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Li Y, Menon G, Kim B, Clark-Cutaia MN, Long JJ, Metoyer GT, Mohottige D, Strauss AT, Ghildayal N, Quint EE, Wu W, Segev DL, McAdams-DeMarco MA. Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live-Donor and Preemptive Kidney Transplantation. Clin Transplant 2024; 38:e15382. [PMID: 38973768 PMCID: PMC11232925 DOI: 10.1111/ctr.15382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. METHODS We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. RESULTS Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64-0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55-0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63-0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07-1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08-1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15-1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21-1.25]). CONCLUSION Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Maya N Clark-Cutaia
- Rory Meyers College of Nursing, New York University, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jane J Long
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Dinushika Mohottige
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexandra T Strauss
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nidhi Ghildayal
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Wenbo Wu
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Udemgba C, Burbank AJ, Gleeson P, Davis CM, Matsui EC, Mosnaim G. Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00632-9. [PMID: 38878860 DOI: 10.1016/j.jaip.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; University Medicine Associates, University Health, San Antonio, Tex.
| | - Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patrick Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Carla M Davis
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Elizabeth C Matsui
- Center for Health & Environment: Education & Research, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Endeavor Health, Glenview, Ill
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Sadeghi D, Motlagh MK, Darvish A, Daryaafzoon M, Mohamadnejad E, Molaei A, Montazerlotf P, Hosseini RSS. Comparative effect of physical health training and psychological training of the theory of reasoned action (TRA) model on the life quality of patients with diabetes in Tehran, Iran: utilization of message texting. BMC Endocr Disord 2024; 24:69. [PMID: 38745189 PMCID: PMC11095030 DOI: 10.1186/s12902-024-01598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND PURPOSE Providing physical health and mental health training promotion is necessary for a sustainable change in attitude and lifestyle of diabetic patients. The present study was conducted with the aim of comparing the effect of physical health training and psychological training of the theory of reasoned action (TRA) model on the life quality of patients with type 2 diabetes. METHODS This experimental study was conducted in 2022 with two intervention groups and one control group consisting of 129 patients with type 2 diabetes who were referred to Imam Khomeini Hospital in Tehran. Over the course of one month, each individual in intervention group 1 received 15 text messages focusing on physical health, while intervention group 2 received 15 psychological text messages related to the TRA. The control group did not receive any text messages during this period. The data collection tool used was the "Audit of Diabetes-Dependent Quality of Life (ADDQoL)" questionnaire, which was completed by the participants before and after the intervention. The data were analyzed using SPSS version 16 software at a statistical significance level of 0.05. RESULTS In the intervention-1 group, the average life quality score was 8.51 units (P < 0.001), while in the intervention-2 group, it was 19.25 units (P < 0.001) higher than the control group. The psychological training group had a 17.62 units (P < 0.05) lower average fasting blood sugar (FBS) and a 10.74 units (P < 0.001) higher average quality of life compared to the physical training group. CONCLUSION The results of this study showed that the effectiveness of psychological training of the TRA model in improving life quality and reducing FBS in patients with diabetes is greater than physical health training. It is suggested that policy makers and health managers base future plans on physical health promotion training along with TRA model mental health training for the development of education in patients with diabetes. Specialists and healthcare workers can also act to improve personal health characteristics, especially those related to reducing FBS and increasing the quality of life of patients with diabetes, by using training through mobile phone text messages, particularly with psychological content TRA based.
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Affiliation(s)
- Donya Sadeghi
- Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Karbasi Motlagh
- Deputy of Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran.
- Education Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Asieh Darvish
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Daryaafzoon
- Department of Health Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Esmaeil Mohamadnejad
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Molaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Montazerlotf
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Narain KDC, Patel A, Skootsky S, Mangione CM. Exploring the Relationship Between Medication Adherence and Diabetes Disparities among Hispanic Patients in a Large Health System. J Gen Intern Med 2024; 39:1149-1155. [PMID: 37962729 PMCID: PMC11116283 DOI: 10.1007/s11606-023-08502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Sub-optimal HbA1c control is a driver of disparities in diabetes outcomes among Hispanic patients. Differences in medication adherence may underlie racial/ethnic differences in HbA1c level. OBJECTIVE To examine the relationship between medication adherence and disparities in HbA1c level among Hispanic patients, relative to other racial/ethnic groups, obtaining care in the University of California Health System (UC Health). DESIGN This study used clinical, administrative, and prescription dispensing data (January-December 2021) derived from the electronic health records of 5 Academic Medical Centers in UC Health, and linear regression models (LRMs) to conduct a cross-sectional analysis of the association between medication adherence, race/ethnicity, and HbA1c level. Adjusted LRMs were run with and without the measure of medication adherence to assess this relationship. PARTICIPANTS Patients with a UC Health primary care physician (PCP), with ≥ 1 PCP visit within the last 3 years, ages 18-75, reporting Asian, Hispanic, or White race/ethnicity, and who had ≥ 2 encounters with an ICD diagnosis of diabetes or had a prescription for a diabetes medication within the last 2 years, as of 12/31/21 (N = 27, 542; Asian = 6253, Hispanic = 7216, White = 14,073). MAIN MEASURES Our measure of medication adherence was the proportion of days covered (PDC) for diabetes medications in 2021. Our outcome was the most recent HbA1c value. KEY RESULTS In the LRM excluding the PDC, Hispanic ethnicity was positively associated with HbA1c level (β = 0.31, p = < 0.001). In the LRM model including PDC, PDC was negatively associated with HbA1c level (β = - 0.18, p = < 0.001). However, the positive relationship between Hispanic ethnicity and HbA1c level did not change (β = 0.31, p = < 0.001). CONCLUSIONS The findings of this study suggest that the relationship between Hispanic ethnicity, HbA1c level, and factors outside of medication adherence should be explored among primary care patients receiving care in Academic Medical Centers.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Center for Health Advancement, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | - Ayan Patel
- Center for Data-Driven Insights & Innovation, University of California Health, Oakland, CA, USA
| | - Samuel Skootsky
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Population Health, University of California Health, Oakland, CA, USA
| | - Carol M Mangione
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Flórez KR, Hwang NS, Hernandez M, Verdaguer-Johe S, Rahnama Rad K. "No sufro, estoy bien/I am not suffering, so I am doing OK": A mixed method exploration of individual and network-level factors and Type 2 Diabetes Mellitus (T2DM) among Mexican American adults in New York City. PLoS One 2024; 19:e0295499. [PMID: 38241426 PMCID: PMC10798639 DOI: 10.1371/journal.pone.0295499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/24/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION The prevalence of type 2 Diabetes Mellitus (T2DM) is 2-3 times greater among Mexican Americans than non-Latino whites, and Mexican Americans are more likely to develop T2DM at younger ages and experience higher rates of complications. Social networks might play a crucial role in both T2DM etiology and management through social support, access to resources, social engagement, and health behavioral norms. OBJECTIVE To quantitatively identify the social network features associated with glycated hemoglobin (HbA1c) in a community sample of Mexican immigrants residing in New York City, and to explore the extent to which these quantitative findings converge with qualitative narratives of their lived experiences. METHODS This study used a convergent mixed methods design. To collect personal network data, we used EgoWeb, and obtained 1,400 personal network ties from 81 participants. HbA1c readings were collected using dried blood spots and categorized according to the laboratory criteria of the American Diabetes Association. Additional survey data were collected using Qualtrics software. To investigate the significance of the network-level factors after accounting for the socioeconomic and demographic individual-level factors that the literature indicates to be associated with T2DM, we used a multiple regression model on quantitative data sources. For the qualitative portion of the study, we selected a subset of individuals who participated in the quantitative portion, which represented 500 personal network ties from 25 participants. We conducted in-depth interviews guided by the visualization of these ties to explore who was helpful or difficult in managing their health and health behaviors. RESULTS Individual-level indicators associated with lower HbA1c scores were body mass index (β = -0.07, p<0.05), and healthy eating index scores (β = -0.03, p<0.02). The network-level predictor associated with higher HbA1c levels was the percentage of diabetic alters in the network (β = 0.08, p <0.001, with a 25% increase in the percentages associated 2.0 change in HbA1c levels. The qualitative data highlighted that most of the diabetes-related information diffused through the social networks of our participants was related to dietary practices, such as reducing sugar and red meat consumption, eating out less, and reducing portion sizes. Notably, even among those with elevated levels and diabetes-related health complications, HbA1c was not considered a part of the lay descriptions of good health since they were not "suffering." Participants regarded doctors as the ultimate authority in diabetes care, even if they had supportive members in their personal networks. CONCLUSION Our study provides quantitative evidence for the significant role of diabetic network members in the etiology and management of T2DM among Mexican Americans. Our qualitative findings suggest important ley terms for T2DM management and the importance of physicians, which could be included in in future social networks studies seeking to diffuse diabetes-related health information for T2DM prevention and management efforts in this population.
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Affiliation(s)
- Karen R. Flórez
- Environmental, Occupational and Geospatial Sciences Department, City University of New York (CUNY), CUNY Graduate School of Public Health and Heath Policy, New York, NY, United States of America
- Center for Systems and Community Design, City University of New York (CUNY), CUNY Graduate School of Public Health and Heath Policy, New York, NY, United States of America
| | - Neil S. Hwang
- Business and Information Systems Department, City University of New York, Bronx Community College, Bronx, NY, United States of America
| | - Maria Hernandez
- El Instituto: Institute of Latina/o, Caribbean and Latin America Studies of College of Liberal Arts and Science, University of Connecticut, Storrs, CT, United States of America
| | - Sandra Verdaguer-Johe
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Kamiar Rahnama Rad
- Paul H. Chook Department of Information Systems and Statistics, City University of New York, Zicklin School of Business Baruch College, New York, NY, United States of America
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Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
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Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Li Y, Hu H, Zheng Y, Donahoo WT, Guo Y, Xu J, Chen WH, Liu N, Shenkman EA, Bian J, Guo J. Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054036. [PMID: 36901047 PMCID: PMC10001625 DOI: 10.3390/ijerph20054036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND We aimed to investigate the association between contextual-level social determinants of health (SDoH) and the use of novel antidiabetic drugs (ADD), including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a) for patients with type 2 diabetes (T2D), and whether the association varies across racial and ethnic groups. METHODS Using electronic health records from the OneFlorida+ network, we assembled a cohort of T2D patients who initiated a second-line ADD in 2015-2020. A set of 81 contextual-level SDoH documenting social and built environment were spatiotemporally linked to individuals based on their residential histories. We assessed the association between the contextual-level SDoH and initiation of SGTL2i/GLP1a and determined their effects across racial groups, adjusting for clinical factors. RESULTS Of 28,874 individuals, 61% were women, and the mean age was 58 (±15) years. Two contextual-level SDoH factors identified as significantly associated with SGLT2i/GLP1a use were neighborhood deprivation index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.81-0.94) and the percent of vacant addresses in the neighborhood (OR 0.91, 95% CI 0.85-0.98). Patients living in such neighborhoods are less likely to be prescribed with newer ADD. There was no interaction between race-ethnicity and SDoH on the use of newer ADD. However, in the overall cohort, the non-Hispanic Black individuals were less likely to use newer ADD than the non-Hispanic White individuals (OR 0.82, 95% CI 0.76-0.88). CONCLUSION Using a data-driven approach, we identified the key contextual-level SDoH factors associated with not following evidence-based treatment of T2D. Further investigations are needed to examine the mechanisms underlying these associations.
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Affiliation(s)
- Yujia Li
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Hui Hu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yi Zheng
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - William Troy Donahoo
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jie Xu
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Wei-Han Chen
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Ning Liu
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Elisabeth A. Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-6533
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Nadadur S. Medication Adherence App for Food Pantry Clients With Diabetes: A Feasibility Study. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bekele BB, Bogale B, Negash S, Tesfaye M, Getachew D, Weldekidan F, Yosef T. Public health interventions on prescription redemptions and secondary medication adherence among type 2 diabetes patients: systematic review and meta-analysis of randomized controlled trials. J Diabetes Metab Disord 2021; 20:1933-1956. [PMID: 34900834 DOI: 10.1007/s40200-021-00878-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Background Despite the inadequate filling of prescriptions among chronic care patients has been a problem, little is known about the intervention effect on it. Objective The aim of this systematic review and meta-analysis (SRMA) was to investigate the effectiveness of various public health interventions on primary and secondary medication adherence among T2DM patients. Methods Searching was done from the major databases; Cochrane Library, Medline/PubMed, EBSCOhost, and SCOPUS. A hand search was made to find grey works of literature. Articles focused on interventions to enhance primary and secondary medication among type 2 diabetes mellitus patients were included. After screening and checking eligibility, the methodological quality was assessed. Secondary medication adherence was synthesized descriptively due to measurement and definition variations across studies. Finally, a meta-analysis was made using the fixed effects model for primary medication adherence. Results 3992 studies were screened for both primary and secondary medication adherences. Among these, 24 studies were included in the analysis for primary (5) and secondary (19) medication adherence. Pooled relative medication redemption difference was RD = 8% (95% CI: 6-11%) among the intervention groups. Age, intervention, provider setting, and IDF region were determinant factors of primary medication adherence. About two-thirds of the studies revealed that interventions were effective in improving secondary medication adherence. Conclusion Both primary and secondary medications were enhanced by a variety of public health interventions for patients worldwide. However, there is a scarcity of studies on primary medication adherence globally, and in resource-limited settings for the type of adherences. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-021-00878-0.
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Affiliation(s)
- Bayu Begashaw Bekele
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.,Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.,Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Biruk Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Samuel Negash
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Melkamsew Tesfaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Dawit Getachew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Fekede Weldekidan
- Department of Public Health, College of Health Science, Ethiopian Defence University, Addis Ababa, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Association Between Neighborhood-level Socioeconomic Deprivation and the Medication Level Variability Index for Children Following Liver Transplantation. Transplantation 2021; 104:2346-2353. [PMID: 32032293 DOI: 10.1097/tp.0000000000003157] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neighborhood socioeconomic deprivation is associated with adverse health outcomes. We sought to determine if neighborhood socioeconomic deprivation was associated with adherence to immunosuppressive medications after liver transplantation. METHODS We conducted a secondary analysis of a multicenter, prospective cohort of children enrolled in the medication adherence in children who had a liver transplant study (enrollment 2010-2013). Participants (N = 271) received a liver transplant ≥1 year before enrollment and were subsequently treated with tacrolimus. The primary exposure, connected to geocoded participant home addresses, was a neighborhood socioeconomic deprivation index (range 0-1, higher indicates more deprivation). The primary outcome was the medication level variability index (MLVI), a surrogate measure of adherence to immunosuppression in pediatric liver transplant recipients. Higher MLVI indicates worse adherence behavior; values ≥2.5 are predictive of late allograft rejection. RESULTS There was a 5% increase in MLVI for each 0.1 increase in deprivation index (95% confidence interval, -1% to 11%; P = 0.08). Roughly 24% of participants from the most deprived quartile had an MLVI ≥2.5 compared with 12% in the remaining 3 quartiles (P = 0.018). Black children were more likely to have high MLVI even after adjusting for deprivation (adjusted odds ratio 4.0 95% confidence interval, 1.7-10.6). CONCLUSIONS This is the first study to evaluate associations between neighborhood socioeconomic deprivation and an objective surrogate measure of medication adherence in children posttransplant. These findings suggest that neighborhood context may be an important consideration when assessing adherence. Differential rates of medication adherence may partly explain links between neighborhood factors and adverse health outcomes following pediatric liver transplantation.
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Donneyong MM, Chang TJ, Jackson JW, Langston MA, Juarez PD, Sealy-Jefferson S, Lu B, Im W, Valdez RB, Way BM, Colen C, Fischer MA, Salsberry P, Bridges JF, Hood DB. Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186684. [PMID: 32937852 PMCID: PMC7557537 DOI: 10.3390/ijerph17186684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022]
Abstract
Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R2 = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.
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Affiliation(s)
- Macarius M. Donneyong
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
- Correspondence: ; Tel.: +1-614-292-0075
| | - Teng-Jen Chang
- College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - John W. Jackson
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA;
| | - Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - Shawnita Sealy-Jefferson
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Bo Lu
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (P.D.J.); (W.I.)
| | - R. Burciaga Valdez
- Family & Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Baldwin M. Way
- Department of Psychology, Ohio State University, Columbus, OH 43210, USA;
| | - Cynthia Colen
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - Michael A. Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women’s Hospital, Boston, MA 02115, USA;
| | - Pamela Salsberry
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
| | - John F.P. Bridges
- Department of Biomedical Informatics, Ohio State University, Columbus, OH 43210, USA;
| | - Darryl B. Hood
- College of Public Health, Ohio State University, Columbus, OH 43210, USA; (S.S.-J.); (B.L.); (C.C.); (P.S.); (D.B.H.)
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Diabetes and Its Effect on Abdominal Aortic Aneurysm Growth Rate in Hispanic Patients. Ann Vasc Surg 2019; 61:254-260. [DOI: 10.1016/j.avsg.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/09/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
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Hirsch AG, Durden TE, Nordberg C, Berger A, Schwartz BS. Associations of Four Community Factors With Longitudinal Change in Hemoglobin A 1c Levels in Patients With Type 2 Diabetes. Diabetes Care 2018; 41:461-468. [PMID: 29258994 PMCID: PMC5864143 DOI: 10.2337/dc17-1200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate associations of community factors with glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS We identified patients with type 2 diabetes who had an HbA1c ≥7.5% (58 mmol/mol) and subsequent HbA1c testing within 90-270 days. We used mixed-effect models to assess whether treatment intensification (TI) and community domains (community socioeconomic deprivation [CSD], food availability, fitness assets, and utilitarian physical activity favorability [quartiled]) were associated with HbA1c change over 6 and 24 months, controlling for demographics, HbA1c, BMI, and time with evidence of type 2 diabetes. We evaluated whether community domains modified associations of TI with HbA1c change using cross product terms. RESULTS There were 15,308 patients with 69,818 elevated HbA1c measures. The average reduction in HbA1c over 6 months was 0.07% less in townships with a high level of CSD (third quartile versus the first). Reductions were 0.10% greater for HbA1c in townships with the best food availability (versus worst). HbA1c reductions were 0.17-0.19% greater in census tracts in the second and third quartiles of utilitarian physical activity favorability versus the first. The association of TI with 6-month HbA1c change was weaker in townships and boroughs with the worst CSD (versus best) and in boroughs with the best fitness assets (versus worst). The association of TI with 24-month HbA1c change was weaker in census tracts with the worst CSD (versus third quartile) and strongest in census tracts most favorable for utilitarian physical activity (versus worst). CONCLUSIONS Community domains were associated with HbA1c change and blunted TI effectiveness.
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Affiliation(s)
- Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - T Elizabeth Durden
- Department of Sociology and Anthropology, Bucknell University, Lewisburg, PA
| | - Cara Nordberg
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA
| | - Andrea Berger
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA
| | - Brian S Schwartz
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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15
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Mei H, Turale S. Coping experience of health concerns and physical disability for older Chinese people: A qualitative, descriptive study. Nurs Health Sci 2017; 19:444-451. [PMID: 28752946 DOI: 10.1111/nhs.12363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 03/31/2017] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
Abstract
In this qualitative, descriptive study, we explored the perspectives of older, community-dwelling Chinese people regarding their experiences of coping with a physical disability and their health concerns. Twenty participants were interviewed in-depth, and data were analyzed using content analysis. Five themes with 13 subthemes emerged that described older people's experiences of coping with health concerns and disability: (i) ignoring health concerns; (ii) managing self; (iii) seeking medical help; (iv) living with physical disability; and (v) relying on limited resources. Most participants did not have sufficient access to health services due to physical disability and financial deficits, so they tended to ignore their health conditions or tackle them independently before seeking medical help. At the same time, they were impacted on by social and cultural factors. Policies are required that offer more resources to community-dwelling people with disabilities in China.
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Affiliation(s)
- He Mei
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | - Sue Turale
- HOPE School of Nursing, Wuhan University, Wuhan, China
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16
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Jimenez K, Vargas C, Garcia K, Guzman H, Angulo M, Billimek J. Evaluating the Validity and Reliability of the Beliefs About Medicines Questionnaire in Low-Income, Spanish-Speaking Patients With Diabetes in the United States. DIABETES EDUCATOR 2016; 43:114-124. [PMID: 27831521 DOI: 10.1177/0145721716675740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this study was to examine the reliability and validity of a Spanish version of the Beliefs about Medicines Questionnaire (BMQ) as a measure to evaluate beliefs about medications and to differentiate adherent from nonadherent patients among low-income Latino patients with diabetes in the United States. Methods Seventy-three patients were administered the BMQ and surveyed for evidence of medication nonadherence. Internal consistency of the BMQ was assessed by Cronbach's alpha along with performing a confirmatory factor analysis. Criterion validity was assessed by comparing mean scores on 3 subscales of the BMQ (General Overuse, General Harm, and Specific Necessity-Concerns difference score) between adherent patients and patients reporting nonadherence for 3 different reasons (unintentional nonadherence, cost-related nonadherence, and nonadherence due to reasons other than cost) using independent samples t tests. Results The BMQ is a reliable instrument to examine beliefs about medications in this Spanish-speaking population. Construct validity testing shows nearly identical factor loading as the original construct map. General Overuse scores were significantly more negative for patients reporting each reason for nonadherence compared with their adherent counterparts. Necessity-Concerns difference scores were significantly more negative for patients reporting nonadherence for reasons other than cost compared with those who did not report this reason for nonadherence. Conclusion The Spanish version of the BMQ is appropriate to assess beliefs about medications in Latino patients with type 2 diabetes in the United States and may help identify patients who become nonadherent to medications for reasons other than out-of-pocket costs.
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Affiliation(s)
- Krystal Jimenez
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Cristina Vargas
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Karla Garcia
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Herlinda Guzman
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek)
| | - Marco Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine (Dr Angulo, Dr Billimek)
| | - John Billimek
- Health Policy Research Institute, University of California, Irvine (Ms Jimenez, Ms Vargas, Ms Garcia, Ms Guzman, Dr Billimek).,Department of Medicine, Division of General Internal Medicine and Primary Care, School of Medicine, University of California, Irvine (Dr Billimek).,Department of Family Medicine, School of Medicine, University of California, Irvine (Dr Angulo, Dr Billimek)
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17
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Salinas JJ, Heyman JM, Brown LD. Financial Barriers to Health Care Among Mexican Americans With Chronic Disease and Depression or Anxiety in El Paso, Texas. J Transcult Nurs 2016; 28:488-495. [PMID: 27460753 DOI: 10.1177/1043659616660362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the barriers to health care access by chronic disease and depression/anxiety diagnosis in Mexican Americans living in El Paso, TX. DESIGN A secondary analysis was conducted using data for 1,002 Hispanics from El Paso, TX (2009-2010). Logistic regression was conducted for financial barriers by number of chronic conditions and depression/anxiety diagnosis. Interaction models were conducted between number of chronic conditions and depression or anxiety. RESULTS Depressed/anxious individuals reported more financial barriers than those with chronic conditions alone. There were significant interactions between number of chronic conditions and depression/anxiety for cost, denied treatment because of an inability to pay, and an inability to pay $25 for health care. CONCLUSION Financial barriers should be considered to maintain optimal care for both mental and physical health in this population. IMPLICATIONS FOR PRACTICE There should be more focus on the impact of depression or anxiety as financial barriers to compliance.
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Affiliation(s)
- Jennifer J Salinas
- 1 University of Texas Health Science Center at Houston School of Public Health, El Paso Regional Campus., El Paso, TX, USA
| | | | - Louis D Brown
- 1 University of Texas Health Science Center at Houston School of Public Health, El Paso Regional Campus., El Paso, TX, USA
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18
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Gariepy G, Kaufman JS, Blair A, Kestens Y, Schmitz N. Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes. Diabet Med 2015; 32:944-50. [PMID: 25440062 DOI: 10.1111/dme.12650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes. METHODS This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008-2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms. RESULTS More physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired. CONCLUSIONS Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.
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Affiliation(s)
- G Gariepy
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
- Douglas Mental Health University Institute, Montreal, Quebec
| | - J S Kaufman
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
| | - A Blair
- Douglas Mental Health University Institute, Montreal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Y Kestens
- Department of Social and Preventative Medicine, University of Montreal, Montreal, Quebec, Canada
| | - N Schmitz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
- Douglas Mental Health University Institute, Montreal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
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August KJ, Billimek J. A theoretical model of how neighborhood factors contribute to medication nonadherence among disadvantaged chronically ill adults. J Health Psychol 2015; 21:2923-2933. [PMID: 26089191 DOI: 10.1177/1359105315589391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In addition to individual-level socioeconomic and psychological factors, the neighborhood environment has been found to be related to medication nonadherence, particularly among low-income, minority populations managing a chronic disease. In this article, we synthesize the relevant literature on how neighborhood factors contribute to engagement in health behaviors and reasons for medication nonadherence among this population. We propose a theoretical framework for understanding the mediating and moderating mechanisms whereby the neighborhood environment may impact medication nonadherence among individuals most at risk for adverse disease outcomes. Guided by this model, we provide recommendations for future research, practice, and policy.
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20
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Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called “EMPATHy” that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. Methods/Design The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be “coaches” to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a “contextualized plan of care” (i.e., a plan of care that addresses a barrier to medication adherence in the patient’s daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. Discussion The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. Trial registration ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
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Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called "EMPATHy" that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. METHODS/DESIGN The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be "coaches" to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a "contextualized plan of care" (i.e., a plan of care that addresses a barrier to medication adherence in the patient's daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. DISCUSSION The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. TRIAL REGISTRATION ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
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de Vries McClintock HF, Wiebe DJ, O'Donnell AJ, Morales KH, Small DS, Bogner HR. Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus. FAMILY & COMMUNITY HEALTH 2015; 38:169-79. [PMID: 25739064 PMCID: PMC4351782 DOI: 10.1097/fch.0000000000000069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.
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Affiliation(s)
- Heather F. de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Douglas J. Wiebe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Alison J. O'Donnell
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Knashawn H. Morales
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Dylan S. Small
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Hillary R. Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
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Billimek J, Malik S, Sorkin DH, Schmalbach P, Ngo-Metzger Q, Greenfield S, Kaplan SH. Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence after treatment intensification. Womens Health Issues 2015; 25:6-12. [PMID: 25442365 PMCID: PMC4275363 DOI: 10.1016/j.whi.2014.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid-lowering medication regimen, and medication adherence can explain this disparity. METHODS Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n = 1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was low-density lipoprotein (LDL) cholesterol. FINDINGS Women had higher LDL cholesterol levels than men (mean [SD], 101.2 [35.2] vs. 92.3 [33.0] mg/dL; p < .001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence related to cost (32.7% vs. 24.2%; p = .040) and related to side effects (47.2% vs. 36.8%; p = .024). For all patients, regimen intensity (p < .05) and nonadherence related to side effects (p < .01) were each associated with higher LDL cholesterol levels. The addition of a new lipid-lowering agent was associated with subsequent nonadherence related to side effects for women (p < .001), but not for men (p = .45; test for interaction p = .048). CONCLUSIONS Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence seemed to be a major contributor to dyslipidemia, particularly for women because of side effects associated with intensifying the lipid-lowering regimen.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California.
| | - Shaista Malik
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Dara H Sorkin
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Priel Schmalbach
- School of Social Ecology, University of California, Irvine, California; School of Medicine, University of California, Irvine, California
| | - Quyen Ngo-Metzger
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sheldon Greenfield
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Sherrie H Kaplan
- Health Policy Research Institute, School of Medicine, University of California, Irvine, California; Department of Medicine, School of Medicine, University of California, Irvine, California
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Huntsman MAH, Olivares FJ, Tran CP, Billimek J, Hui EE. Pain reduction and financial incentives to improve glucose monitoring adherence in a community health center. PLoS One 2014; 9:e114875. [PMID: 25486531 PMCID: PMC4259480 DOI: 10.1371/journal.pone.0114875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022] Open
Abstract
Self-monitoring of blood glucose is a critical component of diabetes management. However, patients often do not maintain the testing schedule recommended by their healthcare provider. Many barriers to testing have been cited, including cost and pain. We present a small pilot study to explore whether the use of financial incentives and pain-free lancets could improve adherence to glucose testing in a community health center patient population consisting largely of non-English speaking ethnic minorities with low health literacy. The proportion of patients lost to follow-up was 17%, suggesting that a larger scale study is feasible in this type of setting, but we found no preliminary evidence suggesting a positive effect on adherence by either financial incentives or pain-free lancets. Results from this pilot study will guide the design of larger-scale studies to evaluate approaches to overcome the variety of barriers to glucose testing that are present in disadvantaged patient populations.
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Affiliation(s)
- Mary Ann H. Huntsman
- Share Our Selves Community Health Center, Costa Mesa, CA, United States of America
| | - Faith J. Olivares
- Share Our Selves Community Health Center, Costa Mesa, CA, United States of America
| | - Christina P. Tran
- Share Our Selves Community Health Center, Costa Mesa, CA, United States of America
| | - John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, University of California Irvine, Irvine, CA, United States of America
| | - Elliot E. Hui
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, United States of America
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