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Cacari Stone L, Sanchez V, Bruna SP, Muhammad M, Zamora Mph C. Social Ecology of Hypertension Management Among Latinos Living in the U.S.-Mexico Border Region. Health Promot Pract 2021; 23:650-661. [PMID: 33709805 DOI: 10.1177/1524839921993044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION While a growing body of research examines individual factors affecting the prevalence and management of hypertension among Latinos, less is known about how socioecological factors operate to determine health and affect implementation of interventions in rural communities. METHOD We conducted eight focus groups to assess perceived risks and protective factors associated with managing hypertension among Latino adults and their family members living in two rural/frontier counties in the U.S.-Mexico border region. This analysis is part of a larger study, Corazon por la Vida (Heart for Life), which involved multiple data collection strategies to evaluate the effectiveness of a primary care and a promotora de salud intervention to manage hypertension. RESULTS Of the 49 focus group participants, 70% were female and 30% were male, 39% were Spanish-only speakers, and 84% had hypertension. Participants' ages ranged between 18 and 75 years, and 63% reported annual incomes below $30,000. Drawing from a social-ecological framework to analyze focus group data, four major themes and subthemes emerged as factors facilitating or inhibiting disease management: (1) individual (emotional burdens, coping mechanisms), (2) social relationships (family as a source of support, family as a source of stress), (3) health system (trust/mistrust, patient-provider communication), and (4) environment (lack of access to safe exercise environment, lack of affordable food). CONCLUSION Our findings are relevant to public health practitioners, researchers, and policymakers seeking to shift from individual level or single interventions aimed at improving treatment-modality adherence to multilevel or multiple interventions for rural Latino communities.
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Genuardi MV, Ogilvie RP, Saand AR, DeSensi RS, Saul MI, Magnani JW, Patel SR. Association of Short Sleep Duration and Atrial Fibrillation. Chest 2019; 156:544-552. [PMID: 30825445 DOI: 10.1016/j.chest.2019.01.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Short sleep may be a risk factor for atrial fibrillation. However, previous investigations have been limited by lack of objective sleep measurement and small sample size. We sought to determine the association between objectively measured sleep duration and atrial fibrillation. METHODS All 31,079 adult patients undergoing diagnostic polysomnography from 1999 to 2015 at multiple sites within a large hospital network were identified from electronic medical records. Prevalent atrial fibrillation was identified by continuous ECG during polysomnography. Incident atrial fibrillation was identified by diagnostic codes and 12-lead ECGs. Logistic regression and Cox proportional hazards modeling were used to examine the association of sleep duration and atrial fibrillation prevalence and incidence, respectively, adjusting for age, sex, BMI, hypertension, coronary artery disease, cerebrovascular disease, peripheral vascular disease, heart failure, and sleep apnea severity. RESULTS We identified 404 cases of prevalent atrial fibrillation among 30,061 individuals (mean age ± SD, 51.0 ± 14.5 years; 51.6% women) undergoing polysomnography. After adjustment, each 1-h reduction in sleep duration was associated with a 1.17-fold (95% CI, 1.11-1.30) increased risk of prevalent atrial fibrillation. Among 27,589 patients without atrial fibrillation at baseline, we identified 1,820 cases of incident atrial fibrillation over 4.6 years median follow-up. After adjustment, each 1-h reduction in sleep duration was associated with a 1.09-fold (95% CI, 1.05-1.13) increased risk for incident atrial fibrillation. CONCLUSIONS Short sleep duration is independently associated with prevalent and incident atrial fibrillation. Further research is needed to determine whether interventions to extend sleep can lower atrial fibrillation risk.
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Affiliation(s)
- Michael V Genuardi
- Division of Cardiology, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA; Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Rachel P Ogilvie
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Aisha Rasool Saand
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | - Rebecca S DeSensi
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Melissa I Saul
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jared W Magnani
- Division of Cardiology, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA; Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
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Liu X, Zhu T, Manojlovich M, Cohen HW, Tsilimingras D. Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects. PLoS One 2017; 12:e0182807. [PMID: 28793323 PMCID: PMC5549965 DOI: 10.1371/journal.pone.0182807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/25/2017] [Indexed: 01/13/2023] Open
Abstract
Background Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP) and its subtypes (isolated uncontrolled systolic BP (SBP), uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP)) have not been investigated among diagnosed hypertensive subjects. Methods A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999–2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBP<90 mm Hg, uncontrolled SDBP as SBP≥140 and DBP≥90 mm Hg, and isolated uncontrolled DBP as SBP<140 and DBP≥90 mm Hg. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of uncontrolled BP and its subtypes were calculated using weighted logistic regression models. Results The interaction effect of race and smoking was significant after adjustment for the full potential confounding covariates (Adjusted p = 0.0412). Compared to never smokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56–0.90), although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58–0.95). However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10–2.65). Conclusion The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially vigilant with non-Hispanic black smokers with diagnosed hypertension.
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Affiliation(s)
- Xuefeng Liu
- Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America
- Frankel Cardiovascular Center, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
- * E-mail:
| | - Tinghui Zhu
- Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America
| | - Milisa Manojlovich
- Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America
| | - Hillel W. Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Dennis Tsilimingras
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States of America
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Zambrana RE, López L, Dinwiddie GY, Ray RM, Eaton CB, Phillips LS, Wassertheil-Smoller S. Association of Baseline Depressive Symptoms with Prevalent and Incident Pre-Hypertension and Hypertension in Postmenopausal Hispanic Women: Results from the Women's Health Initiative. PLoS One 2016; 11:e0152765. [PMID: 27124184 PMCID: PMC4849764 DOI: 10.1371/journal.pone.0152765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/19/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Depression and depressive symptoms are risk factors for hypertension (HTN) and cardiovascular disease (CVD). Hispanic women have higher rates of depressive symptoms compared to other racial/ethnic groups yet few studies have investigated its association with incident prehypertension and hypertension among postmenopausal Hispanic women. This study aims to assess if an association exists between baseline depression and incident hypertension at 3 years follow-up among postmenopausal Hispanic women. METHODS Prospective cohort study, Women's Health Initiative (WHI), included 4,680 Hispanic women who participated in the observational and clinical trial studies at baseline and at third-year follow-up. Baseline current depressive symptoms and past depression history were measured as well as important correlates of depression-social support, optimism, life events and caregiving. Multinomial logistic regression was used to estimate prevalent and incident prehypertension and hypertension in relation to depressive symptoms. RESULTS Prevalence of current baseline depression ranged from 26% to 28% by hypertension category and education moderated these rates. In age-adjusted models, women with depression were more likely to be hypertensive (OR = 1.25; 95% CI 1.04-1.51), although results were attenuated when adjusting for covariates. Depression at baseline in normotensive Hispanic women was associated with incident hypertension at year 3 follow-up (OR = 1.74; 95% CI 1.10-2.74) after adjustment for insurance and behavioral factors. However, further adjustment for clinical covariates attenuated the association. Analyses of psychosocial variables correlated with depression but did not alter findings. Low rates of antidepressant medication usage were also reported. CONCLUSIONS In the largest longitudinal study to date of older Hispanic women which included physiologic, behavioral and psychosocial moderators of depression, there was no association between baseline depressive symptoms and prevalent nor incident pre-hypertension and hypertension. We found low rates of antidepressant medication usage among Hispanic women suggesting a possible point for clinical intervention. TRIAL REGISTRATION Clinicaltrials.gov NCT00000611.
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Affiliation(s)
- Ruth E. Zambrana
- Department of Women’s Studies, Consortium on Race, Gender and Ethnicity, University of Maryland, College Park, Maryland, United States of America
| | - Lenny López
- Division of Hospital Medicine, University of California, San Francisco, California, United States of America
| | - Gniesha Y. Dinwiddie
- African American Studies Department, University of Maryland, College Park, Maryland, United States of America
| | - Roberta M. Ray
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Charles B. Eaton
- Family Medicine & Epidemiology, Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
| | - Lawrence S. Phillips
- Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
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Lafata JE, Karter AJ, O'Connor PJ, Morris H, Schmittdiel JA, Ratliff S, Newton KM, Raebel MA, Pathak RD, Thomas A, Butler MG, Reynolds K, Waitzfelder B, Steiner JF. Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes. J Gen Intern Med 2016; 31:188-195. [PMID: 26282954 PMCID: PMC4720651 DOI: 10.1007/s11606-015-3486-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Among patients with diabetes, racial differences in cardiometabolic risk factor control are common. The extent to which differences in medication adherence contribute to such disparities is not known. We examined whether medication adherence, controlling for treatment intensification, could explain differences in risk factor control between black and white patients with diabetes. METHODS We identified three cohorts of black and white patients treated with oral medications and who had poor risk factor control at baseline (2009): those with glycated hemoglobin (HbA1c) >8 % (n = 37,873), low-density lipoprotein cholesterol (LDL-C) >100 mg/dl (n = 27,954), and systolic blood pressure (SBP) >130 mm Hg (n = 63,641). Subjects included insured adults with diabetes who were receiving care in one of nine U.S. integrated health systems comprising the SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) consortium. Baseline and follow-up risk factor control, sociodemographic, and clinical characteristics were obtained from electronic health records. Pharmacy-dispensing data were used to estimate medication adherence (i.e., medication refill adherence [MRA]) and treatment intensification (i.e., dose increase or addition of new medication class) between baseline and follow-up. County-level income and educational attainment were estimated via geocoding. Logistic regression models were used to test the association between race and follow-up risk factor control. Models were specified with and without medication adherence to evaluate its role as a mediator. RESULTS We observed poorer medication adherence among black patients than white patients (p < 0.01): 50.6 % of blacks versus 39.7 % of whites were not highly adherent (i.e., MRA <80 %) to HbA1c oral medication(s); 58.4 % of blacks and 46.7 % of whites were not highly adherent to lipid medication(s); and 33.4 % of blacks and 23.7 % of whites were not highly adherent to BP medication(s). Across all cardiometabolic risk factors, blacks were significantly less likely to achieve control (p < 0.01): 41.5 % of blacks and 45.8 % of whites achieved HbA1c <8 %; 52.6 % of blacks and 60.8 % of whites achieved LDL-C <100; and 45.7 % of blacks and 53.6 % of whites achieved SBP <130. Adjusting for medication adherence/treatment intensification did not alter these patterns or model fit statistics. CONCLUSIONS Medication adherence failed to explain observed racial differences in the achievement of HbA1c, LDL-C, and SBP control among insured patients with diabetes.
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Affiliation(s)
- Jennifer Elston Lafata
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
- Henry Ford Health System, Detroit, MI, USA.
- Department of Social and Behavioral Health, Virginia Commonwealth University, PO Box 980149, Richmond, VA, 23298, USA.
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patrick J O'Connor
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | | | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Scott Ratliff
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | | | - Melissa G Butler
- Kaiser Permanente Georgia Center for Health Research- Southeast, Atlanta, GA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Beth Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research - Hawaii, Honolulu, HI, USA
| | - John F Steiner
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
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Shahul S, Tung A, Minhaj M, Nizamuddin J, Wenger J, Mahmood E, Mueller A, Shaefi S, Scavone B, Kociol RD, Talmor D, Rana S. Racial Disparities in Comorbidities, Complications, and Maternal and Fetal Outcomes in Women With Preeclampsia/eclampsia. Hypertens Pregnancy 2015; 34:506-515. [PMID: 26636247 DOI: 10.3109/10641955.2015.1090581] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The mechanisms leading to worse outcomes in African-American (AA) women with preeclampsia/eclampsia remain unclear. Our objective was to identify racial differences in maternal comorbidities, peripartum characteristics, and maternal and fetal outcomes. METHODS/RESULTS When compared to white women with preeclampsia/eclampsia, AA women had an increased unadjusted risk of inpatient maternal mortality (OR 3.70, 95% CI: 2.19-6.24). After adjustment for covariates, in-hospital mortality for AA women remained higher than that for white women (OR 2.85, 95% CI: 1.38-5.53), while the adjusted risk of death among Hispanic women did not differ from that for white women. We also found an increased risk of intrauterine fetal death (IUFD) among AA women. When compared to white women with preeclampsia, AA women had an increased unadjusted odds of IUFD (OR 2.78, 95% CI: 2.49-3.11), which remained significant after adjustment for covariates (adjusted OR 2.45, 95% CI: 2.14-2.82). In contrast, IUFD among Hispanic women did not differ from that for white women after adjusting for covariates. CONCLUSIONS AND RELEVANCE Our data suggest that African-American women are more likely to have risk factors for preeclampsia and more likely to suffer an adverse outcome during peripartum care. Future research should examine whether controlling co-morbidities and other risk factors will help to alleviate racial disparities in outcomes in this cohort of women.
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Affiliation(s)
- Sajid Shahul
- a Department of Anesthesia and Critical Care , University of Chicago , Chicago , IL , USA
| | - Avery Tung
- a Department of Anesthesia and Critical Care , University of Chicago , Chicago , IL , USA
| | - Mohammed Minhaj
- a Department of Anesthesia and Critical Care , University of Chicago , Chicago , IL , USA
| | - Junaid Nizamuddin
- a Department of Anesthesia and Critical Care , University of Chicago , Chicago , IL , USA
| | - Julia Wenger
- c Division of Nephrology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Eitezaz Mahmood
- b Department of Anesthesiology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Ariel Mueller
- b Department of Anesthesiology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Shahzad Shaefi
- b Department of Anesthesiology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Barbara Scavone
- a Department of Anesthesia and Critical Care , University of Chicago , Chicago , IL , USA
| | - Robb D Kociol
- d Department of Medicine , CardioVascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Daniel Talmor
- b Department of Anesthesiology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Sarosh Rana
- e Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology , University of Chicago , Chicago , IL , USA
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Mallat SG, Samra SA, Younes F, Sawaya MT. Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey -- I-PREDICT. BMC Public Health 2014; 14:1142. [PMID: 25373466 PMCID: PMC4246605 DOI: 10.1186/1471-2458-14-1142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood Pressure (BP) is not well controlled and factors that predict BP control are not well identified in Lebanon. Improvement of hypertension management requires an understanding of patients' characteristics and factors associated with uncontrolled BP. This national, multicentric, observational prospective study was designed to determine the predictors of BP control in patients followed up to 6 months. METHODS I-PREDICT study was conducted on 988 patients with newly diagnosed or uncontrolled hypertension. Socio-demographic and clinical characteristics were analyzed. The level of agreement between doctors' perceptions on BP control status and JNC VII guidelines was analyzed. RESULTS The predictor associated with poor BP control was diabetes (OR = 0.17, CI = 0.10-0.28 at month-1; OR = 0.15, CI = 0.10-0.24 at month-6). The predictors associated with better BP control at month-6 were the early control of BP at month-1 (OR = 10.39, CI = 6.18-17.47) and combination therapy prescribed at baseline and month-1 (OR = 15.14, CI = 1.09-208.46, P = 0.04). In the sub-group of diabetes, the predictors that were associated with better BP control at 6 months were following diet at V1 (OR = 2.27, CI = 1.01 to 5.12) and BP control at V2 (OR = 7.34, CT = 3.83 to 14.07). The predictors that were associated with poor BP control at 6 months were middle economic class (OR = 0.036, CI = 0.16-0.94) and upper economic class (OR = 0.036; CI = 0.13-0.93).The rate of BP control was significantly higher at month 6 versus month 1 (67.52% vs 44.08%, P = 0.001). Additional analysis showed poor agreement between the doctors' perceptions on BP control status and the guidelines. CONCLUSIONS Reaching an early BP control and combination therapy were significant predictors of better BP control, whereas diabetes was a significant predictor of poor BP control. A poor agreement between JNC VII guidelines and clinical practice was observed. I-PREDICT study identified factors that can be targeted for improving BP control.
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Affiliation(s)
- Samir G Mallat
- Department of Internal Medicine, American University of Beirut, Riad El-Solh, P,O, Box 11-0236, Beirut 11072020, Lebanon.
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Okwuonu CG, Ojimadu NE, Okaka EI, Akemokwe FM. Patient-related barriers to hypertension control in a Nigerian population. Int J Gen Med 2014; 7:345-53. [PMID: 25061335 PMCID: PMC4086668 DOI: 10.2147/ijgm.s63587] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria. METHODS This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication. RESULTS A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants. CONCLUSION Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.
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Affiliation(s)
| | | | - Enajite Ibiene Okaka
- Renal Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, Nigeria
| | - Fatai Momodu Akemokwe
- Neurology Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, Nigeria
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Sánchez V, Cacari Stone L, Moffett ML, Nguyen P, Muhammad M, Bruna S, Urias-Chauvin R. Process evaluation of a promotora de salud intervention for improving hypertension outcomes for Latinos living in a rural U.S.-Mexico border region. Health Promot Pract 2014; 15:356-64. [PMID: 24396118 DOI: 10.1177/1524839913516343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertension is a growing public health problem for U.S.-Mexico border Latinos, who commonly experience low levels of awareness, treatment, and control. We report on a process evaluation that assessed the delivery of Corazón por la Vida, a 9-week promotora de salud-led curriculum to help Latinos manage and reduce hypertension risks in two rural/frontier counties in the New Mexico border region. Ninety-six adults participated in the program, delivered in three waves and in three communities. We assessed program delivery and quality, adherence, exposure, and participant responsiveness. Participant outcome measures included self-reported eating and physical activities and assessment of community resources. Findings suggest that the program was fully delivered (99%) and that most participants (81.7%) were very satisfied with the educational sessions. The average participant attendance for educational sessions was 77.47%. We found significant differences in self-reported behavioral changes depending on the number of sessions completed: The higher the dose of sessions, the better the self-reported outcomes. These findings suggest that a promotora-led curriculum may be useful for promoting self-management of chronic disease in rural/frontier border Latino populations. Future evaluation should focus on training and implementation adaptations within evidence-based chronic disease programs for diverse Latino communities.
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Olomu AB, Gourineni V, Huang JL, Pandya N, Efeovbokhan N, Samaraweera J, Parashar K, Holmes-Rovner M. Rate and predictors of blood pressure control in a federal qualified health center in Michigan: a huge concern? J Clin Hypertens (Greenwich) 2013; 15:254-63. [PMID: 23551725 PMCID: PMC8033927 DOI: 10.1111/jch.12067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/04/2012] [Accepted: 12/13/2012] [Indexed: 12/24/2022]
Abstract
Hypertension (HTN) is particularly burdensome in low-income groups. Federal-qualified health centers (FQHCs) provide care for low-income and medically underserved populations. To assess the rates and predictors of blood pressure (BP) control in an FQHC in Michigan, a retrospective analysis of all patients with HTN, coronary artery disease, and/or diabetes mellitus (DM) seen between January 2006 and December 2008 was conducted. Of 212 patients identified, 154 had a history of HTN and 122 had DM. BP control was achieved in 38.2% of the entire cohort and in 31.1% of patients with DM. The mean age was lower in patients with controlled BP in both the total population (P=.05) and the DM subgroup (P=.02). A logistic regression model found only female sex (odds ratio, 2.27; P=.02) to be associated with BP control and a trend towards an association of age with uncontrolled BP (odds ratio, 0.97; P=.06). BP control in nondiabetics was 47.8% vs 31.1% in diabetic patients (P=.02). We found that patients who attended the FQHC had a lower rate of BP control compared with the national average. Our study revealed a male sex disparity and significantly lower rate of BP control among DM patients.
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Affiliation(s)
- Adesuwa B Olomu
- College of Human Medicine, Michigan State University, East Lansing, MI, USA.
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Salem RM, Pandey B, Richard E, Fung MM, Garcia EP, Brophy VH, Schork NJ, O'Connor DT, Bhatnagar V. The VA Hypertension Primary Care Longitudinal Cohort: Electronic medical records in the post-genomic era. Health Informatics J 2012; 16:274-86. [PMID: 21216807 DOI: 10.1177/1460458210380527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Veterans Affairs Hypertension Primary Care Longitudinal Cohort (VAHC) was initiated in 2003 as a pilot study designed to link the VA electronic medical record system with individual genetic data. Between June 2003 and December 2004, 1,527 hypertensive participants were recruited. Protected health information (PHI) was extracted from the regional VA data warehouse. Differences between the clinic and mail recruits suggested that clinic recruitment resulted in an over-sampling of African Americans. A review of medical records in a random sample of study participants confirmed that the data warehouse accurately captured most selected diagnoses. Genomic DNA was acquired non-invasively from buccal cells in mouthwash; ~ 96.5 per cent of samples contained DNA suitable for genotyping, with an average DNA yield of 5.02 ± 0.12 micrograms, enough for several thousand genotypes. The coupling of detailed medical databases with genetic information has the potential to facilitate the genetic study of hypertension and other complex diseases.
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Shelley D, Tseng TY, Andrews H, Ravenell J, Wu D, Ferrari P, Cohen A, Millery M, Kopal H. Predictors of blood pressure control among hypertensives in community health centers. Am J Hypertens 2011; 24:1318-23. [PMID: 21866185 DOI: 10.1038/ajh.2011.154] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The correlates of blood pressure (BP) control among hypertensive individuals who have access to care in community-based health-care settings are poorly characterized, particularly among minority and immigrant populations. METHODS Using data extracted from electronic medical records in four federally qualified health centers in New York, we investigated correlates of hypertension (HTN) control in cross-sectional analyses. The sample consisted of adult, nonobstetric patients with a diagnosis of HTN and a clinic visit between June 2007 and October 2008 (n = 2,585). RESULTS Forty-nine percent of hypertensive patients had controlled BP at their last visit. Blacks had a higher prevalence of HTN (B, 32.8%; W, 16.2%; H, 11.5%) and were less likely to have controlled BP (B, 42.2%; W, 50.9%; H, 50.8%) compared with Hispanics and whites. Medication intensification did not differ by race/ethnicity. In multivariate analyses higher body mass index (BMI), black race, diabetes, fewer clinical encounters, and male gender were associated with poor BP control. However, when we applied the Seventh Report of the Joint National Committee (JNC 7) definition for BP control for nondiabetic patients (systolic blood pressure (SBP) <140, diastolic blood pressure (DBP) <90) to all patients with HTN, we found no difference in BP control between those with and without diabetes. CONCLUSIONS Blacks had poorer HTN control compared with whites and Hispanics. Significant discrepancies in BP control between hypertensive patients with and without diabetes may be related to a lack of provider adherence to JNC 7 guidelines that define BP control in this population as <130/80. Further research is needed to understand racial disparities in BP control as well as factors influencing clinician's management of BP among patients with diabetes.
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Affiliation(s)
- Donna Shelley
- Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
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Racial and ethnic differences in longitudinal blood pressure control in veterans with type 2 diabetes mellitus. J Gen Intern Med 2011; 26:1278-83. [PMID: 21671132 PMCID: PMC3208462 DOI: 10.1007/s11606-011-1752-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 04/13/2011] [Accepted: 05/18/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have examined racial/ethnic differences in blood pressure (BP) control over time, especially in an equal access system. We examined racial/ethnic differences in longitudinal BP control in Veterans with type 2 diabetes. METHODS We collected data on a retrospective cohort of 5,319 Veterans with type 2 diabetes and initially uncontrolled BP followed from 1996 to 2006 at a Veterans Administration (VA) facility in the southeastern United States. The mean blood pressure value for each subject for each year was used for the analysis with BP control defined as <140/<90 mmHg. The primary outcome measure was proportion with controlled BP. The main predictor variable was race/ethnicity categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic/Other (H/O). Other covariates included age, gender, employment, marital status, service connectedness, and ICD-9 coded medical and psychiatric comorbidities. Generalized linear mixed models were used to assess the relationship between race/ethnicity and BP control after adjusting for covariates. RESULTS Mean follow-up was 5.0 years. The sample was 46% NHW, 26% NHB, 19% H/O, and 9% unknown. The average age was 68 years. In the final model, after adjusting for covariates, NHB race (OR = 1.38, 95%CI: 1.2, 1.6) and H/O race (OR = 1.57, 95% CI: 1.3, 1.8) were associated with increased likelihood of poor BP control (>140/>90 mmHg) over time compared to NHW patients. CONCLUSION Ethnic minority Veterans with type 2 diabetes have significantly increased odds of poor BP control over ∼5 years of follow-up compared to their non-Hispanic White counterparts independent of sociodemographic factors and comorbidity patterns.
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Nguyen QC, Needham Waddell E, Kerker BD, Gwynn RC, Thomas JC, Huston SL. Awareness, treatment, and control of hypertension and hypercholesterolemia among insured residents of New York City, 2004. Prev Chronic Dis 2011; 8:A109. [PMID: 21843412 PMCID: PMC3181182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Health care access and sociodemographic characteristics may influence chronic disease management even among adults who have health insurance. The objective of this study was to examine awareness, treatment, and control of hypertension and hypercholesterolemia, by health care access and sociodemographic characteristics, among insured adults in New York City. METHODS Using data from the 2004 New York City Health and Nutrition Examination Survey, we investigated inequalities in the diagnosis and management of hypertension and hypercholesterolemia among insured adults aged 20 to 64 years (n = 1,334). We assessed differences in insurance type (public, private) and routine place of care (yes, no), by sociodemographic characteristics. RESULTS One in 10 participants with hypertension and 3 in 10 with hypercholesterolemia were unaware and untreated. Having a routine place of care was associated with treatment and control of hypertension and with awareness, treatment, and control of hypercholesterolemia, after adjusting for insurance type, age, sex, race/ethnicity, foreign birth, income, and education. Differences in systolic blood pressure and total cholesterol between people with versus without a routine place of care were 2 to 3 times the difference found between people with public versus private insurance. Few differences were associated with sociodemographic characteristics after adjusting for routine place of care and insurance type; however, male sex, younger age, Asian race, and foreign birth with short-term US residence reduced the odds of having a routine place of care. Neither income nor education predicted having a routine place of care. CONCLUSION Sociodemographic characteristics may influence chronic disease management among the insured through health care access factors such as having a routine place of care.
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Affiliation(s)
- Quynh C. Nguyen
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health
| | - Elizabeth Needham Waddell
- Mailman School of Public Health, Columbia University, New York, New York. At the time of the study, Dr Waddell was affiliated with the New York City Department of Health and Mental Hygiene
| | - Bonnie D. Kerker
- New York City Department of Health and Mental Hygiene, New York, New York
| | - R. Charon Gwynn
- Mailman School of Public Health, Columbia University, New York, New York. At the time of the study, Dr Gwynn was affiliated with the New York City Department of Health and Mental Hygiene
| | - James C. Thomas
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Sara L. Huston
- Maine Center for Disease Control and Prevention, Augusta, Maine, and University of Southern Maine, Portland, Maine. At the time of the study, Dr Huston was affiliated with the University of North Carolina Gillings School of Global Public Health
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Liu R, So L, Mohan S, Khan N, King K, Quan H. Cardiovascular risk factors in ethnic populations within Canada: results from national cross-sectional surveys. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2010; 4:e143-53. [PMID: 21687334 PMCID: PMC3090103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/06/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differences in the prevalence of cardiovascular disease and associated risk factors have been noted across ethnic groups both within and between countries. The Canadian population is becoming increasingly diverse because of immigration. Understanding ethnic differences in cardiovascular risk factors is critically important in planning appropriate prevention strategies for the country's rapidly changing population. We sought to examine the prevalence of cardiovascular risk factors in various Canadian ethnic groups. METHODS We analyzed 3 cross-sectional cycles (for 2000, 2003 and 2005) of the Canadian Community Health Survey of people aged 12 years and older. The surveys were conducted by means of self-reported questionnaires. We used stratified analysis to evaluate the relation between risk factors and ethnicity. The effect of participants' ethnicity on the prevalence of risk factors was estimated by means of logistic regression, with adjustment for differences in age, sex, marital status, education, household income, language spoken, immigration status, residency type (urban or rural), household size, region (province or territory) and chronic diseases (heart disease, stroke, cancer, bronchitis, chronic obstructive pulmonary disease, bowel disease, arthritis, epilepsy, ulcers, thyroid disease and diabetes mellitus). RESULTS We included 371 154 individuals in the analysis. Compared with white people, people from visible minorities (i.e., neither white nor Aboriginal) had a lower prevalence of diabetes mellitus (4.5% v. 4.0%), hypertension (14.7% v. 10.8%), smoking (20.4% v. 9.7%) and obesity (defined as body mass index ≥ 30; 14.8% v. 9.7%) but a higher prevalence of physical inactivity (50.3% v. 58.1%). More specifically, after adjustment for sociodemographic characteristics, people from most visible minorities, in comparison with the white population, were less likely to smoke; were more likely to be physically inactive, with the exception of people of Korean, Japanese and Latin ethnicity; and were less likely to be obese, with the exception of people of black, Latin, Arab or West Asian ethnicity. However, relative to white people, hypertension was more prevalent among those of Filipino or South East Asian background (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.23-1.93) and those of black ancestry (OR 1.69, 95% CI 1.43-2.00). INTERPRETATION Cardiovascular risk factors vary dramatically by ethnic group. Health professionals should increase their promotion of physical activity among visible minorities and should prioritize the detection and control of diabetes and hypertension during routine contact with patients of visible minorities, particularly those of South Asian, Filipino and black ethnicity.
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Hebert K, Beltran J, Tamariz L, Julian E, Dias A, Trahan P, Arcement L. Evidence-Based Medication Adherence in Hispanic Patients With Systolic Heart Failure in a Disease Management Program. ACTA ACUST UNITED AC 2010; 16:175-80. [DOI: 10.1111/j.1751-7133.2010.00150.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eamranond PP, Wee CC, Legedza ATR, Marcantonio ER, Leveille SG. Acculturation and cardiovascular risk factor control among Hispanic adults in the United States. Public Health Rep 2009; 124:818-24. [PMID: 19894424 DOI: 10.1177/003335490912400609] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We sought to determine whether low acculturation, based on language measures, leads to disparities in cardiovascular risk factor control in U.S. Hispanic adults. METHODS We studied 4729 Hispanic adults aged 18 to 85 years from the National Health and Nutrition Examination Survey, 1999-2004. We examined the association between acculturation and control of low-density lipoprotein (LDL) cholesterol, blood pressure, and hemoglobin A1c based on national guidelines among participants with hypercholesterolemia, hypertension, and diabetes, respectively. We used weighted logistic regression adjusting for age, gender, and education. We then examined health insurance, having a usual source of care, body mass index, fat intake, and leisure-time physical activity as potential mediators. RESULTS Among participants with hypercholesterolemia, Hispanic adults with low acculturation were significantly more likely to have poorly controlled LDL cholesterol than Hispanic adults with high acculturation after multivariable adjustment (odds ratio [OR] = 3.4, 95% confidence interval [CI] 1.2, 9.5). Insurance status mildly attenuated the difference in LDL cholesterol control. After adjusting for diet and physical activity, the magnitude of the association increased. Other covariates had little influence on the observed relationship. Among those with diabetes and hypertension, we did not observe statistically significant associations between low acculturation and control of hemoglobin A1c (OR = 0.5, 95% CI 0.2, 1.2), and blood pressure (OR = 1.1, 95% CI 0.6, 1.7), respectively. CONCLUSIONS Low levels of acculturation may be associated with increased risk of inadequate LDL cholesterol control among Hispanic adults with hypercholesterolemia. Further studies should examine the mechanisms by which low acculturation might adversely impact lipid control among Hispanic adults in the U.S.
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Affiliation(s)
- Pracha P Eamranond
- Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA, USA.
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Hope OA, Zeber JE, Kressin NR, Bokhour BG, VanCott AC, Cramer JA, Amuan ME, Knoefel JE, Pugh MJ. New-onset geriatric epilepsy care: Race, setting of diagnosis, and choice of antiepileptic drug. Epilepsia 2009; 50:1085-93. [DOI: 10.1111/j.1528-1167.2008.01892.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T, Phillips E, Spencer J, Allegrante JP. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens 2008; 21:1137-43. [PMID: 18654123 PMCID: PMC3747638 DOI: 10.1038/ajh.2008.240] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Poor medication adherence is a significant problem in hypertensive African Americans. Although motivational interviewing (MINT) is effective for adoption and maintenance of health behaviors in patients with chronic diseases, its effect on medication adherence remains untested in this population. METHODS This randomized controlled trial tested the effect of a practice-based MINT counseling vs. usual care (UC) on medication adherence and blood pressure (BP) in 190 hypertensive African Americans (88% women; mean age 54 years). Patients were recruited from two community-based primary care practices in New York City. The primary outcome was adherence measured by electronic pill monitors; the secondary outcome was within-patient change in office BP from baseline to 12 months. RESULTS Baseline adherence was similar in both groups (56.2 and 56.6% for MINT and UC, respectively, P = 0.94). Based on intent-to-treat analysis using mixed-effects regression, a significant time x group interaction with model-predicted posttreatment adherence rates of 43 and 57% were found in the UC and MINT groups, respectively (P = 0.027), with a between-group difference of 14% (95% confidence interval, -0.2 to -27%). The between-group difference in systolic and diastolic BP was -6.1 mm Hg (P = 0.065) and -1.4 mm Hg (P = 0.465), respectively, in favor of the MINT group. CONCLUSIONS A practice-based MINT counseling led to steady maintenance of medication adherence over time, compared to significant decline in adherence for UC patients. This effect was associated with a modest, nonsignificant trend toward a net reduction in systolic BP in favor of the MINT group.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Medicine, New York University School of Medicine, New York, New York, USA.
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Jones S, Howard L, Thornicroft G. 'Diagnostic overshadowing': worse physical health care for people with mental illness. Acta Psychiatr Scand 2008; 118:169-71. [PMID: 18699951 DOI: 10.1111/j.1600-0447.2008.01211.x] [Citation(s) in RCA: 244] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hicks LS, Sequist TD, Ayanian JZ, Shaykevich S, Fairchild DG, Orav EJ, Bates DW. Impact of computerized decision support on blood pressure management and control: a randomized controlled trial. J Gen Intern Med 2008; 23:429-41. [PMID: 18373141 PMCID: PMC2359515 DOI: 10.1007/s11606-007-0403-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients. METHODS We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms. MEASUREMENTS AND MAIN RESULTS Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P < 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity. CONCLUSIONS CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.
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Affiliation(s)
- Leroi S Hicks
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev 2007; 64:29S-100S. [PMID: 17881625 PMCID: PMC2367222 DOI: 10.1177/1077558707305416] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Racial and ethnic disparities in cardiovascular health care are well documented. Promising approaches to disparity reduction are increasingly described in literature published since 1995, but reports are fragmented by risk, condition, population, and setting. The authors conducted a systematic review of clinically oriented studies in communities of color that addressed hypertension, hyperlipidemia, physical inactivity, tobacco, and two major cardiovascular conditions, coronary artery disease and heart failure. Virtually no literature specifically addressed disparity reduction. The greatest focus has been African American populations, with relatively little work in Hispanic, Asian, and Native American populations. The authors found 62 interventions, 27 addressing hypertension, 9 lipids, 18 tobacco use, 8 physical inactivity, and 7 heart failure. Only 1 study specifically addressed postmyocardial infarction care. Data supporting the value of registries, multidisciplinary teams, and community outreach were found across several conditions. Interventions addressing care transitions, using telephonic outreach, and promoting medication access and adherence merit further exploration.
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Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22:465-75. [PMID: 17144789 DOI: 10.1359/jbmr.061113] [Citation(s) in RCA: 2745] [Impact Index Per Article: 161.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study predicts the burden of incident osteoporosis-related fractures and costs in the United States, by sex, age group, race/ethnicity, and fracture type, from 2005 to 2025. Total fractures were >2 million, costing nearly $17 billion in 2005. Men account for >25% of the burden. Rapid growth in the disease burden is projected among nonwhite populations. INTRODUCTION The aging of the U.S. population will likely lead to greater prevalence of osteoporosis. Policy makers require precise projections of the disease burden by demographic subgroups and skeletal sites to effectively target osteoporosis intervention and treatment programs. MATERIALS AND METHODS A state transition Markov decision model was used to estimate total incident fractures and costs by age, sex, race/ethnicity, and skeletal site for the U.S. population 50 years of age for 2005-2025. RESULTS More than 2 million incident fractures at a cost of $17 billion are predicted for 2005. Total costs including prevalent fractures are more than $19 billion. Men account for 29% of fractures and 25% of costs. Total incident fractures by skeletal site were vertebral (27%), wrist (19%), hip (14%), pelvic (7%), and other (33%). Total costs by fracture type were vertebral (6%), hip (72%), wrist (3%), pelvic (5%), and other (14%). By 2025, annual fractures and costs are projected to rise by almost 50%. The most rapid growth is estimated for people 65-74 years of age, with an increase>87%. An increase of nearly 175% is projected for Hispanic and other subpopulations. CONCLUSIONS Osteoporosis prevention, treatment, and education efforts should address all skeletal sites, not just hip and vertebral, and appropriate attention is warranted for men and diverse race/ethnicity subgroups.
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Affiliation(s)
- Russel Burge
- Procter and Gamble Pharmaceuticals & Personal Health, Mason, OH, USA
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