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Alam AB, Lutsey PL, Chen LY, MacLehose RF, Shao IY, Alonso A. Risk Factors for Dementia in Patients With Atrial Fibrillation. Am J Cardiol 2022; 174:48-52. [PMID: 35473779 DOI: 10.1016/j.amjcard.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
Although dementia and atrial fibrillation (AF) are common in older adults, risk factors for dementia have not been sufficiently characterized in patients with AF. We studied 621,773 patients with AF without dementia at the time of AF diagnosis who were enrolled in the MarketScan Commercial and Medicare Supplemental databases from 2007 to 2015. Dementia incidence and presence of predictors at the time of AF diagnosis (cardiometabolic conditions, mental and neurologic disorders, and other chronic conditions) were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in outpatient and inpatient claims, whereas medication usage was based on outpatient pharmacy claims. A frailty score was calculated using a previously established algorithm. The associations between the predictors of interest and dementia were assessed with multivariable Cox models. Patients had a mean age of 68 years (SD 14 years) and 41% were women. During a mean follow-up of 2.0 years, there were 16,073 cases of dementia. The strongest predictors of dementia were frailty (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.40 to 1.45, per 1-SD increase in the score), cognitive impairment (HR 1.50, 95% CI 1.36 to 1.65), mood disorders (HR 1.49, 95% CI 1.32 to 1.70), schizophrenia (HR 1.86, 95% CI 1.75 to 1.98), and substance abuse (HR 1.58, 95% CI 1.39 to 1.80). Among cardiometabolic conditions, only stroke (HR 1.17, 95% CI 1.13 to 1.22) and diabetes mellitus (HR 1.14, 95% CI 1.11 to 1.18) were associated with small increases in dementia risk after adjusting for demographics, frailty, co-morbidities, and medications. We have identified several risk factors for dementia in patients with AF.
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A Scoping Review of International Barriers to Asthma Medication Adherence Mapped to the Theoretical Domains Framework. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:410-418.e4. [PMID: 32861047 DOI: 10.1016/j.jaip.2020.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Internationally, adult asthma medication adherence rates are low. Studies characterizing variations in barriers by country are lacking. OBJECTIVE To conduct a scoping review to characterize international variations in barriers to asthma medication adherence among adults. METHODS MEDLINE, EMBASE, Web of Science (WOS), and CINAHL were searched from inception to February 2017. English-language studies employing qualitative methods (eg, focus groups, interviews) were selected to assess adult patient- and/or caregiver-reported barriers to asthma medication adherence. Two investigators independently identified, extracted data, and collected study characteristics, methodologic approach, and barriers. Barriers were mapped using the Theoretical Domains Framework and findings categorized according to participants' country of residence, countries' gross national income, and the presence of universal health care (World Health Organization definitions). RESULTS Among 2942 unique abstracts, we reviewed 809 full texts. Among these, we identified 47 studies, conducted in 12 countries, meeting eligibility. Studies included a total of 2614 subjects, predominately female (67%), with the mean age of 19.1 to 70 years. Most commonly reported barriers were beliefs about consequences (eg, medications not needed for asthma control, N = 29, 61.7%) and knowledge (eg, not knowing when to take medication, N = 27, 57.4%); least common was goals (eg, asthma not a priority, N = 1, 2.1%). In 27 studies conducted in countries classified as high income (HIC) with universal health care (UHC), the most reported barrier was participants' beliefs about consequences (N = 17, 63.3%). However, environmental context and resources (N = 12, 66.7%) were more common in HIC without UHC. CONCLUSION International adherence barriers are diverse and may vary with a country's sociopolitical context. Future adherence interventions should account for trends.
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Cremer NM, Baptist AP. Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1294-1301.e7. [PMID: 32035849 DOI: 10.1016/j.jaip.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. OBJECTIVE To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. METHODS Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. RESULTS A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008). CONCLUSIONS Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.
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Affiliation(s)
- Nicole M Cremer
- Division of Internal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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Pickles K, Eassey D, Reddel HK, Locock L, Kirkpatrick S, Smith L. "This illness diminishes me. What it does is like theft": A qualitative meta-synthesis of people's experiences of living with asthma. Health Expect 2018; 21:23-40. [PMID: 28768067 PMCID: PMC5750696 DOI: 10.1111/hex.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND What matters to people in their everyday experiences of living with asthma is influenced by a diverse range of personal, social, medical and environmental factors. Previous reviews of the asthma literature have largely focused on medical aspects of asthma or specific population groups with particular needs. OBJECTIVE To identify, describe and synthesize from the available qualitative literature the views and experiences of adults living with asthma. METHOD We systematically searched for qualitative studies reporting on the personal experience of living with asthma. A meta-synthesis approach was used to analyse and interpret the data. Key themes relating to personal perspectives on asthma were identified and grouped into overarching concepts. RESULTS We identified 26 studies. There was a paucity of literature on the physical burden of asthma symptoms and the role of social support. Our synthesis generated a central concept of the "work" associated with living with asthma: work was of a personal nature, and at times an intensely emotional experience. Individuals tailored their behaviour in response to demands of the physical and social environment, including interactions with health-care professionals. CONCLUSION This is the first systematic review of the qualitative literature reporting on people's own perspectives of living with asthma. Our findings draw attention to the nuances and sensitivities surrounding patient experiences of self-management. Medical care is a central plank of managing chronic conditions, but our health-care systems are now expected to deliver patient-centred care. Considering the broader aspects of asthma management, beyond that of symptoms and treatment, will help to facilitate comprehensive care.
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Affiliation(s)
- Kristen Pickles
- Centre for Values, Ethics & the Law in MedicineUniversity of SydneySydneyNSWAustralia
| | - Daniela Eassey
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
| | - Helen K. Reddel
- Woolcock Institute of Medical ResearchUniversity of SydneySydneyNSWAustralia
| | - Louise Locock
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Susan Kirkpatrick
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordOxfordUK
| | - Lorraine Smith
- Faculty of PharmacyUniversity of SydneySydneyNSWAustralia
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Bennett GH, Carpenter L, Hao W, Song P, Steinberg J, Baptist AP. Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma. Ann Allergy Asthma Immunol 2018; 120:164-168.e1. [PMID: 29290515 PMCID: PMC5803342 DOI: 10.1016/j.anai.2017.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma. OBJECTIVE To identify risk factors and outcomes related to FAO in older adults with asthma. METHODS Subjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed. RESULTS A total of 186 participants were analyzed (48 men and 138 women, mean age 66 years). FAO was demonstrated in 30% of participants. Using regression analysis, predictors of FAO included advanced age, African American race, male sex, and longer duration of asthma. In outcomes analysis, FAO was associated with worsened ACT and AQLQ scores; however, after controlling for confounding factors, logistic regression showed no association. No significant association was found between FAO and exacerbations, fractional exhaled nitric oxide, atopy, rhinitis, education level, depression, smoking, or body mass index. CONCLUSION Risk factors associated with FAO in older adults with asthma include advanced age, African American race, increased asthma duration, and male sex. Unlike younger patients, FAO is not independently associated with worsened asthma control, quality of life, or exacerbations in older patients with asthma. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01979055.
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Affiliation(s)
- Gregory H Bennett
- Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Michigan.
| | - Laurie Carpenter
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Wei Hao
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Peter Song
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joel Steinberg
- Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Michigan; University of Michigan School of Public Health, Ann Arbor, Michigan
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Baptist AP, Hao W, Karamched KR, Kaur B, Carpenter L, Song PXK. Distinct Asthma Phenotypes Among Older Adults with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:244-249.e2. [PMID: 28757370 PMCID: PMC5897052 DOI: 10.1016/j.jaip.2017.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older adults have high rates of asthma morbidity and mortality. Asthma is now recognized as a heterogeneous disease, yet the distinct phenotypes among older adults are unknown. OBJECTIVE The objective of this study was to identify asthma phenotypes in a diverse population of elderly patients with asthma. METHODS Using cluster analysis, 180 older adults with persistent asthma were analyzed. Subjects completed detailed questionnaires, skin prick testing, and spirometry with reversibility. Twenty-four core variables were analyzed. RESULTS Four groups were identified. Subjects in cluster 1 (n = 69) typically had asthma diagnosed after the age of 40 and the shortest duration of asthma. Cluster 2 (n = 40) had the mildest asthma defined by spirometry, Asthma Control test (ACT), and Asthma Quality of Life Questionnaire (AQLQ). They also had the lowest body mass index (BMI), lowest depression score, and least number of comorbidities. Cluster 3 (n = 46) had the longest duration of asthma (56 years) and the highest atopic skin test sensitization (74%). Cluster 4 (n = 25) had the most severe asthma, with extremely low FEV1% predicted (37.8%), lowest ACT, and lowest AQLQ scores. They were more likely to be black and had the highest comorbidities. Using BMI, posttreatment FEV1% predicted, and duration of asthma, 95.6% of subjects were able to be correctly classified. CONCLUSIONS In older adults with asthma, distinct phenotypes vary on key features that are more pronounced among the elderly, including comorbidities, fixed airway obstruction, and duration of asthma ≥40 years. Further work is required to determine the clinical and therapeutic implications for different asthma phenotypes in older adults.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich.
| | - Wei Hao
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Keerthi R Karamched
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | - Bani Kaur
- Department of Internal Medicine, Wayne State University, Detroit, Mich
| | - Laurie Carpenter
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Peter X K Song
- Department of Internal Medicine, Wayne State University, Detroit, Mich
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Costello RW, Foster JM, Grigg J, Eakin MN, Canonica W, Yunus F, Ryan D. The Seven Stages of Man: The Role of Developmental Stage on Medication Adherence in Respiratory Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:813-20. [PMID: 27587315 DOI: 10.1016/j.jaip.2016.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/03/2016] [Accepted: 04/06/2016] [Indexed: 02/08/2023]
Abstract
The circumstances and drivers of the decision to initiate, implement, or persist with a medication differ for individuals at each developmental stage. For school-age children with asthma, the social environment of their family's cultural beliefs and the influence of peer networks and school policies are strong determinants of medication adherence. The stage of adolescence can be a particularly challenging time because there is a reduction in parental supervision of asthma management as the young person strives to become more autonomous. To illustrate the importance of such factors, adherence interventions in children and young adults with asthma have used peer-based supports and social supports, particularly social media platforms. In older patients, it is internal rather than external factors and age-related decline that pose challenges to medication adherence. Seniors face the challenges of polypharmacy, reduced social support, increased isolation, and loss of cognitive function. Strategies to promote adherence must be tailored to the developmental stage and respective behavioral determinants of the target group. This review considers the different attitudes toward medication and the different adherence behaviors in young and elderly patients with chronic respiratory conditions, specifically asthma and chronic obstructive pulmonary disease. Opportunities to intervene to optimize adherence are suggested.
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Affiliation(s)
- Richard W Costello
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Jonathan Grigg
- Blizard Institute, Queen Mary University London, London, United Kingdom
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Walter Canonica
- Allergy and Respiratory Diseases Clinica, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Fasail Yunus
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, University of Indonesia, Persahabatan Hospital, Rawamangun, Jakarta, Indonesia
| | - Dermot Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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Miles C, Arden-Close E, Thomas M, Bruton A, Yardley L, Hankins M, Kirby SE. Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views. NPJ Prim Care Respir Med 2017; 27:57. [PMID: 28993623 PMCID: PMC5634481 DOI: 10.1038/s41533-017-0056-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022] Open
Abstract
Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: (1) partnership between patient and health care professional; (2) issues around medication; (3) education about asthma and its management; (4) health beliefs; (5) self-management interventions; (6) co-morbidities (7) mood disorders and anxiety; (8) social support; (9) non-pharmacological methods; (10) access to healthcare; (11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma.
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Affiliation(s)
- Clare Miles
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | | | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Anne Bruton
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | | | - Sarah E Kirby
- Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
- NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK.
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O'Conor R, Martynenko M, Gagnon M, Hauser D, Young E, Lurio J, Wisnivesky JP, Wolf MS, Federman AD. A qualitative investigation of the impact of asthma and self-management strategies among older adults. J Asthma 2016; 54:39-45. [PMID: 27315570 DOI: 10.1080/02770903.2016.1193602] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought feedback from elderly patients living with asthma to understand their experience with assuming self-management roles for their asthma in order to inform the design and implementation of a primary care-based strategy that could best support their asthma control. METHODS We held six focus groups with a total of 31 English- and Spanish-speaking older adults with a current diagnosis of asthma. Focus groups addressed the effect of asthma on patients' lives and self-management strategies. Transcripts were analyzed using constant comparative techniques. RESULTS Asthma exerted a consistent effect on patients' physical and psychological well-being. Common barriers to self-care included misuse of controller medications and uncertainty whether shortness of breath, fatigue, and cough were due to their asthma or some other chronic illness. Patients developed coping strategies to continue with daily activities even when experiencing symptoms, but did not recognize attainable asthma quality of life. CONCLUSIONS Asthma had a distinct impact on elderly adults' quality of life; due to their longstanding history with this condition, many patients had accepted these symptoms as a "new normal." Developing strategies to reorient patients' perceptions of the possibilities for managing their illness will be critical to the success of asthma self-management support programs specific to older adults.
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Affiliation(s)
- Rachel O'Conor
- a Division of General Internal Medicine , Northwestern University , Chicago , IL , USA
| | - Melissa Martynenko
- b Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Monica Gagnon
- c The Institute for Family Health , New York , NY , USA
| | - Diane Hauser
- c The Institute for Family Health , New York , NY , USA
| | - Edwin Young
- d Mount Sinai St. Luke's , New York , NY , USA
| | - Joseph Lurio
- c The Institute for Family Health , New York , NY , USA
| | - Juan P Wisnivesky
- b Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,e Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Michael S Wolf
- a Division of General Internal Medicine , Northwestern University , Chicago , IL , USA
| | - Alex D Federman
- b Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Goeman D, Jenkins C, Crane M, Paul E, Douglass J. Educational intervention for older people with asthma: a randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 93:586-595. [PMID: 24007766 DOI: 10.1016/j.pec.2013.08.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 07/15/2013] [Accepted: 08/11/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To improve the asthma control and adherence to asthma preventer medication of older people using the Patient Asthma Concerns Tool (PACT) to identify and address unmet needs and patient concerns. METHODS Community dwelling adults over 55 years, living in Victoria or New South Wales were recruited into a single-blind, parallel design, randomised-controlled trial comparing person-centred education including device technique, versus written information-only education. Fifty-eight participants randomised to the intervention group and 56 to the control completed participation. OUTCOME MEASURES asthma control, adherence to preventer medication, asthma related quality of life, asthma exacerbations and written action plan ownership were assessed at baseline, and 3 and 12 months post intervention. RESULTS Intervention participants experienced improvements in asthma control, adherence to asthma preventer medication, reduced exacerbations, improved quality of life and an increase in asthma action plan ownership at 3 and 12 months. CONCLUSION Asthma outcomes in older people can be significantly improved by delivering tailored education that identifies specific patient concerns and unmet needs. PRACTICAL IMPLICATIONS Use of the PACT to identify patient concerns and unmet needs will assist health professionals to improve the health literacy of patients by addressing gaps in their knowledge and perceptions of asthma control.
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Affiliation(s)
- Dianne Goeman
- RDNS Institute, Royal District Nursing Service, St Kilda, Australia; Central Clinical School, Monash University, Melbourne, Australia.
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Denford S, Campbell JL, Frost J, Greaves CJ. Processes of change in an asthma self-care intervention. QUALITATIVE HEALTH RESEARCH 2013; 23:1419-1429. [PMID: 24062418 DOI: 10.1177/1049732313507376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this article, we present a qualitative exploration of the psychological and communication processes that occur within an intervention to improve self-care for people with asthma. In the context of a primary-care-based trial of the intervention, we collected data at three time points for 21 patients, comprising 2 audiotaped consultations (nurse and patient together) and individual semistructured interviews 3 months after the second consultation. Using framework analysis, we identified both psychological processes (illness understanding, affective response to asthma, and reasoned motivation) and patient-provider interactions (active patient involvement and individual tailoring). We use these findings to extend and refine the pre-existing theoretical model of behavior change underpinning the intervention, in particular with relation to patient-provider interaction processes. We conclude that it is important for developers and providers of asthma self-care interventions to attend to the style of delivery as well as the behavior change techniques involved.
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Affiliation(s)
- Sarah Denford
- 1University of Exeter, Exeter, Devon, United Kingdom
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12
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Abstract
A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics.
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Affiliation(s)
- Andrea S Melani
- Fisiopatologia e Riabilitazione Respiratoria, Dipartimento Vasi, Cuore e Torace, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.
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Evers U, Jones SC, Caputi P, Iverson D. The asthma knowledge and perceptions of older Australian adults: implications for social marketing campaigns. PATIENT EDUCATION AND COUNSELING 2013; 91:392-399. [PMID: 23375546 DOI: 10.1016/j.pec.2012.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/24/2012] [Accepted: 12/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The purpose of this research is to gain an understanding of the asthma perceptions of older adults and identify gaps in their asthma knowledge. METHODS In regional New South Wales, Australia, a stratified, random sample of 4066 adults, aged 55 years and over, both with and without an asthma diagnosis, completed a survey based on the Health Belief Model about asthma knowledge and perceptions. RESULTS Almost half of the sample had experienced symptoms of breathlessness in the past four weeks. Breathlessness was a predictor of lower health ratings and poorer mood. Older adults reported low susceptibility to developing asthma. The sample demonstrated poor knowledge of key asthma symptoms including shortness of breath, tightness in the chest and a cough at night. CONCLUSION There is a general lack of asthma awareness in this age group. This could result in not seeking medical help, and thus a reduced quality of life. PRACTICAL IMPLICATIONS Older adults should be made aware of key symptoms and the prevalence of asthma in the older adult population, and be empowered to take control of their respiratory health. Audience segmentation for an intervention should be based on recent experience of breathlessness and asthma diagnosis.
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Affiliation(s)
- Uwana Evers
- Centre for Health Initiatives, University of Wollongong, Wollongong, Australia.
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McDonald VM, Higgins I, Gibson PG. Insight into older peoples' healthcare experiences with managing COPD, asthma, and asthma-COPD overlap. J Asthma 2013; 50:497-504. [PMID: 23638867 DOI: 10.3109/02770903.2013.790415] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to explore older peoples' experiences of asthma or COPD with reference to their journey in the healthcare system. METHODS We recruited older patients with a confirmed diagnosis of asthma or COPD and invited them to participate in a qualitative interview. Interviews were conducted with 21 participants. A line-by-line analysis of the interviews was performed and they were coded for common themes. RESULTS From the data, six main themes emerged, these were; "limits to being", "being with or without a diagnosis", "not being heard or recognized", "expectation, fears, and hopes", "to medicate or not: the underuse, abuse, and misuse", and "needing to understand more". The findings of these interviews provide an important understanding of the behaviors and healthcare needs of older people with asthma and COPD. Older patients' adherence patterns, desire for person-centeredness, and involvement in shared decisions as well as desire for increased objective assessment are described. CONCLUSIONS These findings provide an important understanding of the behaviors and healthcare needs of older people with asthma and COPD, an area that has not been well defined. The knowledge gained about older patients' desire for person--centeredness and involvement in shared decisions, as well as desire for increased objective assessment is essential in improving care.
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Affiliation(s)
- Vanessa M McDonald
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia.
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Cole S, Seale C, Griffiths C. 'The blue one takes a battering' why do young adults with asthma overuse bronchodilator inhalers? A qualitative study. BMJ Open 2013; 3:bmjopen-2012-002247. [PMID: 23427203 PMCID: PMC3586109 DOI: 10.1136/bmjopen-2012-002247] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Overuse of short-acting bronchodilators is internationally recognised as a marker of poor asthma control, high healthcare use and increased risk of asthma death. Young adults with asthma commonly overuse short-acting bronchodilators. We sought to determine the reasons for overuse of bronchodilator inhalers in a sample of young adults with asthma. DESIGN Qualitative study using a purposive extreme case sample. SETTING A large urban UK general practice. PARTICIPANTS Twenty-one adults with moderate asthma, aged 20-32 years. Twelve were high users of short-acting bronchodilators, nine were low users. RESULTS Asthma had a major impact on respondents' lives, disrupting their childhood, family life and career opportunities. High users of short-acting bronchodilators had adapted poorly to having asthma and expressed anger at the restrictions they experienced. Overuse made sense to them: short-acting bronchodilators were a rapid, effective, cheap 'quick-fix' for asthma symptoms. High users had poorer control of asthma and held explanatory models of asthma which emphasised short-term relief via bronchodilation over prevention. Both high and low users held strong views about having to pay for asthma medication, with costs cited as a reason for not purchasing anti-inflammatory inhalers. CONCLUSIONS Young adults who were high users of short-acting bronchodilators had adapted poorly to having asthma and had poor asthma control. They gave coherent reasons for overuse. Strategies that might address high bronchodilator use in young adults include improving education to help young people accept and adapt to their illness, reducing stigmatisation and providing free asthma medication to encourage the use of anti-inflammatory inhalers.
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Affiliation(s)
- Sue Cole
- Elizabeth Courtauld Surgery, Halstead, Essex, UK
| | - Clive Seale
- Department of Sociology, Brunel University, Uxbridge, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
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Crane MA, Douglass JA, Goeman DP, Cousens NE, Jenkins CR. Development and validation of the Patient Asthma Concerns Tool (PACT) to identify the needs of older people with asthma. Respir Med 2012; 106:1501-8. [PMID: 22921865 DOI: 10.1016/j.rmed.2012.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tools which assist practitioners to identify patient concerns and increase understanding of their needs can improve both the delivery of care and adherence to treatment. The aim of this study was to test the validity and reliability of a 14-item tool, to identify the unmet needs and concerns of older people with asthma. METHODS The Patient Asthma Concerns Tool (PACT) was developed from a pool of 55 items derived from a comprehensive literature review. After pilot and field testing, the initial 55 item questionnaire was administered to a community sample (n = 193), psychometrically tested, and refined to a 14 item PACT tool which was evaluated by a group of clinicians. RESULTS The PACT was shown to have good content and construct validity and was well received by clinicians. The PACT also correlated well with the Juniper ACQ and Brooks' adherence score on related variables and showed good reliability with good-excellent Kappa and ICC scores. Internal consistency of factors was high, and the overall Cronbach's α was 0.70. CONCLUSION The PACT questionnaire was shown to be a valid and reliable tool clinically and psychometrically. We intend to test it in primary care settings and anticipate that its use will assist health professionals to identify the needs and concerns of older patients with asthma and direct tailored asthma management accordingly.
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Abstract
As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor. In addition physical disability can lead to difficulty in accessing treatment and using inhaler devices. Practical strategies to improve asthma outcomes in older people have been studied infrequently and the goals of self-management suitable for younger age-groups may not be applicable in this group. Consequently, asthma in older people is deserving of further attention both to basic mechanisms of disease, precision in diagnosis and effective therapeutic strategies, including those that involve self-management and device use.
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Affiliation(s)
- Andrew Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne 3004, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Melbourne 3050, Australia
- Central Clinical School, Monash University, Melbourne 3004, Australia
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Ring N, Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, Wyke S. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2011; 85:e131-e143. [PMID: 21396793 DOI: 10.1016/j.pec.2011.01.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/20/2011] [Accepted: 01/23/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To understand better what helps and/or hinders asthma action plan use from the professionals and patients/carers perspective. METHODS Systematic review and qualitative synthesis (using meta-ethnography). RESULTS Nineteen studies (20 papers) were included in an analysis of patients/carers' and professionals' views. Seven main influences on action plan implementation were identified including perceived un-helpfulness and irrelevance of the plans. Translation and synthesis of the original authors' interpretations suggested that action plan promotion and use was influenced by professional and patient/carers' asthma beliefs and attitudes and patient/carer experiences of managing asthma. Action plan use is hindered because professionals and patients/carers have different explanatory models of asthma, its management and their respective roles in the management process. Patients/carers, based on their experiential knowledge of their condition, perceive themselves as capable, effective in managing their asthma, but health professionals do not always share this view. CONCLUSION Professionally provided medically focused action plans that do not 'fit' with and incorporate the patients'/carers' views of asthma, and their management strategies, will continue to be under-utilised. PRACTICE IMPLICATIONS Professionals need to develop a more patient-centred, partnership-based, approach to the joint development and review of action plans, recognising the experiential asthma knowledge of patients/carers.
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Affiliation(s)
- Nicola Ring
- Alliance for Self-Care Research, School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.
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Goeman DP, Jenkins CR, Crane MA, Bosnic-Anticevich SZ, Douglass JA. Unmet needs of older people with asthma: cross-sectional survey. J Asthma 2011; 48:865-75. [PMID: 21967616 DOI: 10.3109/02770903.2011.616253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Asthma in older people is a major cause of disease burden in Australia and is projected to increase over the next two decades. Current guidelines for asthma care rely predominantly on studies from younger populations. METHODS We undertook a cross-sectional survey of older people with asthma to identify their concerns and their perceived asthma symptom burden. One hundred and ninety-nine people over 55 years of age with asthma were recruited from community pharmacies, in the states of Victoria and NSW, Australia. RESULTS One-hundred and twenty (62%) participants reported "perfectly" or "very well controlled" asthma over the past month, and 78% claimed adherence to asthma treatment. Despite this, 105 (55%) reported experiencing moderate to severe symptoms and 58 (30%) moderate to extreme restrictions on their lifestyle in the past month. Exacerbations were also common with over one-third of participants seeking emergency asthma care or requiring oral corticosteroids in the past 12 months. In spite of 80% of participants reporting confidence of how to manage their asthma properly, only 10% said they would call an ambulance or visit an Emergency Department if their asthma was "out of control." Further asthma self-management education was considered desirable by two-thirds. However, those over 65 years preferred less autonomy in decision-making compared to those under 65 years. CONCLUSION. Older people with asthma experience a high symptom burden. A simplified version of our questionnaire could assist GPs, specialists, and asthma educators to identify the individual needs of older patients and to tailor their delivery of asthma care accordingly.
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Qamar N, Pappalardo AA, Arora VM, Press VG. Patient-centered care and its effect on outcomes in the treatment of asthma. Patient Relat Outcome Meas 2011; 2:81-109. [PMID: 22915970 PMCID: PMC3417925 DOI: 10.2147/prom.s12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline(®), Cochrane Central Register of Controlled Trials, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO(®), complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; "positive" results); none showed true harm (0; "negative"); and the remainder were equivocal (14; "neutral"). Key themes emerged relating to patients' desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients' needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.
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Affiliation(s)
- Nashmia Qamar
- Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Andrea A Pappalardo
- Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Valerie G Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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Goeman DP, Sanci LA, Scharf SL, Bailey M, O'Hehir RE, Jenkins CR, Douglass JA. Improving general practice consultations for older people with asthma: a cluster randomised control trial. Med J Aust 2009; 191:113-7. [PMID: 19619101 DOI: 10.5694/j.1326-5377.2009.tb02708.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 02/09/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a multifaceted educational intervention for general practitioners to improve the outcomes of older people with asthma. DESIGN Cluster randomised controlled trial. PARTICIPANTS AND SETTING 42 GPs recruited from metropolitan Melbourne between 1 August 2006 and 31 July 2007, randomly assigned to an intervention or control group, and 107 patients with asthma, aged 55 years or older (consecutive patients recruited by the GPs). MAIN OUTCOME MEASURES Evaluation by means of a videorecorded consultation with a simulated patient for GPs; and for patients, asthma control and quality of life, lung function and action plan ownership at baseline and at 4 months. RESULTS GPs in the intervention group scored significantly higher than those in the control group for the content and style of their consultation with simulated patients. At 4 months' follow-up, there was no significant difference between patient groups in the asthma control scores, asthma-related quality of life or lung function. CONCLUSION This trial showed an improvement in GPs' performance in delivering asthma care to older people. Despite this, there was no significant improvement in patient outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12607000634471.
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Affiliation(s)
- Dianne P Goeman
- Department of Allergy, Immunology and Respiratory Medicine (AIRmed), Cooperative Research Centre for Asthma and Airways, Alfred Hospital, Monash University, Melbourne, VIC, Australia.
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