken poststroke, when compared to relatives' reports of such behavior (n = 7). Most survivors changed at least some behaviors poststroke to reduce their stroke risk. Further analysis to determine the role of health beliefs in predicting behavior change poststroke was undertaken, focusing on those behaviors that were changed in a large enough proportion of the sample. The beliefs most predictive of behavior change related to perceived stroke seriousness and severity, but the combination of beliefs from the HBM was not predictive of behavior change. CONCLUSION After stroke or TIA, most survivors change their behavior in ways that would contribute to stroke risk reduction. Such effects can be demonstrated using survivor self-report or relatives' report of survivors' behaviors. Using the CABS, partial support for health belief variables as predictors of such behavior change was also identified, suggesting that further investigation of these variables is warranted.
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Affiliation(s)
- Karen Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
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Williams EM, Bruner L, Penfield M, Kamen D, Oates JC. Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus. RHEUMATOLOGY (SUNNYVALE, CALIF.) 2014; 2014:005. [PMID: 26618072 PMCID: PMC4662575 DOI: 10.4172/2161-1149.s4-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group. METHODS Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures. RESULTS When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital. CONCLUSION Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina; Columbia, SC, USA
| | - Larisa Bruner
- Office of Public Health Practice, University of South Carolina; Columbia, SC, USA
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina; Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
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Pepper GV, Nettle D. Perceived Extrinsic Mortality Risk and Reported Effort in Looking after Health. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2014; 25:378-92. [DOI: 10.1007/s12110-014-9204-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sorita A, Funakoshi T, Kashan G, Young ER, Park J. Impact of Prescription Patterns on Compliance With Follow-Up Visits at an Urban Teaching Primary Care Continuity Clinic. J Prim Care Community Health 2014; 5:188-93. [PMID: 24603776 DOI: 10.1177/2150131914523294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although limiting prescription refills is considered as a strategy to increase compliance with the treatment regimen and follow-up, no literature exists to support its effectiveness. We sought to investigate whether decreasing the number of prescription refills affects no-show rate at an urban teaching primary care continuity clinic in New York. METHODS Eight teaching attending physicians and 19 residents implemented a "new prescribing strategy" from February 9 to 22, 2012, which limited the number of refills only to cover until the next intended clinic visit. All adult patient visits were included if follow-up visits were requested to be scheduled within 3 months and prescriptions were given through an electronic prescription system. No-show rates for the first follow-up visits up to 120 days from the initial visits during the interventional period were compared with those during the baseline period (December 15-28, 2011). RESULTS Two hundred twenty-one patients in the baseline period and 278 in the interventional period were included in the analysis. Median total supply of prescription was 6 and 3 months, respectively (P < .001). The no-show rates were not significantly different between the 2 periods (19.0% [42/221] vs 16.6% [46/278], P = .5). In multivariate regression analysis, the no-show rate did not change significantly during the interventional period compared with the baseline period (odds ratio [OR] 1.0; 95% confidence interval, 0.6-1.5; P = .8). Younger age (OR 1.03 per year, P = .008), male gender (OR 2.0, P = .003), Medicaid or Medicare insurance (OR 3.7, P = .01; OR 4.2, P = .02), and diagnosis of diabetes (OR 1.8, P = .04) or asthma (OR 2.0, P = .03) were associated with higher no-show rates. CONCLUSIONS Reducing the number of refills did not significantly affect no-show rates in the immediate follow-up. Alternative strategies should be considered to minimize no-shows.
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Affiliation(s)
- Atsushi Sorita
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tomohiro Funakoshi
- Department of Medicine, Albert Einstein College of Medicine-Beth Israel Medical Center, New York, NY, USA
| | - Glenn Kashan
- Department of Medicine, Albert Einstein College of Medicine-Beth Israel Medical Center, New York, NY, USA
| | - Edwin R Young
- University Medical Practice Associates, New York, NY, USA
| | - Jayson Park
- Department of Medicine, Albert Einstein College of Medicine-Beth Israel Medical Center, New York, NY, USA
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Williams EM, Ortiz K, Browne T. Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus. Int J Chronic Dis 2014; 2014:361792. [PMID: 26464854 PMCID: PMC4590929 DOI: 10.1155/2014/361792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Kasim Ortiz
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC 29208, USA
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Gurol‐Urganci I, de Jongh T, Vodopivec‐Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2013; 2013:CD007458. [PMID: 24310741 PMCID: PMC6485985 DOI: 10.1002/14651858.cd007458.pub3] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This review is an update of the original Cochrane review published in July 2012. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments. Patient reminders may help reduce missed appointments. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could provide an important, inexpensive delivery medium for reminders for healthcare appointments. OBJECTIVES To update our review assessing the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of costs; health outcomes; patients' and healthcare providers' evaluation of the intervention and perceptions of safety; and possible harms and adverse effects associated with the intervention. SEARCH METHODS Original searches were run in June 2009. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 8), MEDLINE (OvidSP) (January 1993 to August 2012), EMBASE (OvidSP) (January 1993 to August 2012), PsycINFO (OvidSP) (January 1993 to August 2012) and CINAHL (EbscoHOST) (January 1993 to August 2012). We also reviewed grey literature (including trial registers) and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third author. Two authors assessed the risk of bias of the included studies. As the intervention characteristics and outcome measures were similar across included studies, we conducted a meta-analysis to estimate an overall effect size. MAIN RESULTS We included eight randomised controlled trials involving 6615 participants. Four of these studies were newly identified during this update.We found moderate quality evidence from seven studies (5841 participants) that mobile text message reminders improved the rate of attendance at healthcare appointments compared to no reminders (risk ratio (RR) 1.14 (95% confidence interval (CI) 1.03 to 1.26)). There was also moderate quality evidence from three studies (2509 participants) that mobile text message reminders had a similar impact to phone call reminders (RR 0.99 (95% CI 0.95 to 1.02). Low quality evidence from one study (291 participants) suggests that mobile text message reminders combined with postal reminders improved the rate of attendance at healthcare appointments compared to postal reminders alone (RR 1.10 (95% CI 1.02 to 1.19)). Overall, the attendance to appointment rates were 67.8% for the no reminders group, 78.6% for the mobile phone messaging reminders group and 80.3% for the phone call reminders group. One study reported generally that there were no adverse effects during the study period; none of the studies reported in detail on specific adverse events such as loss of privacy, data misinterpretation, or message delivery failure. Two studies reported that the costs per text message per attendance were respectively 55% and 65% lower than costs per phone call reminder. The studies included in the review did not report on health outcomes or people's perceptions of safety related to receiving reminders by text message. AUTHORS' CONCLUSIONS Low to moderate quality evidence included in this review shows that mobile phone text messaging reminders increase attendance at healthcare appointments compared to no reminders, or postal reminders.Text messaging reminders were similar to telephone reminders in terms of their effect on attendance rates, and cost less than telephone reminders. However, the included studies were heterogeneous and the quality of the evidence therein is low to moderate. Further, there is a lack of information about health effects, adverse effects and harms, user evaluation of the intervention and user perceptions of its safety. The current evidence therefore still remains insufficient to conclusively inform policy decisions.There is a need for more high-quality randomised trials of mobile phone messaging reminders, that measure not only patients' attendance rates, but also focus on the cost-effectiveness of these interventions. Health outcomes, patients' and healthcare providers' evaluation and perceptions of the safety of the interventions, potential harms, and adverse effects of mobile phone messaging reminders should be assessed. Studies should report message content and timing in relation to the appointment.
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Affiliation(s)
- Ipek Gurol‐Urganci
- London School of Hygiene and Tropical MedicineHealth Services Research and PolicyLondonUK
| | | | - Vlasta Vodopivec‐Jamsek
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicinePoljanski nasip 58LjubljanaSlovenia1000
| | - Rifat Atun
- Imperial College LondonImperial College Business SchoolSouth Kensington CampusLondonUKSW7 2AZ
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Ledford CJW, Ledford CC, Childress MA. Extending Physician ReACH: influencing patient activation and behavior through multichannel physician communication. PATIENT EDUCATION AND COUNSELING 2013; 91:72-78. [PMID: 23219484 DOI: 10.1016/j.pec.2012.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/19/2012] [Accepted: 11/11/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Despite evidence-based recommendations, physical activity as a self-management technique is underutilized. Many physical activity interventions require significant resources, ranging from repeated phone follow-up with nursing staff to intensive sessions with cooperating physical therapists. This intervention, Extending Physician ReACH (Relationship And Communication in Healthcare), examined physician to patient communication tactics for promoting walking exercise to patients with type 2 diabetes, using limited clinic time and financial resources. METHODS This was a single-site, six-month prospective intervention, which implemented theoretically driven, evidenced-based information factor strategies. Of the 128 volunteers who participated in the initial clinic visit, 67 patients with type 2 diabetes completed the six-month intervention. RESULTS Significant intervention effects were detected risk perception, social norms, and patient activation. CONCLUSIONS This study was designed to identify information factors that could affect physician success in motivating patients with type 2 diabetes to enact the ADA physical activity recommendations. PRACTICE IMPLICATIONS The success of this intervention models a strategy through which clinicians can reach beyond "one-shot" persuasion without placing onerous time and resource demands on physicians.
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Affiliation(s)
- Christy J W Ledford
- Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, USA.
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Ledford CJW, Ledford CC, Childress MA. Exploring patient activation in the clinic: measurement from three perspectives. HEALTH EDUCATION & BEHAVIOR 2012; 40:339-45. [PMID: 22984210 DOI: 10.1177/1090198112455173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives. DATA SOURCE/STUDY SETTING Multimethod observation in 2010 within a family medicine clinic. STUDY DESIGN Part of an intervention with 130 patients with type 2 diabetes, this observational study further looked at PA in 19 physician-patient dyads. Data Collection. Observations occurred in a teaching hospital, which served as recruiting and study site. PRINCIPAL FINDINGS PA correlated with knowledge, self-efficacy, promotion orientation, and exercise intent. Patient-reported PA did not correlate with researcher-observed or physician-reported PA behavior. Researcher-observed PA correlated with physician-observation items. CONCLUSIONS Results provide evidence for measuring different perspectives in studies of PA. When patients report they are activated in self-management, behavior does not indicate they are active in clinical communication, a critical component of collaborative decision making.
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Affiliation(s)
- Christy J W Ledford
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Multiple interacting factors corresponding to repetitive use of complementary and alternative medicine. Complement Ther Med 2012; 20:190-8. [DOI: 10.1016/j.ctim.2012.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 12/04/2011] [Accepted: 01/13/2012] [Indexed: 11/18/2022] Open
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Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2012:CD007458. [PMID: 22786507 DOI: 10.1002/14651858.cd007458.pub2] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Missed appointments are a major cause of inefficiency in healthcare delivery, with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments, and reminders may help alleviate this problem. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications such as Short Message Service (SMS) and Multimedia Message Service (MMS) could provide an important, inexpensive delivery medium for reminders for healthcare appointments. OBJECTIVES To assess the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of patients' and healthcare providers' evaluation of the intervention; costs; and possible risks and harms associated with the intervention. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009). We also reviewed grey literature (including trial registers) and reference lists of articles. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We included studies assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third author. Primary outcomes of interest were rate of attendance at healthcare appointments. We also considered health outcomes as a result of the intervention, patients' and providers' evaluation of the intervention, perceptions of safety, costs, and potential harms or adverse effects. As the intervention characteristics and outcome measures were similar across included studies, we conducted a meta-analysis to estimate an overall effect size. MAIN RESULTS We included four randomised controlled trials involving 3547 participants. Three studies with moderate quality evidence showed that mobile text message reminders improved the rate of attendance at healthcare appointments compared to no reminders (risk ratio (RR) 1.10 (95% confidence interval (CI) 1.03 to 1.17)). One low quality study reported that mobile text message reminders with postal reminders, compared to postal reminders, improved rate of attendance at healthcare appointments (RR 1.10 (95% CI 1.02 to 1.19)). However, two studies with moderate quality of evidence showed that mobile phone text message reminders and phone call reminders had a similar impact on healthcare attendance (RR 0.99 (95% CI 0.95 to 1.03). The costs per attendance of mobile phone text message reminders were shown to be lower compared to phone call reminders. None of the included studies reported outcomes related to harms or adverse effects of the intervention, nor health outcomes or user perception of safety related to the intervention. AUTHORS' CONCLUSIONS There is moderate quality evidence that mobile phone text message reminders are more effective than no reminders, and low quality evidence that text message reminders with postal reminders are more effective than postal reminders alone. Further, according to the moderate quality evidence we found, mobile phone text message reminders are as effective as phone call reminders. Overall, there is limited evidence on the effects of mobile phone text message reminders for appointment attendance, and further high-quality research is required to draw more robust conclusions.
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Affiliation(s)
- Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London,UK.
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Akhter K, Dockray S, Simmons D. Exploring factors influencing non-attendance at the diabetes clinic and service improvement strategies from patients' perspectives. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rosen MI, Ryan C, Rigsby M. Motivational Enhancement and MEMS Review to Improve Medication Adherence. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.19.4.183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractElectronic caps (most often Microelectronic Monitoring Systems; MEMS) that record date and time of bottle opening have been widely used to describe medication adherence. This paper expands upon descriptions of adherence-focused therapy built around review of MEMS data with the patient, adding the application of Motivational Enhancement Therapy (MET) principles. MEMS Feedback Therapy involves (a) motivational interviewing to complement the skill-building aspects of MEMS review; (b) detailed MEMS review with discussion of patterns of missed doses, and thoughts, feelings and habits accompanying missed doses; and (c) medication-taking routines to suggest after MET and MEMS review have prepared the patient to follow advice.
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Bhatt K, Reid ME, Lewis NA, Asnani MR. Knowledge and health beliefs of Jamaican adolescents with sickle cell disease. Pediatr Blood Cancer 2011; 57:1044-8. [PMID: 21416581 DOI: 10.1002/pbc.23091] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/25/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The adolescent stage of life is generally perceived to be a challenging period, which may be magnified when a chronic illness such as sickle cell disease (SCD) is present. In this study, we sought to determine the knowledge and health beliefs of Jamaican adolescents with SCD as these factors may impact their self-management skills. PROCEDURE An interviewer-administered questionnaire was completed by 117 patients (93 SS:24 SC; 48 males:69 females) between the ages of 15 and 19 years at their routine health maintenance visit to the Sickle Cell Unit, UWI. A maximum total score of 17 could be attained for knowledge. The health belief questions were assessed using a 5-point Likert scale and correlations between knowledge and health beliefs were done. Multiple regression models were created to study the predictors of knowledge and health belief scores. The study was granted ethical approval by UWI/UHWI Ethics Committee. RESULTS The mean knowledge score was 64% (range 88-29%). No differences were found in the mean knowledge scores between genotypes and educational attainment but females appeared to score higher than males (P-value <0.05). Most adolescents perceived SCD to be a severe illness and thought it is important for people to know their SCD status. However, almost 30% thought their partners would be hard to convince for testing. Higher knowledge scores predicted positive health beliefs in the adolescent. CONCLUSIONS Whereas most adolescents were knowledgeable about how the disease was inherited and tested for, further education especially about disease and pregnancy complications is needed.
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Affiliation(s)
- Komal Bhatt
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona Campus, Kingston, Jamaica
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Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at scheduled healthcare appointments. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007458] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Siminoff LA, Hausmann LRM, Ibrahim S. Barriers to obtaining diagnostic testing for coronary artery disease among veterans. Am J Public Health 2008; 98:2207-13. [PMID: 18381987 DOI: 10.2105/ajph.2007.123224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to identify factors associated with appointment nonattendance for diagnostic testing of coronary artery disease among veterans. For patients with possible heart disease, appointment nonattendance may seriously compromise short- and long-term outcomes. Understanding factors associated with nonattendance may help improve care while reducing inefficiency in service delivery. METHODS We surveyed patients who attended (n = 240) or did not attend (n = 139) a scheduled cardiac appointment at a midwestern Veterans Administration medical center. Multivariable regression models were used to assess factors associated with nonattendance. RESULTS Younger age, lower income, unemployment, and longer wait times for appointments were predictive of nonattendance. Nonattenders reported fewer cardiac symptoms and were more likely to attribute their symptoms to something other than heart disease. Nonattendance was also associated with a coping style characterized by avoidance of aversive information. Logistical issues, fear of diagnostic procedures, disbelief that one had heart disease, and medical mistrust were some of the reasons given for missed appointments. CONCLUSIONS Appointment nonattendance among veterans scheduled for cardiology evaluation was associated with several important cognitive factors. These factors should be considered when one is designing clinical systems to reduce patient nonattendance.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Häussler B, Fischer GC, Meyer S, Sturm D. Risk assessment in diabetes management: how do general practitioners estimate risks due to diabetes? Qual Saf Health Care 2007; 16:208-12. [PMID: 17545348 PMCID: PMC2464989 DOI: 10.1136/qshc.2006.019539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the ability of general practitioners (GPs) in Germany to estimate the risk of patients with diabetes developing complications. METHODS An interview study using a structured questionnaire to estimate risks of four case vignettes having diabetes-specific complications within the next 10 years, risk reduction and life expectancy potential. A representative random sample of 584 GPs has been drawn, of which 150 could be interviewed. We compared GPs' estimates among each other (intraclass correlation coefficient (ICC) and Cohen's (multirater-) kappa) and with risks for long-term complications generated by the multifactor disease model "Mellibase", which is a knowledge-based support system for medical decision management. RESULTS The risk estimates by GPs varied widely (ICC 0.21 95% CI (0.13 to 0.36)). The average level of potential risk reduction was between 47% and 70%. Compared with Mellibase values, on average, the GPs overestimated the risk threefold. Mean estimates of potential prolongation of life expectancy were close to 10 years for each patient, whereas the Mellibase calculations ranged from 3 to 10 years. CONCLUSIONS Overestimation could lead to unnecessary care and waste of resources.
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Fernández M, Alarcón GS, Calvo-Alén J, Andrade R, McGwin G, Vilá LM, Reveille JD. A multiethnic, multicenter cohort of patients with systemic lupus erythematosus (SLE) as a model for the study of ethnic disparities in SLE. ACTA ACUST UNITED AC 2007; 57:576-84. [PMID: 17471524 DOI: 10.1002/art.22672] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine health disparities as a function of ethnicity using data from LUpus in MInorities, NAture versus nurture (LUMINA), a longitudinal study of patients with systemic lupus erythematosus (SLE); to build an explanatory model of how ethnic disparities occur in this setting; and to suggest appropriate interventions. METHODS LUMINA patients (meeting American College of Rheumatology criteria for SLE) ages >/=16 years of African American, Hispanic (from Texas), Hispanic (from Puerto Rico), or Caucasian ethnicity were studied. In addition to examining the basic features of the cohort, we examined, by univariable and multivariable analyses, the factors associated with disease activity, damage accrual, lupus nephritis, and mortality. An empiric model based on the data presented (and the literature reviewed) was derived to explain the disparities observed. RESULTS There were substantial differences in the socioeconomic/demographic, clinical, and genetic features among patients from the different ethnic groups, with Texan Hispanic and African American patients exhibiting overall a lower socioeconomic status, different genetic associations, more serious disease at a younger age, and worse intermediate and final outcomes than the Caucasian and Puerto Rican Hispanic patients. A model of disease outcome as a function of the disparities observed was created. CONCLUSION Ethnic disparities occur in SLE. Environmental, socioeconomic/demographic, psychosocial, genetic, and clinical factors play an important role as determinants of the ethnic differences observed. Measures aimed at eliminating these disparities are suggested while further research is conducted to elucidate the basis of these disparities and their changes at the societal level and to eliminate the gap between the rich and the poor.
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Costedoat-Chalumeau N, Amoura Z, Hulot JS, Aymard G, Leroux G, Marra D, Lechat P, Piette JC. Very low blood hydroxychloroquine concentration as an objective marker of poor adherence to treatment of systemic lupus erythematosus. Ann Rheum Dis 2007; 66:821-4. [PMID: 17324970 PMCID: PMC1954674 DOI: 10.1136/ard.2006.067835] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Poor adherence to treatment is difficult to diagnose accurately. Hydroxychloroquine (HCQ) has a long elimination half-life and its concentration in whole blood can be measured easily. OBJECTIVE To evaluate the utility of a very low blood HCQ concentration as a marker of poor compliance in patients with systemic lupus erythematosus (SLE). METHODS HCQ concentrations were determined on a blinded basis in 203 unselected patients with SLE. At the end of the study, the patients were informed of the results and retrospectively interviewed about their adherence to treatment. RESULTS 14 (7%) patients said that they had stopped taking HCQ (n = 8) or had taken it no more than once or twice a week (n = 6). Their mean (SD) HCQ concentration was 26 (46) ng/ml. range (0-129 ng/ml) By contrast, the other patients had a mean HCQ concentration of 1079 ng/ml range (205-2629 ng/ml). The principal barriers to adherence were related to HCQ treatment characteristics. Adherence subsequently improved in 10 of the 12 patients whose blood HCQ concentrations were remeasured. CONCLUSIONS Very low whole-blood HCQ concentrations are an objective marker of prolonged poor compliance in patients with SLE. Regular drug assays might help doctors in detect non-compliance and serve as a basis for counselling and supporting these patients.
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Service de Médecine Interne, Centre de Référence National pour le Lupus Systémique et le Syndrome des Antiphospholipides, CHU Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
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Costedoat-Chalumeau N, Amoura Z, Hulot JS, Lechat P, Piette JC. Faut-il doser l'hydroxychloroquine chez les patients lupiques ? Rev Med Interne 2006; 27:655-7. [PMID: 16766090 DOI: 10.1016/j.revmed.2006.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
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Dassow P. Setting educational priorities for women's preventive health: measuring beliefs about screening across disease states. J Womens Health (Larchmt) 2005; 14:324-30. [PMID: 15916506 DOI: 10.1089/jwh.2005.14.324] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To measure women's beliefs about disease screening in a consistent manner across disease states to identify priority areas for educational and motivational interventions. METHODS A cross-sectional, mailed survey of female patients, age > or =52, was conducted through a primary care practice-based research network. The Risk Behavior Diagnosis Scale, a validated 12-item instrument, was used to measure beliefs about disease severity, disease susceptibility, ability to obtain screening (self-efficacy), and response efficacy. These beliefs were measured for colon cancer, breast cancer, and osteoporosis. RESULTS One hundred twenty-eight surveys were returned from 425 women invited to participate (RR 30%). Significant differences in beliefs were noted across disease states for disease severity (F = 21.67, p < 0.001), disease susceptibility (F = 14.68, p < 0.001), self-efficacy (F = 42.85, p < 0.001), and response efficacy (F = 55.49, p < 0.001). Analysis by logistic regression indicated four beliefs to be associated with adherence to screening recommendations: colon cancer severity, colon cancer susceptibility, breast cancer screening self-efficacy, and osteoporosis screening self-efficacy (all p < 0.05). CONCLUSIONS Women hold varied beliefs about disease screening that are specific for different disease states. For the three diseases studied, priority areas for educational and motivational interventions should include beliefs about colon cancer severity, colon cancer susceptibility, breast cancer screening self-efficacy, and osteoporosis screening self-efficacy.
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Affiliation(s)
- Paul Dassow
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky, USA.
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Al-Hassan MA, Omran SM. The effects of health beliefs on health care-seeking decisions of Jordanian patients with myocardial infarction symptoms. Int J Nurs Pract 2005; 11:13-20. [PMID: 15610340 DOI: 10.1111/j.1440-172x.2005.00497.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The main purpose of this study was to examine the significance of health beliefs, perceived seriousness of harmful consequences and perceived barriers in explaining health care-seeking decisions of patients experiencing myocardial infarction symptoms. A structured interview guide developed by the researchers that included health beliefs, patient delay, sociodemographics and clinical characteristics of the patients was introduced to 79 myocardial infarction patients on the third day of hospitalization. Thirty-eight per cent of the patients delayed the health care-seeking decision > 1 h. Gender, age and perceived seriousness of the consequences significantly distinguished between delayers and non-delayers, correctly classifying 77% of the cases. Delayers were more likely to be female and young adults, and those who perceived increased negative consequences to myocardial infarction. Educational and counselling programmes for individuals at increased risk for myocardial infarction should consider the negative influence of perceived seriousness of consequences on the decision-making process of the patients. Also, interventions to change women's perception of their vulnerability to this illness are needed.
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Affiliation(s)
- Musa A Al-Hassan
- Adult Health Nursing Department, School of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan.
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Abstract
PURPOSE Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments. METHODS Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings. RESULTS Participants identified 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants' lack of understanding of the scheduling system. CONCLUSIONS The results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants' perspectives of personal respect.
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Affiliation(s)
- Naomi L Lacy
- University of Nebraska Medical Center Department of Family Medicine, 983075 Nebraska Medical Center, Omaha, NE 68198-3075, USA.
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Uribe AG, Alarcón GS, Sanchez ML, McGwin G, Sandoval R, Fessler BJ, Bastian HM, Friedman AW, Baethge BA, Reveille JD. Systemic lupus erythematosus in three ethnic groups. XVIII. Factors predictive of poor compliance with study visits. ACTA ACUST UNITED AC 2004; 51:258-63. [PMID: 15077269 DOI: 10.1002/art.20226] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the baseline factors predictive of poor compliance with study visits in a longitudinal multiethnic lupus cohort study. METHODS Patients with systemic lupus erythematosus (n = 344) representing a total of 2,069 potential study visits were studied. Of the participants, 24.4% were Hispanic, 43.3% African American, and 32.3% Caucasian. Noncompliance was defined as missing 2 or more study visits. For the purpose of these analyses, visits completed only by review of medical records were considered missing. Baseline socioeconomic-demographic, clinical, and psychosocial features between compliant and noncompliant patients were compared. Variables with P < 0.10 were then entered into a multivariable logistic regression analysis with compliance being the dependent variable. RESULTS There were 178 compliant and 166 noncompliant patients. Noncompliant patients were more likely to be young, unmarried, of African American ethnicity, live closer to the medical centers, and have longer disease duration and greater disease activity as assessed by the physician than the compliant patients. In the multivariable model, longer disease duration (P = 0.010), higher level of disease activity (P = 0.009), and shorter distance to travel to study visits (P = 0.046) were predictors of noncompliance; their odds ratios and confidence intervals were below 1. CONCLUSIONS We have identified baseline patient characteristics that may predict noncompliance with study visits (disease duration, disease activity, and distance to the medical center). This information will serve as the basis for developing interventions to curtail noncompliance. Our data may have applicability in other lupus cohort studies.
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Karter AJ, Parker MM, Moffet HH, Ahmed AT, Ferrara A, Liu JY, Selby JV. Missed Appointments and Poor Glycemic Control. Med Care 2004; 42:110-5. [PMID: 14734947 DOI: 10.1097/01.mlr.0000109023.64650.73] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE When patients miss scheduled medical appointments, continuity and effectiveness of healthcare delivery is reduced, appropriate monitoring of health status lapses, and the cost of health services increases. We evaluated the relationship between missed appointments and glycemic control (glycosylated hemoglobin or HbA1c) in a large, managed care population of diabetic patients. RESEARCH DESIGN AND METHODS Missed appointment rate was related cross-sectionally to glycemic control among 84,040 members of the Kaiser Permanente Northern California Diabetes Registry during 2000. Adjusted least-square mean estimates of HbA1c were derived by level of appointment keeping (none missed, 1-30% missed, and >30% missed appointments for the calendar year) stratified by diabetes therapy. RESULTS Twelve percent of the subjects missed more than 30% of scheduled appointments during 2000. Greater rates of missed appointments were associated with significantly poorer glycemic control after adjusting for demographic factors (age, sex), clinical status, and health care utilization. The adjusted mean HbA1c among members who missed >30% of scheduled appointments was 0.70 to 0.79 points higher (P <0.0001) relative to those attending all appointments. Patients who missed more than 30% of their appointments were less likely to practice daily self-monitoring of blood glucose and to have poor oral medication refill adherence. CONCLUSION Patients who underuse care lack recorded information needed to determine level of risk. Frequently missed appointments were associated with poorer glycemic control and suboptimal diabetes self-management practice, are readily ascertained in clinical settings, and therefore could have clinical utility as a risk-stratifying criterion indicating the need for targeted case management.
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Affiliation(s)
- Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA.
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Murdock A, Rodgers C, Lindsay H, Tham TCK. Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J R Soc Med 2002. [PMID: 12042374 PMCID: PMC1279909 DOI: 10.1258/jrsm.95.6.284] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
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Affiliation(s)
- A Murdock
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast BT16 1RH, Northern Ireland, UK
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Murdock A, Rodgers C, Lindsay H, Tham TCK. Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. J R Soc Med 2002; 95:284-6. [PMID: 12042374 PMCID: PMC1279909 DOI: 10.1177/014107680209500605] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
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Affiliation(s)
- A Murdock
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast BT16 1RH, Northern Ireland, UK
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Cappelli M, Hunter AGW, Stern H, Humphreys L, Van Houten L, O'Rourke K, Viertelhausen S, Perras H, Lagarde AE. Participation rates of Ashkenazi Jews in a colon cancer community-based screening/prevention study. Clin Genet 2002; 61:104-14. [PMID: 11940085 DOI: 10.1034/j.1399-0004.2002.610205.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In a recent colon cancer risk study, genetic assessment and colonoscopy were offered to virtually all of the adult Ashkenazi Jews in an urban community. The present study was designed to examine factors influencing participation and response in the initial study and to suggest strategies for improving participation in future health promotion programs. The study comprised a random sample of three groups of individuals who had been targeted for participation in the previous study: those who had (a) agreed to participate (n = 234); (b) declined participation (n = 179); and (c) failed to respond to a mailed recruitment package (n = 128). All participants completed a brief telephone survey. Key multivariate predictors of both response and participation were individuals' perceptions of the drawbacks of participating in colon cancer screening research and the degree of decisional conflict they experienced. Response was further predicted by the influence of spouses, family history of colon cancer, past knowledge of genetic testing for colon cancer, and education level. Participation was predicted by awareness that the study was supported by the Ashkenazi Jewish community, past experience with genetic testing, individuals' perceptions of the benefits of participating, and whether or not they had children. The degree to which individuals understand the purpose and nature of genetic screening research, along with their levels of decisional conflict and other psychosocial factors, may influence the likelihood of their participation in such research. Results of this study suggest a number of possible strategies for improving participation and response rates in disease prevention and detection studies.
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Affiliation(s)
- M Cappelli
- Psychology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada.
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Loeb SJ, O'Neill J, Gueldner SH. Health motivation: a determinant of older adults' attendance at health promotion programs. J Community Health Nurs 2001; 18:151-65. [PMID: 11560108 DOI: 10.1207/s15327655jchn1803_02] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The primary purpose of conducting this study was to determine if there is a significant relation between health motivation and participation in health promotion programs in a sample of community-dwelling older adults (n = 106). Health motivation was measured using Cox's (1985) Health Self-Determinism Index, and participation in health promotion programs was measured by tallying the self-reported number of programs attended within the past year by each individual. The effects of selected demographic variables on these two variables were also examined. The conceptual framework guiding the study was the Health-Promoting Self-Care System Model (Simmons, 1990). Intrinsically motivated older persons attended fewer programs (p < .01) than those who were more extrinsically motivated. Higher educational level (p < .001) and fewer health problems (p < .01) emerged as significant predictor variables for intrinsic health motivation, and those with less formal education attended more health promotion programs (p < .05).
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Affiliation(s)
- S J Loeb
- School of Nursing, Pennsylvania State University, 307D Health and Human Development East, University Park, PA 16802, USA.
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Hughes HE, Love A, Peabody K, Kardong-Edgren S. Diabetes Education Programs for African American Women: what works? DIABETES EDUCATOR 2001; 27:46-50, 52-4. [PMID: 11912616 DOI: 10.1177/014572170102700106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- H E Hughes
- The Health Studies Department, Texas Woman's University, Denton, Texas, where all authors are currently pursuing doctorates in health education
| | - A Love
- The Health Studies Department, Texas Woman's University, Denton, Texas, where all authors are currently pursuing doctorates in health education
| | - K Peabody
- The Health Studies Department, Texas Woman's University, Denton, Texas, where all authors are currently pursuing doctorates in health education
| | - S Kardong-Edgren
- The Health Studies Department, Texas Woman's University, Denton, Texas, where all authors are currently pursuing doctorates in health education
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Wdowik MJ, Kendall PA, Harris MA, Auld G. Expanded health belief model predicts diabetes self-management in college students. JOURNAL OF NUTRITION EDUCATION 2001; 33:17-23. [PMID: 12031201 DOI: 10.1016/s1499-4046(06)60005-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An instrument was designed to determine relationships between constructs of the Expanded Health Belief Model and to identify characteristics of college students who successfully manage their diabetes. The Diabetes College Scale was developed to measure attitudes and behaviors pertinent to diabetes management and college life. It was tested for content validity, test-retest reliability, and internal consistency. Data were collected from college students using a cross-sectional design. Campus health care providers were invited via electronic mail to administer the survey to students with Type I diabetes. Ninety-eight questionnaires were mailed to interested providers, of which 86 (88%) were returned. Mean scores for attitude constructs, seven behaviors, and two outcomes were measured. Twenty-six experts established content validity. Instrument reliability was evaluated using paired t-tests, Cronbach's alpha, and correlation coefficients. Correlation coefficients and stepwise multiple regression analysis evaluated relationships among variables measured. Intention and emotional response were strong predictors of exercise, whereas health importance and intention were predictive of testing blood sugar. Situational factors and emotional response were substantial barriers to optimal diabetes self-care. College health care providers should address these areas in providing services to this population. Additional testing of the instrument is also recommended.
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Affiliation(s)
- M J Wdowik
- Hartshorn Health Services, Colorado State University, Fort Collins 80523-1571, USA
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