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Adelekan A, Alrashah AS, Al Hutaylah IS, Lipert A, Dibwe PM, Rasmus P. Preferred Medium of Receiving Diagnostic News Depending on Patients' Perception of Their Health Status (Healthy or Sick). Patient Prefer Adherence 2020; 14:903-915. [PMID: 32581517 PMCID: PMC7269663 DOI: 10.2147/ppa.s247726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study aims to gain insight into people's preferred medium of receiving diagnostic news depending on their perception of their health status (either sick or healthy). METHODS Comprehensive research was carried out on two main groups of past and prospective patients, Polish respondents (N=72) and International respondents (N= 214), using a CAWI (Computer-Assisted Web Interview) technique. Respondents were asked in an online questionnaire about the past history of illness, whether they would like to receive their diagnostic news and preferred medium of receiving diagnostic news whether they perceive they are sick or healthy. RESULTS Amongst the international group, majority of respondents (143 resp. - 73.71%) would generally like to receive their diagnostic news and 156 resp. (80.83%) would prefer to receive their bad diagnostic news (BDN) from medical specialist doctors as opposed to other technological and non-technological means. Meanwhile, in the polish group, 65 resp. (90.28%) would like to generally receive their diagnostic news and 66 resp. (91.67%) would prefer to receive their BDN from medical specialist doctors as opposed to other proposed means of obtaining BDN. CONCLUSION The result of this study indicates that medical doctors, especially specialists, are still a preferred medium of receiving diagnostic news. However, a certain proportion of respondents will be open to technological medium in receiving their diagnostic news.
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Affiliation(s)
- Adediran Adelekan
- Medical University of Lodz, Department of Medical Psychology, Lodz, Poland
- Correspondence: Adediran Adelekan Medical University of Lodz, Flat 22, Narutowicza 30, Lodz90-135, PolandTel +48-729-696-726 Email
| | | | | | - Anna Lipert
- Medical University of Lodz, Department of Sport Medicine, Lodz, Poland
| | | | - Paweł Rasmus
- Medical University of Lodz, Department of Medical Psychology, Lodz, Poland
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Pavlik VN, Chan W, Hyman DJ, Feldman P, Ogedegbe G, Schwartz JE, McDonald M, Einhorn P, Tobin JN. Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials. Curr Hypertens Rev 2016; 11:123-31. [PMID: 25808682 DOI: 10.2174/1573402111666150325234503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/13/2015] [Accepted: 03/24/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP. Three of the groups performed a pooled analysis of trial results to determine: 1) the magnitude of the combined intervention effect; and 2) how the pooled results could inform the methodology for future health-system level BP interventions. METHODS Using a cluster randomized design, the trials enrolled AAs with uncontrolled hypertension to test interventions targeting a combination of patient and clinician behaviors. The 12-month Systolic BP (SBP) and Diastolic BP (DBP) effects of intervention or control cluster assignment were assessed using mixed effects longitudinal regression modeling. RESULTS 2,015 patients representing 352 clusters participated across the three trials. Pooled BP slopes followed a quadratic pattern, with an initial decline, followed by a rise toward baseline, and did not differ significantly between intervention and control clusters: SBP linear coefficient = -2.60±0.21 mmHg per month, p<0.001; quadratic coefficient = 0.167± 0.02 mmHg/month, p<0.001; group by time interaction group by time group x linear time coefficient=0.145 ± 0.293, p=0.622; group x quadratic time coefficient= -0.017 ± 0.026, p=0.525). RESULTS were similar for DBP. The individual sites did not have significant intervention effects when analyzed separately. CONCLUSION Investigators planning behavioral trials to improve BP control in health systems serving AAs should plan for small effect sizes and employ a "run-in" period in which BP can be expected to improve in both experimental and control clusters.
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Affiliation(s)
- Valory N Pavlik
- Clinical Directors Network, Inc. (CDN), New York, NY 10018; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University/ Montefiore Medical Center, Bronx, NY 10461.
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Feldman PH, McDonald MV, Barrón Y, Gerber LM, Peng TR. Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial. J Comp Eff Res 2016; 5:155-68. [PMID: 26946952 DOI: 10.2217/cer.15.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Assess the comparative effectiveness of two blood pressure (BP) control interventions for black patients with uncontrolled hypertension. PATIENTS & METHODS A total of 845 patients were enrolled in a three-arm cluster randomized trial. On admission of an eligible patient, field nurses were randomized to usual care, a basic or augmented intervention. RESULTS Across study arms there were no significant 12 months differences in BP control rates (primary outcome) (25% usual care, 26% basic intervention, 22% augmented intervention); systolic BP (143.8 millimeters of mercury [mmHg], 146.9 mmHG, 143.9 mmHG, respectively); medication intensification (47, 43, 54%, respectively); or self-management score (18.7, 18.7, 17.9, respectively). Adjusted systolic BP dropped more than 10 mmHg from baseline to 12 months (155.5-145.4 mmHg) among all study participants. CONCLUSION Neither the augmented nor basic intervention was more effective than usual care in improving BP control, systolic BP, medication intensification or patient self-management. Usual home care yielded substantial improvements, creating a high comparative effectiveness threshold. CLINICAL TRIAL REGISTRATION NCT00139490.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Linda M Gerber
- Department Healthcare Policy & Research, Weill Cornell Medical College, New York, NY 10065, USA
| | - Timothy R Peng
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
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Feldman PH, McDonald MV, Trachtenberg MA, Schoenthaler A, Coyne N, Teresi J. Center for stroke disparities solutions community- based care transition interventions: study protocol of a randomized controlled trial. Trials 2015; 16:32. [PMID: 25622823 PMCID: PMC4322449 DOI: 10.1186/s13063-015-0550-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/05/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities persist in stroke occurrence, recurrence, morbidity and mortality. Uncontrolled hypertension (HTN) is the most important modifiable risk factor for stroke risk. Home health care organizations care for many patients with uncontrolled HTN and history of stroke; however, recurrent stroke prevention has not been a home care priority. We are conducting a randomized controlled trial (RCT) to compare the effectiveness, relative to usual home care (UHC), of two Community Transitions Interventions (CTIs). The CTIs aim to reduce recurrent stroke risk among post-stroke patients via home-based transitional care focused on better HTN management. METHODS/DESIGN This 3-arm trial will randomly assign 495 black and Hispanic post-stroke home care patients with uncontrolled systolic blood pressure (SBP) to one of three arms: UHC, UHC complemented by nurse practitioner-delivered transitional care (UHC + NP) or UHC complemented by an NP plus health coach (UHC + NP + HC). Both intervention arms emphasize: 1) linking patients to continuous, responsive preventive and primary care, 2) increasing patients'/caregivers' ability to manage a culturally and individually tailored BP reduction plan, and 3) facilitating the patient's reintegration into the community after home health care discharge. The primary hypothesis is that both NP-only and NP + HC transitional care will be more effective than UHC alone in achieving a SBP reduction. The primary outcome is change in SPB at 3 and 12 months. The study also will examine cost-effectiveness, quality of life and moderators (for example, race/ethnicity) and mediators (for example, changes in health behaviors) that may affect treatment outcomes. All outcome data are collected by staff blinded to group assignment. DISCUSSION This study targets care gaps affecting a particularly vulnerable black/Hispanic population characterized by persistent stroke disparities. It focuses on care transitions, a juncture when patients are particularly susceptible to adverse events. The CTI is innovative in adapting for stroke patients an established transitional care model shown to be effective for HF patients, pairing the professional NP with a HC, implementing a culturally tailored intervention, and placing primary emphasis on longer-term risk factor reduction and community reintegration rather than shorter-term transitional care outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01918891 ; Registered 5 August 2013.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 107 East 70th Street, 10021, New York, NY, USA.
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Melissa A Trachtenberg
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, 227 East 30th Street, 634, 10016, New York, NY, USA.
| | - Noreen Coyne
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Jeanne Teresi
- Columbia University Stroud Center and New York State Psychiatric Institute, Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, 10471, Bronx, NY, USA.
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Ryvicker M, Feldman PH, Chiu YL, Gerber LM. The role of patient activation in improving blood pressure outcomes in Black patients receiving home care. Med Care Res Rev 2013; 70:636-52. [PMID: 23864112 DOI: 10.1177/1077558713495452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Variations in patients' self-management knowledge, skills, and confidence as measured by the Patient Activation Measure (PAM) have been linked to variations in health behavior and outcomes. In a randomized trial, we tested two blood pressure (BP) control interventions, one grounded in activation principles. Study participants were Black home care patients (N = 587) with uncontrolled hypertension. This article examines intervention impacts on 12-month PAM score change, other predictors of PAM change, and associations between PAM change and BP outcomes. In multivariate models, the interventions did not significantly affect PAM change. Baseline characteristics associated with increased PAM were lower PAM score, higher income, higher health literacy, younger age, lower systolic BP, diabetes, and fewer medications. PAM increase was associated with a modest reduction in diastolic BP but not with improved systolic BP or BP control. Although studies suggest that increasing activation may lead to improved patient outcomes, this study did not find it to be so.
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Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2013:CD008722. [PMID: 23450587 PMCID: PMC4900876 DOI: 10.1002/14651858.cd008722.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. OBJECTIVES To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. SEARCH METHODS We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client's adherence to dietary advice. We defined 'client' as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. MAIN RESULTS We included 38 studies involving 9445 participants. Among studies that measured diet adherence outcomes between an intervention group and a control/usual care group, 32 out of 123 diet adherence outcomes favoured the intervention group, 4 favoured the control group whereas 62 had no significant difference between groups (assessment was impossible for 25 diet adherence outcomes since data and/or statistical analyses needed for comparison between groups were not provided). Interventions shown to improve at least one diet adherence outcome are: telephone follow-up, video, contract, feedback, nutritional tools and more complex interventions including multiple interventions. However, these interventions also shown no difference in some diet adherence outcomes compared to a control/usual care group making inconclusive results about the most effective intervention to enhance dietary advice. The majority of studies reporting a diet adherence outcome favouring the intervention group compared to the control/usual care group in the short-term also reported no significant effect at later time points. Studies investigating interventions such as a group session, individual session, reminders, restriction and behaviour change techniques reported no diet adherence outcome showing a statistically significant difference favouring the intervention group. Finally, studies were generally of short duration and low quality, and adherence measures varied widely. AUTHORS' CONCLUSIONS There is a need for further, long-term, good-quality studies using more standardized and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases.
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Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François d’Assise Hôpital, Québec, Canada.
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Gerber LM, Mann SJ, McDonald MV, Chiu YL, Sridharan S, Feldman PH. Diuretic use in black patients with uncontrolled hypertension. Am J Hypertens 2013; 26:174-9. [PMID: 23382401 PMCID: PMC3626036 DOI: 10.1093/ajh/hps029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/16/2012] [Accepted: 07/20/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Highly publicized recommendations favor the use of diuretics as a first-line or add-on agent in the management of hypertension, particularly among black patients and patients with resistant hypertension. Failure to follow such guidelines might contribute to high rates of uncontrolled hypertension. This study assessed diuretic prescribing patterns in a sample of black patients with uncontrolled hypertension who were identified from a population of home care recipients. METHODS The study was conducted in an urban home health organization. Participants were black, aged 21 to 80 years, and had a diagnosis of hypertension. Participants with uncontrolled hypertension were identified, and in-home interviewers collected information on prescribed antihypertensive medications. RESULTS Of 658 participants, 5.5% were not prescribed any antihypertensives, and only 46% were prescribed a diuretic. Participants who were not taking a diuretic were taking fewer antihypertensive medications (1.7 vs. 2.9; P < 0.0001), had a higher mean diastolic blood pressure (89.2 vs. 85.5; P = 0.0005), and were more likely to have a systolic blood pressure ≥160mm Hg (57.6% vs. 49.0%; P = 0.04). The adjusted mean systolic and diastolic blood pressures were 5 and 4mm Hg lower, respectively, in patients who were taking a diuretic. CONCLUSIONS In this sample of black patients with uncontrolled hypertension, despite wide publicizing of the recommendations for use of diuretics, a majority are still not receiving a diuretic. This important issue merits continued attention.
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Affiliation(s)
- Linda M Gerber
- Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
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Abstract
PURPOSE OF REVIEW Adherence to proven, effective medications remains low, resulting in high rates of clinical complications, hospital readmissions, and death. The use of technology to identify patients at risk and to target interventions for poor adherence has increased. This review focuses on research that tests these emerging technologies and evaluates the effect of technology-based adherence interventions on cardiovascular outcomes. RECENT FINDINGS Recent studies have evaluated technology-based interventions to improve medication adherence by using pharmaceutical databases, tailoring educational information to individual patient needs, delivering technology-driven reminders to patients and providers, and integrating in-person interventions with electronic alerts. Cellular phone reminders and in-home electronic technology used to communicate reminder messages have shown mixed results. Only one study has shown improvement in both adherence and clinical outcome. Current trials suggest that increasing automated reminders will complement but not replace the benefits seen with in-person communication for medication taking. SUMMARY Integration of in-person contacts with technology-driven medication adherence reminders, electronic medication reconciliation, and pharmaceutical databases may improve medication adherence and have a positive effect on cardiovascular clinical outcomes. Opportunities for providers to monitor the quality of care based on new adherence research are evolving and may be useful as standards for quality improvement emerge.
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Pezzin LE, Feldman PH, Mongoven JM, McDonald MV, Gerber LM, Peng TR. Improving blood pressure control: results of home-based post-acute care interventions. J Gen Intern Med 2011; 26:280-6. [PMID: 20945114 PMCID: PMC3043175 DOI: 10.1007/s11606-010-1525-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 08/18/2010] [Accepted: 09/07/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Blood pressure (BP) control remains elusive for many Americans. Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control, hypertension (HTN) management has not been a high priority in post-acute care. OBJECTIVE To examine the effects of two home-based interventions designed to improve BP outcomes among high-risk African-American patients. DESIGN Cluster randomized controlled trial. PARTICIPANTS A total of 845 newly admitted patients with uncontrolled HTN (JNC7 stages 1 or 2). INTERVENTIONS The "basic" intervention delivered key HTN information to clinicians and patients, and a home BP monitor to patients, while the patients received usual post-acute care. The "augmented" intervention provided more intensive and extensive HTN information, monitoring and feedback for 3 months beyond the index home care admission. MEASURES Primary: BP control. Secondary: reductions in mmHG SBP and DBP, improvements in proportions improving JNC7 stage or achieving clinically meaningful reductions in SBP and DBP. METHODS Multivariate regression models. KEY RESULTS The basic intervention produced no significant BP improvements; the augmented intervention significantly improved stage 2 patients' outcomes. Among stage 2 patients, the augmented intervention increased BP control by 8.7 percentage points relative to usual care (8.9% vs. 17.6%; p=0.01), yielded an 8.3 mmHG relative reduction in SBP (p=0.01), and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points (p=0.01). CONCLUSION Among stage 2 patients, a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control, plus improvements in secondary BP outcomes.
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Affiliation(s)
- Liliana E Pezzin
- Department of Medicine and Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Affiliation(s)
- Harlan M. Krumholz
- From the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine; the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT
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Affiliation(s)
- Harlan M. Krumholz
- From the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine; the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
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