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Case MA, Boorman EP, Ruvalcaba E, Vest MT, Hansel NN, Putcha N, Eakin MN. Guideline Alignment and Medication Concordance in COPD. CHEST PULMONARY 2024; 2:100017. [PMID: 38645884 PMCID: PMC11027369 DOI: 10.1016/j.chpulm.2023.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD. RESEARCH QUESTION To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes. STUDY DESIGN AND METHODS This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression. RESULTS Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance. INTERPRETATION Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.
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Affiliation(s)
- Meredith A Case
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Eric P Boorman
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Michael T Vest
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE
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Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 114:107847. [PMID: 37331280 PMCID: PMC11184508 DOI: 10.1016/j.pec.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. METHODS This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. RESULTS Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. CONCLUSIONS Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. PRACTICE IMPLICATION Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, VA Boston Healthcare System, Boston, USA; HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA.
| | - Marianne S Matthias
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA; University of Minnesota, Department of Medicine, Minneapolis, USA
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Burdzy A, Dai M, Nagubandi V, Nguyen M, Marten C, Paul-Quinn J. Tackling Health Inequities: A Unique, Asynchronous Course Designed Through Peer-to-Peer Methods. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231203917. [PMID: 37822776 PMCID: PMC10563473 DOI: 10.1177/23821205231203917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES This study investigates the efficacy and feasibility of an asynchronous, peer-to-peer health disparities enrichment course on postbaccalaureate prehealth students' knowledge, behaviors, and reaction to course materials. INTRODUCTION Growing awareness of social inequities has prompted educators of prehealth and medical students to explore student education by addressing systemic healthcare issues. This cross-sectional study assessed reactions, learning, and self-reported behavior changes in students after taking the course "Social Determinants, Disparities, and Preparing for the Future of Healthcare" (SDDH). METHODS The curriculum was designed by prehealth postbaccalaureate students for their peers. Course goals were to educate participants on social determinants of health and to build cultural and structural competence in their roles as future healthcare professionals. SDDH is an asynchronous, noncredit-bearing, 5-h online course with 10 modules covering various topics. The Kirkpatrick Model was used to assess the effectiveness of the curriculum, alongside qualitative and quantitative analyses of student performance. RESULTS Out of the 102 active students in the prehealth program that accepted the invitation to join, 29 students successfully completed the course (rate of completion = 28%). On average, students expressed positive reactions and attitudes toward the course and experienced an observable increase in knowledge assessment scores upon curriculum completion (P-value = .0002). Students' self-reported observations demonstrated sustained behavioral change 3 months after course completion. CONCLUSION It is critical to educate prehealth students on health disparities, structural, and cultural competence. A course such as SDDH may help prehealth students build effective communication skills for advocacy and develop an empathetic, patient-centered approach earlier on in their career pursuit. Some barriers to students completing the entire course include its length, uncredited status, and voluntary self-enrollment.
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Affiliation(s)
- Alexander Burdzy
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Dai
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Veda Nagubandi
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - My Nguyen
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sage Bionetworks, Seattle, Washington, USA
| | - Carly Marten
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sage Bionetworks, Seattle, Washington, USA
| | - Jennifer Paul-Quinn
- Penn Pre-Health Programs, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Wallace-Farquharson T, Rhee H, Duckworth L, Elder JH, Wilkie DJ. Children's and adolescents' descriptors of asthma symptoms: An integrative review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100063. [PMID: 38745641 PMCID: PMC11080484 DOI: 10.1016/j.ijnsa.2022.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 01/03/2023] Open
Abstract
Background Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms-how it is perceived and reported-remain challenging in pediatric clinical and research settings. Objective To synthesize the existing pediatric literature on children's and adolescents' word descriptors of asthma symptoms. Methods In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents' word descriptors of asthma symptoms. Results The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents' descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. 'helpless', 'afraid of dying') and sensory words (e.g. 'pressure in chest', 'tightness, lungs feel shut') to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking. Conclusions Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents' experience of asthma symptoms.
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Affiliation(s)
| | - Hyekyun Rhee
- School of Nursing, University of Texas at Austin, Austin, TX, United States of America
| | - Laurie Duckworth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States of America
| | | | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States of America
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Leung T, Burgess DJ, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Slaven JE, O'Connor C, Walker K, Zou DS, Austin E, Akins J, Miller J, Chinman M, Matthias MS. Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study. JMIR Res Protoc 2022; 11:e37712. [PMID: 36066967 PMCID: PMC9490546 DOI: 10.2196/37712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. OBJECTIVE The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. METHODS This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. RESULTS Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. CONCLUSIONS Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37712.
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Affiliation(s)
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Teresa Damush
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Matthew J Bair
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Caitlin O'Connor
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Kiara Walker
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Denise S Zou
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Emily Austin
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - John Akins
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - James Miller
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care, Pittsburgh, PA, United States.,RAND Corporation Pittsburgh Office, Pittsburgh, PA, United States
| | - Marianne S Matthias
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Atkinson RB, Khubchandani JA, Chun MBJ, Reidy E, Ortega G, Bain PA, Demko C, Barreiro-Rosado J, Kent TS, Smink DS. Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review. J Grad Med Educ 2022; 14:37-52. [PMID: 35222820 PMCID: PMC8848887 DOI: 10.4300/jgme-d-21-00414.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. OBJECTIVE The authors sought to determine what cultural competency curricula exist specifically in GME. METHODS In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. RESULTS Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. CONCLUSIONS Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.
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Affiliation(s)
- Rachel B. Atkinson
- Rachel B. Atkinson, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Jasmine A. Khubchandani
- Jasmine A. Khubchandani, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Maria B. J. Chun
- Maria B. J. Chun, PhD, is a Specialist and Associate Chair in Administration and Finance, Department of Surgery, John A. Burns School of Medicine, University of Hawaii
| | - Emma Reidy
- Emma Reidy, MPH, is Senior Project Manager, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Gezzer Ortega
- Gezzer Ortega, MD, MPH, is Lead Faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical
| | - Paul A. Bain
- Paul A. Bain, PhD, is Reference and Instruction Librarian, Countway Library of Medicine, Harvard Medical School
| | - Caroline Demko
- Caroline Demko, is a First-Year Masters Student, Goldman School of Public Policy, University of California, Berkeley
| | - Jeenn Barreiro-Rosado
- Jeenn Barreiro-Rosado, is a Research Assistant, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Tara S. Kent
- Tara S. Kent, MD, MS, is Associate Professor of Surgery, Vice Chair for Education, and Program Director, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas S. Smink
- Douglas S. Smink, MD, MPH, is Chief of Surgery, Brigham and Women's Faulkner Hospital, Associate Chair of Education and Associate Professor of Surgery, and Core Faculty, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
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Kinahan JY, Graham JMI, Hébert YV, Sampson M, O'Hearn K, Klaassen RJ. Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:121-134. [PMID: 33136776 DOI: 10.1097/mph.0000000000001984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
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Affiliation(s)
- Julia Y Kinahan
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | - Johann M I Graham
- Children's Hospital of Eastern Ontario Research Institute
- Regional Hospital Center of Lanaudiere, Saint-Charles-Borromée
- Laval University, Quebec City, QC, Canada
| | - Yamilée V Hébert
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | | | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute
- Division of Hematology/Oncology, Department of Pediatrics
- University of Ottawa, Ottawa, ON
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Otto AK, Reblin M, Harper FWK, Hamel LM, Moore TF, Ellington L, Eggly S. Impact of Patients' Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists. JCO Oncol Pract 2021; 17:e676-e685. [PMID: 33411574 DOI: 10.1200/op.20.00820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists. METHODS This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other. RESULTS Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication. DISCUSSION Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Public Health Sciences at the University of Miami, Miami, FL
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Felicity W K Harper
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lauren M Hamel
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Tanina F Moore
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
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Russell EA, Tsai C, Linton JM. Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020; 21:100779. [PMID: 32922213 PMCID: PMC7480259 DOI: 10.1016/j.cpem.2020.100779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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Eliacin J, Matthias MS, Burgess DJ, Patterson S, Damush T, Pratt-Chapman M, McGovern M, Chinman M, Talib T, O'Connor C, Rollins A. Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:46-60. [PMID: 32399857 DOI: 10.1007/s10488-020-01048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.
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Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA.
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Department of Communication Studies, IUPUI, Indianapolis, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - Teresa Damush
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- General Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, George Washington University Cancer Center, Washington, DC, USA
| | - Mark McGovern
- Psychiatry & Behavioral Sciences; Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Chinman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Caitlin O'Connor
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
| | - Angela Rollins
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
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11
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Racial differences in user experiences and perceived value of electronic symptom monitoring in a cohort of black and white bladder and prostate cancer patients. Qual Life Res 2020; 30:3213-3227. [PMID: 32112276 DOI: 10.1007/s11136-020-02442-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Electronic patient-reported outcomes (ePROs) are increasingly being used for symptom monitoring during routine cancer care, but have rarely been evaluated in diverse patient populations. We assessed ePRO user experiences and perceived value among Black and White cancer patients. METHODS We recruited 30 Black and 49 White bladder and prostate cancer patients from a single institution. Participants reported symptoms using either a web-based or automated telephone interface over 3 months and completed satisfaction surveys and qualitative interviews focused on user experiences and value. Using a narrative mixed methods approach, we evaluated overall and race-specific differences in ePRO user experiences and perceived value. RESULTS Most participants selected the web-based system, but Blacks were more likely to use the automated telephone-based system than Whites. In satisfaction surveys, Whites more commonly reported ease in understanding and reporting symptoms compared with Blacks. Blacks more often reported that the ePRO system was helpful in facilitating symptom-related discussions with clinicians. During interviews, Blacks described how the ePRO helped them recognize symptoms, while Whites found value in better understanding and tracking symptoms longitudinally. Blacks also expressed preferences for paper-based ePRO options due to perceived ease in better understanding of symptom items. CONCLUSION Electronic patient-reported outcomes are perceived as valuable for variable reasons by Black and White cancer populations, with greater perceived value for communicating with clinicians reported among Blacks. To optimize equitable uptake of ePROs, oncology practices should offer several ePRO options (e.g., web-based, phone-based), as well as paper-based options, and consider the e-health literacy needs of patients during implementation.
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12
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Sezgin E, Noritz G, Elek A, Conkol K, Rust S, Bailey M, Strouse R, Chandawarkar A, von Sadovszky V, Lin S, Huang Y. Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint. J Med Internet Res 2020; 22:e14202. [PMID: 32053114 PMCID: PMC7055855 DOI: 10.2196/14202] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
Digital health tools and technologies are transforming health care and making significant impacts on how health and care information are collected, used, and shared to achieve best outcomes. As most of the efforts are still focused on clinical settings, the wealth of health information generated outside of clinical settings is not being fully tapped. This is especially true for children with medical complexity (CMC) and their families, as they frequently spend significant hours providing hands-on medical care within the home setting and coordinating activities among multiple providers and other caregivers. In this paper, a multidisciplinary team of stakeholders discusses the value of health information generated at home, how technology can enhance care coordination, and challenges of technology adoption from a patient-centered perspective. Voice interactive technology has been identified to have the potential to transform care coordination for CMC. This paper shares opinions on the promises, limitations, recommended approaches, and challenges of adopting voice technology in health care, especially for the targeted patient population of CMC.
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Affiliation(s)
- Emre Sezgin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Alexander Elek
- Family Advisory Council, Nationwide Children's Hospital, Columbus, OH, United States
| | - Kimberly Conkol
- Care Coordination and Utilization Management, Nationwide Children's Hospital, Columbus, OH, United States
| | - Steve Rust
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Matthew Bailey
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Robert Strouse
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Aarti Chandawarkar
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Simon Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Yungui Huang
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Abstract
Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.
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Affiliation(s)
- Shaunte McKay
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
| | - Victoria Parente
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
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Wasserman J, Palmer RC, Gomez MM, Berzon R, Ibrahim SA, Ayanian JZ. Advancing Health Services Research to Eliminate Health Care Disparities. Am J Public Health 2019; 109:S64-S69. [PMID: 30699021 PMCID: PMC6356134 DOI: 10.2105/ajph.2018.304922] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 11/04/2022]
Abstract
Findings from health services research highlight continuing health care disparities in the United States, especially in the areas of access to health care and quality of care. Although attention to health care disparities has increased, considerable knowledge gaps still exist. A better understanding of how cultural, behavioral, and health system factors converge and contribute to unequal access and differential care is needed. Research-informed approaches for reducing health care disparities that are feasible and capable of sustained implementation are needed to inform policymakers. More important, for health equity to be achieved, it is essential to create a health care system that provides access, removes barriers to care, and provides equally effective treatment to all persons living in the United States.
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Affiliation(s)
- Joan Wasserman
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Richard C Palmer
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Marcia M Gomez
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Rick Berzon
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - Said A Ibrahim
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
| | - John Z Ayanian
- Joan Wasserman and Richard C. Palmer are with the Office of Extramural Research Administration, National Institute on Minority Health and Health Disparities, Bethesda, MD. Marcia M. Gomez is with the Office of Strategic Planning, Legislation, and Scientific Policy, National Institute on Minority Health and Health Disparities. Rick Berzon is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities. Said A. Ibrahim was with the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. John Z. Ayanian is with the Institute for Healthcare Policy and Innovation; Division of General Medicine, Medical School; Department of Health Management and Policy, School of Public Health; and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor. Richard C. Palmer is also a Guest Editor for this supplement issue
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15
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Ward LM, Thomas J. Patient Perception of Physicians and Medication Adherence Among Older Adults With Hypertension. J Aging Health 2018; 32:95-105. [DOI: 10.1177/0898264318806390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: To assess association between patient perception of physicians and adherence to antihypertensive medication among Medicare beneficiaries. Method: Logistic regression was used to assess association between the Patient Perception of Physicians Scale score and adherence to antihypertensive medication. The 2007 Medicare Current Beneficiary Survey data were used to create a 12-item patient perception of physician scale and 2008 Medicare Part D claims to assess adherence. Results: There were 2,510 beneficiaries included in the sample. The mean age was 76.4 years ( SD = ±6.88 years). Sixty-five percent of the sample was adherent in filling their antihypertensive medication. Beneficiaries with more favorable perceptions of their physician (scores 37 or higher) were more likely to be adherent to antihypertensive medications than beneficiaries with scores less than 37 (odds ratio [OR] = 1.341, 95% confidence interval [CI] = [1.101, 1.632], p = .0035). Discussion: These findings provide some evidence that patient perceptions of their physician are associated with adherence, and that the physician–patient relationship is an important factor.
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Affiliation(s)
- Lori M. Ward
- University of Mississippi Medical Center, Jackson, MS, USA
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16
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Burbank AJ, Todoric K, Steele P, Rosen J, Zhou H, Frye M, Loughlin CE, Ivins S, Mills K, Massey LD, Reeve BB, Hernandez ML. Age and African-American race impact the validity and reliability of the asthma control test in persistent asthmatics. Respir Res 2018; 19:152. [PMID: 30111326 PMCID: PMC6094875 DOI: 10.1186/s12931-018-0858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
Background The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making. Methods Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6–8 weeks later. The ACT-based asthma control assessment was compared to physician assessment. Results For baseline and follow-up visits, internal consistency, as measured using Cronbach’s alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ≤19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ≤21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status. Conclusions Concerns for the ACT’s ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making. Trial registration ClinicalTrials.gov: NCT02671643, NCT02662413. Electronic supplementary material The online version of this article (10.1186/s12931-018-0858-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA. .,Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA.
| | - Krista Todoric
- Penn State Hershey Allergy, Asthma & Immunology, Hershey, PA, USA
| | - Pamela Steele
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Rosen
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Haibo Zhou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Marcia Frye
- Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC, USA
| | - Sally Ivins
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | - Katherine Mills
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, 104 Mason Farm Road, Chapel Hill, NC, 27599-7310, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle L Hernandez
- Division of Pediatric Allergy, Immunology and Rheumatology, University of North Carolina, Chapel Hill, NC, USA
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18
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Haw J, Cunningham S, O'Doherty KC. Epistemic tensions between people living with asthma and healthcare professionals in clinical encounters. Soc Sci Med 2018; 208:34-40. [PMID: 29758476 DOI: 10.1016/j.socscimed.2018.04.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE Asthma is a common respiratory condition with high prevalence rates globally. While there are effective treatments, asthma remains an important health concern as people continue to die from severe attacks. Improving the experiences of, and health outcomes for, people with asthma depends heavily on their interactions with healthcare professionals. Understanding negative clinical encounters will benefit people with asthma and healthcare providers. OBJECTIVE To examine epistemic tensions in negative clinical encounters from a patient perspective, with an aim to better understand how patients respond to these tensions. Much of the scholarship on patient interactions with healthcare providers examines interpersonal or structural factors. Thus, focusing our analysis on tensions between lay and expert knowledge in negative clinical encounters provides a novel contribution to this body of scholarship. METHOD As part of a larger qualitative study (n = 70) examining the lived experiences of people who have asthma or a child with asthma, semi-structured interviews with 17 participants who described having negative clinical encounters were analyzed for themes. RESULTS Participants responded to epistemic tensions in two main ways: (1) by incorporating expert knowledge; and (2) by resisting/challenging expert knowledge. In both cases, participants also described feeling frustrated and uncertain about their or their child's clinical care. We analyze these responses by drawing on Lindström and Karlsson's (2016) conceptualization of epistemic tensions as arising from 3 characteristics of epistemic asymmetry: access, rights, and responsibility. CONCLUSION Based on this study, (1) a patient's confidence in claiming epistemic access and asserting epistemic rights when epistemic tensions arise are related to the context and their own history of living with asthma; and (2), epistemic tensions can make visible the power relations in the patient-clinician relationship, which can lead to the exertion of biomedical authority, or the taking up of patient's lay knowledge.
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Affiliation(s)
- Jennie Haw
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Shannon Cunningham
- Department of Medicine - Division of Nephrology, 3-063 Research Transition Facility, University of Alberta, Edmonton, AB T6G 2V2, Canada.
| | - Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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Garnero TL, Davis NJ, Perez-Nieves M, Hadjiyianni I, Cao D, Ivanova JI, Peyrot M. Insulin non-persistence among people with type 2 diabetes: how to get your patients to stay on insulin therapy. Postgrad Med 2018; 130:394-401. [PMID: 29571275 DOI: 10.1080/00325481.2018.1457396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Continuing use of medication is key to effective treatment and positive health outcomes, particularly in chronic conditions such as diabetes. However, in primary care, non-persistence (i.e. discontinuing or interrupting treatment) with insulin therapy is a common problem among patients with type 2 diabetes. To help primary care physicians manage patients who are non-persistent or likely not to be persistent, this review aimed to provide an overview of modifiable and non-modifiable factors associated with insulin non-persistence as well as practical strategies to address them. Data were extracted from published studies evaluating factors associated with non-persistence among patients with type 2 diabetes. A targeted literature review was performed using PubMed to identify recent studies (2000-2016) reporting measures of non-persistence with insulin therapy. Practical strategies to identify and prevent non-persistence were based on the authors' direct experience in primary care. Non-modifiable factors associated with non-persistence included gender, age, prior treatments, and cost of therapy. Before/at insulin initiation, modifiable factors included patients' perception of diabetes, preference for oral medication, and concerns/expectations about treatment complexity, inconvenience, or side effects. After initiation, modifiable factors included syringe use, difficulties during the first week of therapy, side effects, and insufficient glycemic control. Open-ended and patient-centered questions and a blame-free environment can help physicians identify, prevent, and reduce non-persistence behaviors. Possible questions to start a conversation with patients are provided. Effective physician-patient communication is essential to the management of diabetes. Primary care physicians should be familiar with the most common reasons for insulin non-persistence.
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Affiliation(s)
- Theresa L Garnero
- a University of California at San Francisco , San Francisco , CA , USA
| | | | | | | | - Dachuang Cao
- c Eli Lilly and Company , Indianapolis , IN , USA
| | | | - Mark Peyrot
- e Loyola University Maryland , Baltimore , MD , USA
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Jones L, Sheeran N, Lanyon H, Evans K, Martincovic T. Nurses’ perceptions of communicating with minority parents in a neonatal nursery: a communication accommodation theory approach. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/17538068.2018.1460959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Liz Jones
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Nicola Sheeran
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Hanna Lanyon
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Karina Evans
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Samuel CA, Schaal J, Robertson L, Kollie J, Baker S, Black K, Mbah O, Dixon C, Ellis K, Eng E, Guerrab F, Jones N, Kotey A, Morse C, Taylor J, Whitt V, Cykert S. Racial differences in symptom management experiences during breast cancer treatment. Support Care Cancer 2017; 26:1425-1435. [PMID: 29150730 DOI: 10.1007/s00520-017-3965-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Racial disparities in cancer treatment-related symptom burden are well documented and linked to worse treatment outcomes. Yet, little is known about racial differences in patients' treatment-related symptom management experiences. Such understanding can help identify modifiable drivers of symptom burden inequities. As part of the Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS) study, we examined racial differences in symptom management experiences among Black and White breast cancer survivors (BCS). METHODS We conducted six focus groups (n = 3 Black BCS groups; n = 3 White BCS groups) with 22 stages I-IV BCS at two cancer centers. Focus groups were audio-recorded and transcribed verbatim. Based on key community-based participatory research principles, our community/academic/medical partner team facilitated focus groups and conducted qualitative analyses. RESULTS All BCS described positive symptom management experiences, including clinician attentiveness to symptom concerns and clinician recommendations for pre-emptively managing symptoms. Black BCS commonly reported having to advocate for themselves to get information about treatment-related symptoms, and indicated dissatisfaction regarding clinicians' failure to disclose potential treatment-related symptoms or provide medications to address symptoms. White BCS often described dissatisfaction regarding inadequate information on symptom origins and clinicians' failure to offer reassurance. CONCLUSIONS This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.
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Affiliation(s)
- Cleo A Samuel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Schaal
- The Partnership Project, 620 S. Elm St, Suite 381, Greensboro, NC, 27406, USA
| | - Linda Robertson
- Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, POB 2 Room, 438, Pittsburgh, PA, 15232, USA
| | - Jemeia Kollie
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Stephanie Baker
- Department of Public Health Studies, Elon University, Campus Box 2337, Elon, NC, 27224, USA
| | - Kristin Black
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Olive Mbah
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Crystal Dixon
- Department of Public Health Education, University of North Carolina at Greensboro, 437 Coleman Building, P.O. Box 26170, Greensboro, NC, 27402-6169, USA
| | - Katrina Ellis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Eugenia Eng
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Fatima Guerrab
- Department of Public Health Education, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27701, USA
| | - Nora Jones
- Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA
| | - Amanda Kotey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Claire Morse
- Guilford College, 5800 W Friendly Ave, Greensboro, NC, 27410, USA
| | - Jessica Taylor
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Vickie Whitt
- Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA
| | - Samuel Cykert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.,School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA
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Li L, Comulada WS, Lin C, Lan CW, Cao X, Wu Z. Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China. HEALTH COMMUNICATION 2017; 32:1368-1375. [PMID: 27710137 PMCID: PMC5382133 DOI: 10.1080/10410236.2016.1221754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Provider-client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider-client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider-client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider-client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider-client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider-client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - W. Scott Comulada
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Chiao-Wen Lan
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention
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Gesser-Edelsburg A, Shahbari NAE. Decision-making on terminating pregnancy for Muslim Arab women pregnant with fetuses with congenital anomalies: maternal affect and doctor-patient communication. Reprod Health 2017; 14:49. [PMID: 28376917 PMCID: PMC5379523 DOI: 10.1186/s12978-017-0312-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study focused on decision-making on terminating pregnancy for Arab Muslim women in Israel who were pregnant with fetuses diagnosed with congenital anomalies. It examined the impact of the doctor-patient interaction on the women's decision, especially in light of social and religious pressures not to terminate under any circumstances. Our goal was to identify perceptions and attitudes of Muslim Arab women who choose to continue their pregnancy following the detection of congenital anomalies in prenatal tests. Specific objectives included (1) To examine the Muslim Arab women's perceptions on genetic testing, and ascertain the reasons for their decision to continue the pregnancy following the detection of a congenital anomaly in the fetus; and (2) To examine risk communication of gynecologists regarding genetic testing and abortions, and regarding the decision of continuing or terminating a pregnancy following detection of a congenital anomaly. METHODS The research framework used the constructivist classical qualitative method to understand the experience of women at high risk for congenital anomalies and their experience of how doctors communicate the risk. RESULTS It showed that the emotional element is no less dominant than religious and social elements. The findings emphasized the disparities between doctors and women regarding emotional involvement (non-directive counselling). The women interviewees (N = 24) felt that this expressed insensitivity. As far as we know, the emotional component has not been raised in previous studies of Muslim women at high risk for congenital defects in their fetus, and therefore comprises a significant contribution of the present study. CONCLUSIONS To mitigate gaps, doctors should take affect into consideration in their communication with patients. It is important for doctors to understand the emotional element in risk communication, both in how they respect women's emotions and in creating an emotional interaction between themselves and the women.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel.
| | - Nour Abed Elhadi Shahbari
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838, Israel
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Young HN, Len-Rios ME, Brown R, Moreno MM, Cox E. How does patient-provider communication influence adherence to asthma medications? PATIENT EDUCATION AND COUNSELING 2017; 100:696-702. [PMID: 27916463 DOI: 10.1016/j.pec.2016.11.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/23/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence. METHODS A national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways. RESULTS Significantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence. CONCLUSION Patient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation. PRACTICE IMPLICATIONS To promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients' trust and increase patient motivation to use asthma medications.
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Affiliation(s)
- Henry N Young
- Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA.
| | - Maria E Len-Rios
- Advertising and Public Relations, Grady College of Journalism & Mass Communication, University of Georgia, Athens, GA, USA.
| | - Roger Brown
- Medical Research Consulting, Middleton, WI, USA.
| | - Megan M Moreno
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA.
| | - Elizabeth Cox
- Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Mustapha JA, Fisher BT, Rizzo JA, Chen J, Martinsen BJ, Kotlarz H, Ryan M, Gunnarsson C. Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods. J Racial Ethn Health Disparities 2017. [PMID: 28205152 DOI: 10.1007/s40615–016–0261–9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors. METHODS This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates. RESULTS Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis. CONCLUSIONS Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
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Affiliation(s)
- J A Mustapha
- Metro Health University of Michigan Health, Wyoming, MI, USA
| | - Bryan T Fisher
- Vascular and Endovascular Surgery, The Surgical Clinic, PLLC, Nashville, TN, USA
| | | | - Jie Chen
- University of Maryland, College Park, MD, USA
| | | | | | - Michael Ryan
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA
| | - Candace Gunnarsson
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA.
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26
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Mustapha JA, Fisher BT, Rizzo JA, Chen J, Martinsen BJ, Kotlarz H, Ryan M, Gunnarsson C. Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods. J Racial Ethn Health Disparities 2017. [PMID: 28205152 DOI: 10.1007/s40615–016–0261–9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors. METHODS This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates. RESULTS Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis. CONCLUSIONS Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
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Affiliation(s)
- J A Mustapha
- Metro Health University of Michigan Health, Wyoming, MI, USA
| | - Bryan T Fisher
- Vascular and Endovascular Surgery, The Surgical Clinic, PLLC, Nashville, TN, USA
| | | | - Jie Chen
- University of Maryland, College Park, MD, USA
| | | | | | - Michael Ryan
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA
| | - Candace Gunnarsson
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA.
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27
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Mustapha JA, Fisher BT, Rizzo JA, Chen J, Martinsen BJ, Kotlarz H, Ryan M, Gunnarsson C. Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods. J Racial Ethn Health Disparities 2017; 4:10.1007/s40615-016-0261-9. [PMID: 28205152 PMCID: PMC5626799 DOI: 10.1007/s40615-016-0261-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/22/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors. METHODS This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates. RESULTS Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis. CONCLUSIONS Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
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Affiliation(s)
- J A Mustapha
- Metro Health University of Michigan Health, Wyoming, MI, USA
| | - Bryan T Fisher
- Vascular and Endovascular Surgery, The Surgical Clinic, PLLC, Nashville, TN, USA
| | | | - Jie Chen
- University of Maryland, College Park, MD, USA
| | | | | | - Michael Ryan
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA
| | - Candace Gunnarsson
- CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA.
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28
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Janevic MR, Baptist AP, Bryant-Stephens T, Lara M, Persky V, Ramos-Valencia G, Uyeda K, Hazan R, Garrity A, Malveaux FJ. Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence. J Asthma 2016; 54:514-519. [PMID: 27901627 DOI: 10.1080/02770903.2016.1242136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed. METHODS Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics. RESULTS Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p <.05) from baseline to follow-up. Knowledge and Between-Provider Communication improved significantly (p <.05) within all four sites; Access improved significantly in Chicago, Philadelphia, and Puerto Rico; Trust improved significantly in Chicago, Los Angeles, and Philadelphia; and Patient-Provider Communication improved significantly in Philadelphia only. CONCLUSION Pediatric asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children.
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Affiliation(s)
- Mary R Janevic
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Alan P Baptist
- b Division of Allergy and Clinical Immunology , University of Michigan Medical School , Ann Arbor , MI , USA
| | | | - Marielena Lara
- d Children's Hospital of Los Angeles, University of Southern California , Los Angeles , CA , USA.,e RAND Corporation , Santa Monica , CA , USA
| | - Victoria Persky
- f University of Illinois at Chicago School of Public Health , Chicago , IL , USA
| | | | - Kimberly Uyeda
- h Los Angeles Unified School District , Los Angeles , CA , USA
| | - Rebecca Hazan
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Ashley Garrity
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
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Morgan M, Kenten C, Deedat S, Farsides B, Newton T, Randhawa G, Sims J, Sque M. Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on Donation, Transplantation and Ethnicity (DonaTE). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BackgroundBlack, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.ObjectiveTo identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.MethodsThree-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.SettingCommunity focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).Participants(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.Data sourcesFocus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.Review methodsSystematic review and narrative synthesis.Results(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.LimitationsParticipants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.ConclusionsThe research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.Future workGreater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Myfanwy Morgan
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Charlotte Kenten
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Sarah Deedat
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Tim Newton
- Dental Institute, King’s College London, London, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Jessica Sims
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Magi Sque
- Faculty of Education, Health and Wellbeing, University of Wolverhampton and Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Speck AL, Hess M, Baptist AP. An Electronic Asthma Self-Management Intervention for Young African American Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:89-95.e2. [PMID: 26441151 DOI: 10.1016/j.jaip.2015.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. OBJECTIVE The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. METHODS A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. RESULTS A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P < .01), and asthma quality of life as measured by the Mini Asthma Quality of Life Questionnaire improved from 4.0 to 5.1 (P < .01). CONCLUSIONS The Breathe Michigan program is feasible for recruitment and retention, and demonstrated an improvement in asthma control and quality of life for young African American adults.
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Affiliation(s)
- Aimee L Speck
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich
| | - Michael Hess
- School of Information, University of Michigan, Ann Arbor, Mich
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Mich.
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Harper FWK, Eggly S, Crider B, Kobayashi H, Kathleen RN, Meert L, Ball A, Penner LA, Gray H, Albrecht TL. Patient- and Family-Centered Care as an approach to reducing disparities in asthma outcomes in urban African American children: A review of the literature. J Natl Med Assoc 2015; 107:4-17. [PMID: 27269485 PMCID: PMC4901523 DOI: 10.1016/s0027-9684(15)30019-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We thank Cathy Eames (Director, Library Services, Detroit Medical Center) for valuable input and assistance with the search strategy. Funding for this research was supported by a grant from Children's Hospital of Michigan Research Foundation (Principal Investigator: Terrance L. Albrecht, Ph.D.). BACKGROUND Patient- and family-centered care (PFCC) has the potential to address disparities in access and quality of healthcare for African American pediatric asthma patients by accommodating and responding to the individual needs of patients and families. STUDY OBJECTIVES To identify and evaluate research on the impact of family-provider interventions that reflect elements of PFCC on reducing disparities in the provision, access, quality, and use of healthcare services for African American pediatric asthma patients. METHODS Electronic searches were conducted using PubMed, CINAHL, and Psyclnfo databases. Inclusion criteria were peer-reviewed, English-language articles on family-provider interventions that (a) reflected one or more elements of PFCC and (b) addressed healthcare disparities in urban African American pediatric asthma patients (≤18years). RESULTS Thirteen interventions or programs were identified and reviewed. Designs included randomized clinical trials, controlled clinical trials, pre- and post-interventions, and program evaluations. CONCLUSIONS Few interventions were identified as explicitly providing PFCC in a pediatric asthma context, possibly because of a lack of consensus on what constitutes PFCC in practice. Some studies have demonstrated that PFCC improves satisfaction and communication during clinical interactions. More empirical research is needed to understand whether PFCC interventions reduce care disparities and improve the provision, access, and quality of asthma healthcare for urban African American children. ELECTRONIC DATABASES USED PubMed, CINAHL, and Psyclnfo ABBREVIATIONS AA-African American: CCT-Controlled clinical trial; ED-Emergency Department; ETS-Environmental tobacco smoke; FCC- Family Centered Care; PFCC-Patient and Family Centered Care; RCT- Randomized, controlled trial.
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Affiliation(s)
- Felicity W K Harper
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine.
| | - Susan Eggly
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine
| | | | | | - R N Kathleen
- Children's Hospital of Michigan, Department of Pediatrics, Wayne State University School of Medicine
| | - L Meert
- Children's Hospital of Michigan, Department of Pediatrics, Wayne State University School of Medicine
| | - Allison Ball
- Children's Hospital of Michigan, Department of Pediatrics, Wayne State University School of Medicine
| | - Louis A Penner
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine
| | - Herman Gray
- Children's Hospital of Michigan, Department of Pediatrics, Wayne State University School of Medicine
| | - Terrance L Albrecht
- Karmanos Cancer Institute Population Studies and Disparities Research Program, Department of Oncology, Wayne State University School of Medicine
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Strooker JA, Nota SPFT, Hageman MGJS, Ring DC. Patients with greater symptom intensity and more disability are more likely to be surprised by a hand surgeon's advice. Clin Orthop Relat Res 2015; 473:1478-83. [PMID: 25280552 PMCID: PMC4353519 DOI: 10.1007/s11999-014-3971-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND A clash between a patient's assumptions and a doctor's advice can feel adversarial which might influence satisfaction ratings and compliance with treatment recommendations. A better understanding of sources of patients' bewilderment might lead to improved strategies for conveying counterintuitive information that improve patient comfort and wellbeing. QUESTIONS/PURPOSES This study addressed the following questions: (1) Are magnitude of disability, pain intensity, symptoms of depression, or health anxiety associated with a higher level of surprise when a patient is presented with diagnostic information and/or therapeutic recommendations? (2) Does the surgeon accurately perceive the patient's bewilderment? (3) Does the surgeon's perception of patient bewilderment correlate with diagnosis or a patient's magnitude of disability, pain intensity, symptoms of depression, or health anxiety? PATIENTS AND METHODS In this prospective cohort study, we invited new patients who met prespecified criteria during a 3-month period in one hand-surgery practice to enroll; of 93 patients invited, 84 (90%) agreed to participate. Patients reported demographics and completed the short versions of the DASH questionnaire (QuickDASH), the Patient Health Questionnaire, the Pain Self-Efficacy Questionnaire, and the Short Health Anxiety Inventory; rated their pain intensity; and rated the degree to which the information given by the surgeon was unexpected or surprising on an 11-point ordinal scale. The surgeon also rated his impression of the patient's surprise on an 11-point ordinal scale. RESULTS Only greater symptom intensity and magnitude of disability (QuickDASH) correlated with greater unexpected information when rated by the patient (ß = 0.058; p < 0.001). There was a correlation between patient surprise and the surgeon's perception of the patient's surprise (r = 0.58; p < 0.001). Greater surgeon-perceived patient surprise correlated with nonspecific illness (p = 0.007; ß = 3.0). CONCLUSIONS Patients with greater symptom intensity and magnitude of disability, and perhaps also patients with nonspecific diagnoses, are more likely to be surprised by a hand surgeon's advice. Future research might address the ability of previsit preparation (using decision aids or other alternative means of education) to ameliorate the discordance between patient assumptions and hand surgeon advice.
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Affiliation(s)
- Joost A. Strooker
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Sjoerd P. F. T. Nota
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Michiel G. J. S. Hageman
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David C. Ring
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Pacheco CM, Ciaccio CE, Nazir N, Daley CM, DiDonna A, Choi WS, Barnes CS, Rosenwasser LJ. Homes of low-income minority families with asthmatic children have increased condition issues. Allergy Asthma Proc 2014; 35:467-74. [PMID: 25584914 DOI: 10.2500/aap.2014.35.3792] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The home is increasingly associated with asthma. It acts both as a reservoir of asthma triggers and as a refuge from seasonal outdoor allergen exposure. Racial/ethnic minority families with low incomes tend to reside in neighborhoods with low housing quality. These families also have higher rates of asthma. This study explores the hypothesis that black and Latino urban households with asthmatic children experienced more home mechanical, structural condition-related areas of concern than white households with asthmatic children. Participant families (n = 140) took part in the Kansas City Safe and Healthy Homes Program, had at least one asthmatic child, and met income qualifications of no more than 80% of local median income; many were below 50%. Families self-identified their race. Homes were assessed by environmental health professionals using a standard set of criteria and a specific set of on-site and laboratory sampling and analyses. Homes were given a score for areas of concern between 0 (best) and 53 (worst). The study population self-identified as black (46%), non-Latino white (26%), Latino (14.3%), and other (12.9%). Mean number of areas of concern were 18.7 in Latino homes, 17.8 in black homes, 13.3 in other homes, and 13.2 in white homes. Latino and black homes had significantly more areas of concern. White families were also more likely to be in the upper portion of the income. In this set of 140 low-income homes with an asthmatic child, households of minority individuals had more areas of condition concerns and generally lower income than other families.
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Affiliation(s)
- Christina M. Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Melton C, Graff C, Holmes GN, Brown L, Bailey J. Health literacy and asthma management among African-American adults: an interpretative phenomenological analysis. J Asthma 2014; 51:703-13. [PMID: 24654706 DOI: 10.3109/02770903.2014.906605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE African-Americans share a disproportionate burden of asthma and low health literacy and have higher asthma morbidity and mortality. Factors that link the relationship between health literacy and health outcomes are unclear. This study aimed to use patients' experiences of managing asthma to better understand the relationship between health literacy and health outcomes. METHODS This study was the qualitative component of a mixed methods study. Following quantitative data collection, four participants, two with low print-related health literacy and two with adequate print-related health literacy, completed semi-structured interviews. Interview data were analyzed using interpretative phenomenological analysis. RESULTS Three themes emerged from the analysis: information desired versus information received, trial and error, and expectations of the patient-provider relationship. Individuals with adequate print-related health literacy had different strategies for overcoming barriers related to communicating with their providers, learning about their disease and experiences of discrimination within the healthcare system. CONCLUSIONS Individuals with adequate print-related health literacy may be more equipped to participate in shared decision making and feel more confident to successfully manage their disease. It is also important that health literacy is discussed in the context of the cultural and racial background of the population of interest. This interdependent relationship between health literacy and culture is particularly important for African-Americans.
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Affiliation(s)
- Courtnee Melton
- Research Center on Health Disparities, Equity, and the Exposome, University of Tennessee Health Science Center , Memphis, TN , USA
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Carlin C, Yee AB, Fagnano M, Halterman JS. The influence of Hispanic ethnicity on parent-provider communication about asthma. Clin Pediatr (Phila) 2014; 53:380-6. [PMID: 24281159 PMCID: PMC3949158 DOI: 10.1177/0009922813510598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research has shown that minority caregivers of children with asthma report poorer communication with health care providers than nonminority caregivers. Less is known about the specific influence of Hispanic ethnicity on parent-provider communication. Our objective was to evaluate the influence of Hispanic ethnicity on parent-provider communication regarding their child's asthma and on caregiver confidence in communicating with their child's provider at a primary care visit. Data were obtained from 166 caregivers of children (2-12 years) with persistent asthma. Caregiver perceptions of provider communication and confidence were evaluated. We found that Hispanic compared to non-Hispanic caregivers reported better communication with providers on several items. Hispanic caregivers also were more likely to indicate full confidence in their ability to communicate with providers. These findings suggest Hispanic caregivers may experience better parent-provider communication than non-Hispanics. Further investigation is needed to assess provider- and clinic-specific factors that may influence communication between minority caregivers and providers.
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Affiliation(s)
- Courtney Carlin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Alison B Yee
- Department of Psychiatry Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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Abstract
Prior research has identified deficiencies in the standard process of providing instructions for care at discharge from the emergency department (ED). Patients typically receive a brief verbal instruction, along with preformatted written discharge documents. Studies have found that understanding and retention of such information by families are very poor, leading to nonadherence in follow-up care, unnecessary return visit to the ED, and poor health outcomes. The combination of systems factors (information content, delivery methods, and timing) and patient factors (health literacy, language proficiency, and cultural factors) contributes to the challenge of providing successful discharge communication. Internet and mobile devices provide a novel opportunity to better engage families in this process.Mobile health can address both system- and patient-level challenges. By incorporating images, animation, and full Web-based video content, more comprehensible content that is better suited for patients with lower health literacy and today's visual learners can be created. Information can also be delivered both synchronously and asynchronously, enabling the health care providers to deliver health education to the patients electronically to their home, where health care occurs. Furthermore, the providers can track information access by patients, customize content to the individual patients, and reach other caregivers who may not be present during the ED visit. Further research is needed to develop the systems and best practices for incorporating mobile health in the ED setting.
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What do resource-oriented approaches mean to general practitioners and how can they be facilitated in primary care? A qualitative study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:187641. [PMID: 23986779 PMCID: PMC3748733 DOI: 10.1155/2013/187641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 12/03/2022]
Abstract
Although resource orientation, as a part of health promotion, should play a major role in general practice, the anchoring and realization of resource-oriented approaches remain small in Germany. The aim of this study was to analyze what resource orientation means to general practitioners (GPs) and develop strategies as to how this can be facilitated in GP practice. Within a qualitative research approach, 19 semi-structured telephone interviews were recorded, transcribed, and analyzed using qualitative content analysis. Within the interviews, the inclusion of the patients' individual resources is described as core competence of GPs. Supporting the patients' disease coping strategies and self-help were seen as important by GPs. However, perceptions as to which resources are considered to be fundamental ranged widely across the participant group. The results confirm the important role of resource-oriented approaches in general practice. However, a general definition of resource orientation is needed. In addition, working conditions for GPs need to be taken into account to ensure that these contribute to a healthy work-life balance. The need for GP training was identified to improve communication skills. Further integration of GPs in health promotion and communal structures would be beneficial.
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Holsey CN, Collins P, Zahran H. Disparities in Asthma Care, Management, and Education Among Children With Asthma. CLINICAL PULMONARY MEDICINE 2013; 20:172-177. [PMID: 27570439 PMCID: PMC4999068 DOI: 10.1097/cpm.0b013e3182991146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health disparities are pervasive in the United States. Health and health care disparities are the differences or gaps in health (eg, life expectancy, morbidity, risk factors, and quality of life) and health care access and quality between segments of the United States population as related to race/ethnicity and socioeconomic status (eg, income, education). Multiple factors are associated with such disparities in asthma management and education. This article explores some of those factors and summarizes the strategies developed and interventions implemented to address disparities associated with asthma care and education among racial and ethnic minority children. It also discusses the need for further research to identify effective asthma education approaches for improving the management of asthma among racial and ethnic minority children. More exploration of the root causes of health care disparities, including policy studies in the area of social determinates of health and health equity, is also needed.
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Affiliation(s)
- Chanda N. Holsey
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Pamela Collins
- Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hatice Zahran
- Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
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Bellin MH, Kub J, Frick KD, Bollinger ME, Tsoukleris M, Walker J, Land C, Butz AM. Stress and quality of life in caregivers of inner-city minority children with poorly controlled asthma. J Pediatr Health Care 2013; 27:127-34. [PMID: 23414978 PMCID: PMC3575578 DOI: 10.1016/j.pedhc.2011.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/21/2011] [Accepted: 09/30/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Caregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL. METHOD Data were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL. RESULTS Children (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL. DISCUSSION Findings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.
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Affiliation(s)
- Melissa H Bellin
- Health Specialization, School of Social Work, University of Maryland, Baltimore, MD 21201, USA.
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Abstract
Asthma is a complex condition that requires individualized interventions. The purpose of this article is to describe the relationship between the physical and social environments with asthma symptoms, present evidence that supports environmental interventions in asthma control and the implications for asthma management. There is evidence that indoor and outdoor allergens relate to asthma morbidity. Knowledge about which environmental exposures present risk is essential because many of these exposures can be modified, reduced, or eliminated. The community health nurse should provide care relative to the client's indoor and outdoor environment and existing allergens.
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Affiliation(s)
- Yvonne M Sterling
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana 70112, USA.
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Leong AB, Ramsey CD, Celedón JC. The challenge of asthma in minority populations. Clin Rev Allergy Immunol 2013; 43:156-83. [PMID: 21538075 DOI: 10.1007/s12016-011-8263-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The burden and disparity of asthma in race/ethnic minorities present a significant challenge. In this review, we will evaluate data on asthma epidemiology in minorities, examine potential reasons for asthma disparities, and discuss strategies of intervention and culturally sensitive care.
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Affiliation(s)
- Albin B Leong
- Pediatric Pulmonology and Allergy, Roseville Kaiser Medical Center, 1600 Eureka Road, Roseville, CA 95661, USA.
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Mazurek JM, Storey E. Physician-patient communication regarding asthma and work. Am J Prev Med 2012; 43:72-5. [PMID: 22704750 DOI: 10.1016/j.amepre.2012.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthy People 2020-specific respiratory diseases objectives seek to increase the proportion of people with current asthma who receive appropriate asthma care. For adults, this includes a discussion of whether asthma is work-related. PURPOSE To establish a baseline measure of physician-patient communication regarding asthma and work. METHODS This study used data from 27,157 non-institutionalized U.S. adult respondents of the 2010 National Health Interview Survey (analyzed in 2011). Adults employed at any time in the 12 months prior to the interview with a health-professional diagnosis of current asthma who have been told by a health professional that their asthma was probably work-related or ever discussed the relatedness of asthma and work were identified. Weighted proportions and, using logistic regression analysis, prevalence ORs for factors that may have predicted communication with a health professional regarding an asthma-work relationship were calculated. RESULTS An estimated 6.6% (95% CI=5.1%, 8.2%) of employed adults with current asthma have been told that their asthma is work-related. Among those not so informed, 7.4% (95% CI=5.6%, 9.2%) ever discussed the topic. When responses to both questions were considered, the proportion was 13.5% (95% CI=11.3%, 15.8%). Employed adults aged ≥30 years, those reporting adverse asthma outcomes, and those of Hispanic ethnicity had higher odds of having communication with a health professional about the relation between their asthma and their work. CONCLUSIONS One in seven employed adults with asthma report communicating with their health professional about the role of workplace exposures in their asthma. Opportunities to increase this dialogue should be examined.
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Affiliation(s)
- Jacek M Mazurek
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia 26505, USA.
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Zeni MB. Systematic review of health literacy in Cochrane database studies on paediatric asthma educational interventions: searching beyond rigorous design. INT J EVID-BASED HEA 2012; 10:3-8. [PMID: 22405413 DOI: 10.1111/j.1744-1609.2011.00250.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to evaluate if paediatric asthma educational intervention studies included in the Cochrane Collaboration database incorporated concepts of health literacy. METHODS Inclusion criteria were established to identify review categories in the Cochrane Collaboration database specific to paediatric asthma educational interventions. Articles that met the inclusion criteria were selected from the Cochrane Collaboration database in 2010. The health literacy definition from Healthy People 2010 was used to develop a 4-point a priori rating scale to determine the extent a study reported aspects of health literacy in the development of an educational intervention for parents and/or children. RESULTS Five Cochrane review categories met the inclusion criteria; 75 studies were rated for health literacy content regarding educational interventions with families and children living with asthma. A priori criteria were used for the rating process. While 52 (69%) studies had no information pertaining to health literacy, 23 (31%) reported an aspect of health literacy. Although all studies maintained the rigorous standards of randomized clinical trials, a model of health literacy was not reported regarding the design and implementation of interventions. CONCLUSIONS While a more comprehensive health literacy model for the development of educational interventions with families and children may have been available after the reviewed studies were conducted, general literacy levels still could have been addressed. The findings indicate a need to incorporate health literacy in the design of client-centred educational interventions and in the selection criteria of relevant Cochrane reviews. Inclusion assures that health literacy is as important as randomization and statistical analyses in the research design of educational interventions and may even assure participation of people with literacy challenges.
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Affiliation(s)
- Mary Beth Zeni
- Nursing Research, Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
Identifying that health inequalities exist is not enough; nor does the knowledge that a patient has a high-risk genotype or comes from a higher risk socioeconomic background does not, by itself, help the patient. To thoroughly examine the origins of health disparities, a broad view of environmental and molecular influences must be included. As these factors are identified, it is important to focus on interventions that can change outcomes for patients. Tools for education, community involvement, literacy, and environmental safety need to be developed, tested and disseminated. The basic science of health disparities must move forward in a coordinated fashion by structuring research that is an integrated effort between basic sciences, clinical medicine and include all traditionally underserved communities. Only through these collaborations can we hope to eliminate health inequalities in the future.
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Affiliation(s)
- Kimberly Danieli Watts
- Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza Box # 43, Chicago, IL 60614, USA.
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Eakin MN, Rand CS, Bilderback A, Bollinger ME, Butz A, Kandasamy V, Riekert KA. Asthma in Head Start children: effects of the Breathmobile program and family communication on asthma outcomes. J Allergy Clin Immunol 2011; 129:664-70. [PMID: 22104603 DOI: 10.1016/j.jaci.2011.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/26/2011] [Accepted: 10/05/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors. OBJECTIVE This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care. METHODS Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care. RESULTS Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures. CONCLUSIONS Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity.
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Affiliation(s)
- Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
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Jerant A, Sohler N, Fiscella K, Franks B, Franks P. Tailored interactive multimedia computer programs to reduce health disparities: opportunities and challenges. PATIENT EDUCATION AND COUNSELING 2011; 85:323-330. [PMID: 21146950 PMCID: PMC3070866 DOI: 10.1016/j.pec.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 11/21/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To review the theory and research evidence suggesting that tailored interactive multimedia computer programs (IMCPs) aimed at optimizing patient health behaviors could lessen socio-demographic health disparities. METHODS Selective critical review of research regarding IMCPs tailored to psychological mediators of behavior and their effects on health behavior and outcomes among socio-demographically disadvantaged patients. RESULTS Tailored IMCPs can address patient factors (e.g. language barriers, low self-efficacy) and buffer provider (e.g. cognitive bias) and health system (e.g. office visit time constraints) factors that contribute to poor provider-patient communication and, thereby, suboptimal health behaviors. Research indicates disadvantaged individuals' interactions with providers are disproportionately affected by such factors, and that their behaviors respond favorably to tailored information, thus suggesting tailored IMCPs could mitigate disparities. However, no randomized controlled trials (RCTs) have examined this question. The optimal design and deployment of tailored IMCPs for disadvantaged patients also requires further study. CONCLUSION Preliminary research suggests tailored IMCPs have the potential to reduce health disparities. RCTs designed expressly to examine this issue are warranted. PRACTICE IMPLICATIONS Many socio-demographic health disparities exist, and there is a dearth of proven disparity-reducing interventions. Thus, if tailored IMCPs were shown to lessen disparities, the public health implications would be considerable.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
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Biksey T, Zickmund S, Wu F. Disparities in risk communication: a pilot study of asthmatic children, their parents, and home environments. J Natl Med Assoc 2011; 103:388-91. [PMID: 21809787 DOI: 10.1016/s0027-9684(15)30334-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents' knowledge and control of asthma triggers in home environments can help reduce risks associated with asthmatic children's respiratory health. This pilot study used both qualitative and quantitative methods to determine parental knowledge of their children's asthma triggers in home environments, control of those triggers, and information received and trusted. Twelve parents of asthmatic children in the greater Pittsburgh area--8 white and 4 African American--participated in one-on-one interviews about home exposures to asthma triggers. All parents described the link between asthma symptoms and both environmental tobacco smoke (ETS) and pet dander exposures. House dust mites and mold were also commonly identified asthma triggers. All 8 white parents reported receiving information from physicians about controlling home environmental triggers of asthma, but the 4 African American parents reported having received no such information. However, all 12 parents reported having greater trust in information received from physicians than from other sources. White parents were significantly more aware of potential asthma triggers and performed significantly more actions to control the triggers in their homes. African American parents noted stressful experiences with primary and secondary care, less recall of information sharing about asthma triggers, and a focus on symptom management vs trigger avoidance.
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Affiliation(s)
- Thomas Biksey
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, PA 15219-3130, USA
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Bredfeldt CE, Compton-Phillips AL, Snyder MH. Effects of between visit physician-patient communication on Diabetes Recognition Program scores. Int J Qual Health Care 2011; 23:664-73. [PMID: 21937586 DOI: 10.1093/intqhc/mzr061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine whether physicians who interact with their patients between office visits using secure messaging and phone provide better care for patients with diabetes when controlling for physician, patient and care center characteristics. DESIGN Retrospective study. SETTING Kaiser Permanente Mid-Atlantic States. PARTICIPANTS 174 Primary Care Physicians. INTERVENTION We modeled the relationship between communication via secure messaging or phone communication and Diabetes Recognition Program (DRP) scores with a Generalized Estimating Equations model. Covariates included physician age and panel size, patient age, race, income and number of comorbidities, and the population density around the care center. MAIN OUTCOME MEASURE DRP scores. RESULTS Physicians whose patients were predominantly white or mixed race were more likely than other physicians to use secure messaging and phone with their patients between visits, but there was no significant association between such contacts and DRP scores (P> 0.1). In contrast, physicians with predominantly black or Hispanic patients had significantly higher DRP scores associated with the use of secure messaging (P< 0.01) and higher, though not statistically significant, DRP scores associated with the use of phone (P< 0.1). These associations were strongest for outcome measures such as HbA1c and lipid levels, and were weaker or nonexistent for process measures such as annual foot and eye exams. CONCLUSIONS The use of secure messaging, and, to a lesser extent, phone, appears to be associated with higher quality diabetes care, particularly among at-risk populations.
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Affiliation(s)
- Christine E Bredfeldt
- Department of Research, Mid-Atlantic Permanente Research Institute, Rockville, MD 20852, USA.
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McDowell L, Hilfinger Messias DK, Estrada RD. The work of language interpretation in health care: complex, challenging, exhausting, and often invisible. J Transcult Nurs 2011; 22:137-47. [PMID: 21317402 DOI: 10.1177/1043659610395773] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The value of qualified language interpretation services for limited-English-proficient patients is gaining increasing recognition by policy makers and researchers in the United States. Yet the actual work experiences of health care interpreters have not been adequately studied. The purpose of this qualitative research was to explore the work experiences of formal and informal interpreters (n = 27). The core narrative finding from the interview data was the complex, challenging, exhausting, and often invisible work of language interpretation. Critical examination of health care interpreters' complex work and interactions with patients, providers, and administrators is needed to provide more effective and integrated services for limited-English proficient patients.
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