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Yoon E, Hur S, Opsasnick L, Huang W, Batio S, Curtis LM, Benavente JY, Lewis-Thames MW, Liebovitz DM, Wolf MS, Serper M. Disparities in Patient Portal Use Among Adults With Chronic Conditions. JAMA Netw Open 2024; 7:e240680. [PMID: 38421645 PMCID: PMC10905301 DOI: 10.1001/jamanetworkopen.2024.0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Disparities in patient access and use of health care portals have been documented. Limited research has evaluated disparities in portal use during and after the COVID-19 pandemic. Objective To assess prevalence of health care portal use before, during, and after the most restrictive phase of the pandemic (2019-2022) among the COVID-19 & Chronic Conditions (C3) cohort and to investigate any disparities in use by sociodemographic factors. Design, Setting, and Participants This cohort study uses data from the C3 study, an ongoing, longitudinal, telephone-based survey of participants with multiple chronic conditions. Participants were middle aged and older-adult primary care patients who had an active portal account, recruited from a single academic medical center in Chicago, Illinois, between 2019 and 2022. Data were analyzed between March and June 2022. Main Outcomes and Measures Outcomes of portal use (ie, number of days of portal login by year) were recorded for all study participants by the electronic data warehouse. All parent studies had uniform sociodemographic data and measures of social support, self-efficacy, health literacy, and health activation. Results Of 536 participants (mean [SD] age, 66.7 [12.0] years; 336 [62.7%] female), 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified as other race, including Asian, Native American or Alaskan Native, and self-reported other race. In multivariable analyses, portal login activity was higher during the 3 years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with adequate health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64). Lower portal activity was associated with older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female sex (IRR, 0.77; 95% CI, 0.66-0.91). Compared with non-Hispanic White patients, lower portal activity was observed among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64). Conclusions and Relevance This cohort study using data from the C3 study identified changes in portal use over time and highlighted populations that had lower access to health information. The COVID-19 pandemic was associated with an increase in portal use. Sociodemographic disparities by sex and age were reduced, although disparities by health literacy widened. A brief validated health literacy measure may serve as a useful digital literacy screening tool to identify patients who need further support.
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Affiliation(s)
- Esther Yoon
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Supportive Oncology, Rush University Cancer Center, Chicago, Illinois
| | - Scott Hur
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wei Huang
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura M. Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julia Yoshinso Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marquita W. Lewis-Thames
- Department of Medical Social Science, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Michael S. Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Graham EK, Atherton OE, Mroczek DK, McGhee C, Pieramici L, Lewis-Thames M, Curtis L, Cella D, Opsasnick L, Lovett R, O’Conor R, Wolf MS. Longitudinal Associations Between Multimorbidities and Patient-Reported Quality of Life. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad173. [PMID: 38285639 PMCID: PMC10824385 DOI: 10.1093/geronb/gbad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES The global prevalence of multimorbidity is increasing as the population ages. As individuals get older, they are likely to develop multiple chronic conditions, and nearly two-thirds of older adults in the United States are estimated to experience 2 or more chronic conditions. The present preregistered study examined whether multimorbidity was associated with longitudinal changes in health-related quality of life (i.e., anxiety, depression, and physical function) and whether these associations were moderated by sociodemographic factors (i.e., sex, race, marital status, income, insurance, and education). METHODS Data come from the Health Literacy and Cognitive Function Among Older Adults Longitudinal Study (LitCog), a prospective cohort study of English-speaking older adults (N = 900). At each measurement occasion, participants reported anxiety, depression, and physical function using the Patient Reported Outcomes Information System, chronic conditions, and sociodemographic characteristics. We employed multilevel growth models to estimate changes in health-related quality of life, with multimorbidities as a predictor and sociodemographics as covariates. RESULTS Results indicated that individuals with multiple chronic conditions reported persistently high levels of anxiety and depression, and worse physical function. We found evidence for racial health disparities, such that individuals who identified as non-White experienced worse health-related quality of life as multimorbidities increased, relative to White participants. DISCUSSION These results contribute to the current conversation about the long-term impacts of structural and systemic barriers experienced by minoritized groups. We further discuss the public health implications of multimorbidity in older adulthood.
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Affiliation(s)
- Eileen K Graham
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Olivia E Atherton
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Chloe McGhee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Lily Pieramici
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Marquita Lewis-Thames
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Curtis
- Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca Lovett
- Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael S Wolf
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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O'Conor R, Bonham M, Magnuson G, Opsasnick L, Hurtado J, Yoshino Benavente J, Curtis LM, Wolf MS. Caregiver health literacy and health task performance: Findings from the LitCog caregiver cohort study. PEC Innov 2023; 3:100240. [PMID: 38161686 PMCID: PMC10757034 DOI: 10.1016/j.pecinn.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
Objective Many older adults receive assistance in managing their chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in older adults' health management at home. We examined associations between caregiver health literacy and performance on health tasks. Methods Caregivers to older adults enrolled in a cognitive aging cohort were recruited to participate in a supplemental interview (n = 97). Caregivers completed one structured interview that included assessments of health literacy and health task performance. Results Caregivers demonstrated a range of health literacy skills (44% adequate, 36% marginal, 20% low health literacy). In adjusted analyses, caregivers with marginal and low health literacy demonstrated worse overall performance on the health tasks, and poorer interpretation of health information presented on print documents and recall of spoken communication (p's < 0.05). Conclusion Caregivers with marginal or low health literacy demonstrated poorer performance on everyday health tasks that they commonly assist older adults with. The application of health literacy best-practices to support better training and capacity-building for caregivers is warranted. Innovation Few studies have considered the health literacy skills of caregivers and its application to caregivers' abilities to carry out common supportive tasks.
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Affiliation(s)
- Rachel O'Conor
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Morgan Bonham
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Grace Magnuson
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeimmy Hurtado
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura M. Curtis
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Russell A, Filec S, Serper M, Opsasnick L, Batio S, O'Conor RM, Curtis L, Kwasny M, Benavente JY, Wismer G, Bonham M, Zheng P, Lovett R, Arvanitis M, Ladner DP, McCaffery K, Linder JA, Bailey SC, Wolf MS. Impact of COVID-19 on the capacity to self-manage health and chronic conditions. PEC Innov 2023; 2:100163. [PMID: 37197693 PMCID: PMC10167781 DOI: 10.1016/j.pecinn.2023.100163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
Objective To investigate well-being, lifestyle behaviors, self-management capacity and healthcare utilization among adults with chronic conditions at the outbreak of the COVID-19 pandemic. Methods Data was collected from two interviewer-administered telephone surveys conducted between March 27 - May 22, 2020. Participants were patients at Chicago-area clinics. Self-report and validated measures were used for study-related outcomes. Results A total of 553 participants (age range 23-88) completed data collection at both timepoints. One in five (20.7%) participants experienced stress due to the coronavirus most or all the time and rates of negative well-being were high (WHO-5 Index mean = 58.7%). Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, greater COVID-19 related stress was associated with less physical activity, lower self-efficacy, greater difficulty managing health and medications, and delays in seeking medical care due to the coronavirus. Conclusions Mental well-being, lifestyle behaviors, self-management capacity, and healthcare utilization were impacted in the months following the COVID outbreak. Innovation These findings suggest health systems should implement proactive measures for detecting and treating emotional and behavioral COVID-related concerns.
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Affiliation(s)
- Andrea Russell
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Sarah Filec
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Marina Serper
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Rachel M. O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Laura Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Mary Kwasny
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Guisselle Wismer
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Morgan Bonham
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Pauline Zheng
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Rebecca Lovett
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Marina Arvanitis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Daniela P. Ladner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | | | - Jeffrey A. Linder
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Stacy Cooper Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
| | - Michael S. Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr., 10th Floor, Chicago, IL, United States of America
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O'Conor R, Bonham M, Opsasnick L, Magnuson G, Yoshino Benavente J, Curtis LM, Morrissey Kwasny M, Wolf M. LitCog Caregiver Cohort: a prospective, observational cohort study investigating US caregivers' health literacy, self-care skills and cognitive function. BMJ Open 2023; 13:e075921. [PMID: 37857547 PMCID: PMC10603521 DOI: 10.1136/bmjopen-2023-075921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Many older adults receive assistance in managing chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in a patient's self-care. Health literacy and cognition are important determinants of older adults' health outcomes, but few studies have examined caregiver health literacy, cognition and self-care skills and their relations to patient outcomes. METHODS AND ANALYSIS We will expand an ongoing cognitive ageing cohort study (LitCog) to enroll a parallel caregiver cohort. Caregivers are eligible if they are (1) ≥18 years of age, (2) provided care for ≥6 months and (3) assisted with at least one activity of daily living, instrumental activity of daily living or health management task. Caregivers will complete interviews at time points corresponding with the LitCog participant interviews. Caregivers will complete assessments of health literacy, self-care skills, cognitive function, caregiver healthcare task difficulty, caregiver burden, caregiver self-efficacy, activation, technology use, busyness and routine and relationship quality. Caregivers will self-report the nature and intensity of care provided, and their own health status. Associations between caregiver presence and caregiver capacity with patient outcomes will be examined in a series of regression models, and mediating and moderating factors will be tested. ETHICS AND DISSEMINATION The Institutional Review Board at Northwestern University has approved the study protocol (STU00026255). Results will be published in peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and caregivers.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grace Magnuson
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura M Curtis
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Morrissey Kwasny
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Miller-Winder AP, Schierer A, Relerford RR, Murawski A, Opsasnick L, Olvera C, Curtis LM, Kim KY, Ramirez-Zohfeld V, Lindquist LA. Subjective cognitive decline and missed aging-in-place/long-term care planning. J Am Geriatr Soc 2023; 71:3314-3316. [PMID: 37235515 PMCID: PMC10592648 DOI: 10.1111/jgs.18425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Amber P. Miller-Winder
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Allison Schierer
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raven R. Relerford
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Opsasnick
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Charles Olvera
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laura M. Curtis
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lee A. Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Light SW, Opsasnick L, Bailey SC, Yoshino Benavente J, Eifler M, Lovett RM, Russell A, Yoon E, McCaffery K, Wolf MS. Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection: A Local Perspective From One U.S. City. Med Care 2023; 61:409-414. [PMID: 37068043 PMCID: PMC10167936 DOI: 10.1097/mlr.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND At the onset of the pandemic, there was poor public awareness and inaction in response to COVID-19; it is less known whether this translated to subsequent infections. OBJECTIVES To explore whether adults who perceived COVID-19 as less of a threat and who were not taking early actions were more likely to become infected over the following year. RESEARCH DESIGN Survey data from the ongoing (COVID-19 & Chronic Conditions (C3) anonymized for review) cohort study. PARTICIPANTS Six hundred forty-two adults with a mean age of 63 and ≥1 chronic condition. MEASURES Self-reported attitudes and behaviors regarding COVID-19 were assessed from March 13 to April 3, 2020, and COVID-19 infection status was captured between May 2020 and January 2021. Bivariate and multivariable analyses examined associations between early perceptions and behaviors with later infection. RESULTS Approximately 7% reported infection with COVID-19 (N = 46). Adults who perceived the threat of COVID-19 less seriously at the initial outbreak were more likely to test positive over the following year [odds ratio (OR): 0.81, CI: 0.70-0.94; P = 0.006]. Those who were less likely to believe their actions would affect whether they would become infected were more likely to test positive (OR: 0.87, CI: 0.77-0.99; P = 0.03), as were adults who reported not changing their routines (OR: 0.45; CI: 0.24-0.85; P = 0.01). CONCLUSIONS Adults with delayed responses in acknowledging the threat of COVID-19 and in changing behaviors were more likely to contract the virus. This investigation provides insight into the consequences of inadequate public understanding and response to COVID-19, and it highlights the importance of promoting early awareness among high-risk groups during public health crises.
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Affiliation(s)
- Sophia W. Light
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Stacy C. Bailey
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Morgan Eifler
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rebecca M. Lovett
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrea Russell
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Esther Yoon
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael S. Wolf
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Russell AM, Opsasnick L, Weiner-Light S, Bailey SC, O'Brien M, Wolf MS. Medication Dosing Schedules, Medication Knowledge, and Dosing Errors of Adults Taking Complex Drug Regimens. J Health Care Poor Underserved 2023. [PMID: 37464489 PMCID: PMC10405634 DOI: 10.1353/hpu.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This study examined how patients take complex medication regimens at home. Participants were primary care patients, 21 years or older, and prescribed three or more medications. Interviews assessed medication dosing schedules, medication knowledge, and dosing errors. Participants (N=441) were middle aged (mean 56.9); the majority were Hispanic/Latino (73.4%), had limited English proficiency (59.0%), and had limited health literacy (89.0%). One in five participants dosed medication five or more times per day, although no participants in the sample had a label instructing them to take medication more than times times daily. On average, participants correctly identified the purpose of 65% of their medications. Half of participants made one or more dosing errors. Less than high school education and a regimen size of six or more medications were independently associated with less medication knowledge, whereas language discordant label instructions were associated with dosing errors. Screening for regimen dosing complication and interventions to simplify dosing schedules are needed.
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Kim M, Opsasnick L, Batio S, Benavente JY, Bonham M, Zheng P, Lovett RM, Bailey SC, Kwasny M, Ladner DP, Chou SH, Linder JA, Weintraub S, Luo Y, Zee PC, Wolf MS. Trajectories of Sleep Disturbance and Self-Management of Chronic Conditions during COVID-19 among Middle-aged and Older Adults. Res Sq 2023:rs.3.rs-2440390. [PMID: 36711985 PMCID: PMC9882680 DOI: 10.21203/rs.3.rs-2440390/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. Objective To evaluate trajectories of sleep disturbance, and their associations with one's capacity to self-manage chronic conditions. Design A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020 - May 23, 2022). Participants Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Exposure Trajectories of self-reported sleep disturbance across 5 time points. Main Outcomes 3 self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Results 549 adults aged 23 to 91 years were included in the analysis. Two thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with older age (RR 1.57, 95% CI 1.09, 2.26, P<.05), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P=.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P=.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P=.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P=.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P<.001). Conclusions Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University
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10
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Russell AM, Opsasnick L, Yoon E, Bailey SC, O'Brien M, Wolf MS. Association between medication regimen complexity and glycemic control among patients with type 2 diabetes. J Am Pharm Assoc (2003) 2022; 63:769-777. [PMID: 36682933 DOI: 10.1016/j.japh.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and comorbid conditions require patients to take complex medication regimens. Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear. OBJECTIVES Our objectives were: (1) to examine associations between regimen complexity (with the Medication Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare overall MRCI with other measures of regimen complexity (overall and diabetes-specific medication count) and diabetes-specific MRCI. METHODS This was a secondary data analysis of cross-sectional data from a parent trial. Participants were patients with T2DM taking at least 3 chronic medications followed in safety net clinics in the Chicago area. The MRCI measures complexity based on dosing frequency, route of administration, and special instructions for prescribed medications. MRCI scores were created for overall regimens and diabetes-specific medications. Sociodemographics and outpatient visit utilization were included in models as covariates. Linear regression was used to examine the associations between variables of interest and hemoglobin A1C. RESULTS Participants (N = 432) had a mean age of 56.9 years, most were female (66.0%), and Hispanic or Latino (73.3%). Regimen complexity was high based on overall medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). Higher diabetes-specific MRCI was associated with higher A1C in bivariate and multivariable models. In multivariable models, overall MRCI greater than 14, fewer outpatient health care visits, male gender, and absence of health insurance were independently associated with higher A1C. The variance in A1C explained by MRCI was higher compared to medication count for overall and diabetes-specific regimen complexity. CONCLUSIONS More complex regimens are associated with worse A1C and measuring complexity with MRCI may have advantages. Deprescribing, increasing insurance coverage, and promoting engagement in health care may improve A1C among underserved populations with complex regimens.
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O'Conor R, Eifler M, Opsasnick L, Curtis L, Benavente JY, Lindquist L, Wolf M. CAREGIVER HEALTH LITERACY AS A MODIFIABLE TARGET TO PROMOTE OLDER ADULT HEALTH. Innov Aging 2022. [PMCID: PMC9765752 DOI: 10.1093/geroni/igac059.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Many older adults receive assistance in managing chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in a patient’s self-care. Health literacy (HL) is as an important determinant of older adults’ health outcomes, but few studies have examined caregiver HL and patient outcomes. We interviewed 162 patient-caregiver dyads during an ongoing cognitive aging cohort study to examine associations between caregiver HL, measured using the Newest Vital Sign, and older adults’ health outcomes. Physical function and mental health symptoms were assessed using PROMIS short form assessments. Patients’ also self-reported emergency department (ED) visits and hospitalizations over the past 12 months. Chi-square and t-tests were performed, as appropriate. Patients were on average 73 years old and managing 4 comorbidities. The majority were female (70%), identified as Black (35%) or White (60%). Caregivers’ mean age was 64 years; half were female (56%) and had limited HL (48%). Limited caregiver HL was associated with poorer physical function (M=43.0 (8.5) vs. M=46.0 (9.1), p=0.05), greater comorbidities (M=4.0 (1.9) vs M=3.3 (1.8), p=0.02) and more ED visits in the past year (36.7% vs. 19.3%, p=0.01). No differences by caregiver HL were observed for patients’ mental health or hospitalization. Findings suggest that caregivers with limited HL are caring for medically complex patients, and further research should examine whether limited caregiver HL leads to poorer self-management of chronic conditions. The development of HL training for caregivers may better equip them to assist older adults and improve older adult health.
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Affiliation(s)
- Rachel O'Conor
- Northwestern University, Chicago, Illinois, United States
| | - Morgan Eifler
- Northwestern University, Chicago, Illinois, United States
| | | | - Laura Curtis
- Northwestern University, Chicago, Illinois, United States
| | | | - Lee Lindquist
- Northwestern University, Chicago, Illinois, United States
| | - Michael Wolf
- Northwestern University, Chicago, Illinois, United States
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12
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Lindquist LA, Miller-Winder AP, Schierer A, Murawski A, Opsasnick L, Kim KY, Ramirez-Zohfeld V. Improvement in self-efficacy among older adults aging-in-place during COVID-19. J Am Geriatr Soc 2022; 70:3318-3321. [PMID: 35838195 PMCID: PMC9349408 DOI: 10.1111/jgs.17946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Lee A. Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amber P. Miller-Winder
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Allison Schierer
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren Opsasnick
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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13
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Kim M, Opsasnick L, Batio S, Benavente JY, Zheng P, Lovett RM, Bailey SC, Kwasny MJ, Ladner DP, Chou SH, Linder JA, Weintraub S, Luo Y, Zee PC, Wolf MS. Prevalence and risk factors of sleep disturbance in adults with underlying health conditions during the ongoing COVID-19 pandemic. Medicine (Baltimore) 2022; 101:e30637. [PMID: 36123887 PMCID: PMC9477708 DOI: 10.1097/md.0000000000030637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To determine the prevalence of sleep disturbance during the coronavirus disease 2019 (COVID-19) pandemic among US adults who are more vulnerable to complications because of age and co-morbid conditions, and to identify associated sociodemographic and psychosocial factors. Cross-sectional survey linked to 3 active clinical trials and 2 cohort studies, conducted between 11/30/2020 and 3/3/2021. Five academic internal medicine practices and 2 federally qualified health centers. A total of 715 adults ages 23 to 91 years living with one or more chronic conditions. A fifth (20%) of participants reported poor sleep. Black adults were twice as likely to report poor sleep compared to Whites. Self-reported poor physical function (51%), stress (42%), depression (28%), and anxiety (36%) were also common and all significantly associated with poor sleep. Age ≥70 years and having been vaccinated for COVID-19 were protective against poor sleep. Sex, education, income, alcohol use, and employment status were not significantly associated with sleep quality. In this diverse sample of adults with chronic conditions, by race, ethnicity, and socioeconomic status, disparities in sleep health amid the ongoing pandemic were apparent. Worse physical function and mental health were associated with poor sleep and should be considered targets for health system interventions to prevent the many subsequent consequences of disturbed sleep on health outcomes. Measurements: self-reported sleep quality, physical function, stress, depression, and anxiety.
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Affiliation(s)
- Minjee Kim
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- * Correspondence: Minjee Kim, Department of Neurology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue Suite 1150, Chicago IL 60611, USA (e-mail: )
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Stephanie Batio
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Julia Y. Benavente
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Pauline Zheng
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Rebecca M. Lovett
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Stacy C. Bailey
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Mary J. Kwasny
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Sherry H.Y. Chou
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Jeffrey A. Linder
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Sandra Weintraub
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Phyllis C. Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
- Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago IL, USA
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14
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Lindquist LA, Miller‐Winder AP, Schierer A, Murawski A, Opsasnick L, Curtis LM, Kim K, Ramirez‐Zohfeld V. Aspects of cognition that impact aging-in-place and long-term care planning. J Am Geriatr Soc 2022; 70:2646-2652. [PMID: 35726136 PMCID: PMC9489627 DOI: 10.1111/jgs.17927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Older adults frequently defer decisions about their aging-in-place/long-term care (AIP-LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP-LTC planning. METHODS As part of the PlanYourLifespan (PYL)-LitCog study, we longitudinally examined AIP-LTC decision-making among a cohort (LitCog) of community-based older adults (65 years and older) recruited from hospital-associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence-based online intervention that facilitates AIP-LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP-LTC decision-making. Cross-sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP-LTC decision-making. RESULTS Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non-White), subjects were more likely to have made AIP-LTC decisions if they had adequate inductive reasoning (ETS letter sets total-OR = 1.14 (95% CI = 1.03-1.27; p < 0.05)) and adequate working memory (size judgment span total-OR = 1.76 (95% CI = 1.13-2.73; p < 0.05)). There were no differences in decision-making observed in verbal abilities, long-term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision-making response at baseline. CONCLUSION Inductive reasoning and working memory are critical to AIP-LTC decision-making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP-LTC needs.
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Affiliation(s)
- Lee A. Lindquist
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Amber P. Miller‐Winder
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Allison Schierer
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Lauren Opsasnick
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Laura M. Curtis
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Kwang‐Youn Kim
- Division of Preventative MedicineNorthwestern UniversityChicagoIllinoisUSA
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15
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Klinedinst TC, Opsasnick L, Benavente JY, Wolf M, O'Conor R. The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults. J Appl Gerontol 2022; 41:2566-2573. [PMID: 35950560 DOI: 10.1177/07334648221120246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Busyness (the density of activities) and daily routine (patterns of organizing time) are two understudied factors that likely impact medication-taking behaviors. We examined the association between busyness and routine with medication adherence (MA) in 405 older adults with adequate cognition using multivariable models. The final model included an interaction term between daily routine and busyness. MA scores (measured by the ASK-12, higher scores mean more barriers to adherence) were higher for individuals reporting low and moderate levels of daily routine versus those with high daily routine. MA scores were higher for individuals reporting moderate and high busyness versus those reporting low busyness. The busyness/routine interaction term was significant for MA; among highly busy individuals, those with high daily routine had lower MA scores than those with low routine. A daily routine may be a modifiable factor for improving MA among older adults, particularly among those with busy lives.
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Affiliation(s)
- Tara C Klinedinst
- Occupational Therapy Department, School of Rehabilitation Sciences, 6186University of Oklahoma Health Sciences Center Schusterman Center, Tulsa, OK, USA.,605473Department of Family Medicine, OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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16
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Lovett RM, Opsasnick L, Russell A, Yoon E, Weiner-Light S, Serper M, Cooper Bailey S, Wolf MS. Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey. BMJ Open 2022; 12:e052495. [PMID: 34996790 PMCID: PMC8743840 DOI: 10.1136/bmjopen-2021-052495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation. DESIGN Cross-sectional analysis of wave 3 (1-22 May 2020) survey data from the ongoing Chicago COVID-19 Comorbidities (C3) study. SETTING Seven academic and community health centres in Chicago, Illinois. PARTICIPANTS 565 adults aged 23-88 with one or more chronic conditions completing at least one prior C3 study wave. PRIMARY AND SECONDARY OUTCOME MEASURES Clinically relevant anxiety and depressive symptoms as measured using Patient-Reported Outcomes Measurement Information System short forms. Self-reported emotional and health-related responses to COVID-19 were measured through a combination of single-item questions and validated measures. RESULTS Rates of anxiety and depressive symptoms were 14% (81/563) and 15% (84/563), respectively. Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic. CONCLUSIONS Identifying and addressing mental health concerns may be an important factor to consider in COVID-19 prevention and management among high-risk medical populations.
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Affiliation(s)
- Rebecca M Lovett
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Opsasnick
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrea Russell
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther Yoon
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sophia Weiner-Light
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marina Serper
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stacy Cooper Bailey
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael S Wolf
- Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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17
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O'Conor R, Benavente JY, Eifler M, Opsasnick L, Curtis L, Lindquist L, Wolf M. Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens. Innov Aging 2021. [PMCID: PMC8969957 DOI: 10.1093/geroni/igab046.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.
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Affiliation(s)
- Rachel O'Conor
- Northwestern University, Chicago, Illinois, United States
| | | | - Mogan Eifler
- Northwestern University, Chicago, Illinois, United States
| | | | - Laura Curtis
- Northwestern University, Chicago, Illinois, United States
| | - Lee Lindquist
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Michael Wolf
- Northwestern University, Chicago, Illinois, United States
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18
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Lindquist L, Miller A, Muhammed R, Opsasnick L, Murawski A, Ramirez-Zohfeld V. Increased Self-Efficacy among Older Adults Aging-in-Place during COVID-19. Innov Aging 2021. [PMCID: PMC8681423 DOI: 10.1093/geroni/igab046.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Self-efficacy is defined as a person's belief in their capacity to execute behaviors necessary to produce specific performance attainments. It also reflects confidence in the ability to exert control over motivation, behavior, and environment. During the COVID-19 pandemic, older adults were stressed with forced isolation, concerns over mortality, and finding alternate means of fulfilling their home-based needs. We sought to assess how COVID-19 pandemic affected the self-efficacy of a cohort of older adults aging-in-place. The LITCOG cohort is a group of community-dwelling older adults (65 years and older) who have had longitudinally assessment of cognition, health literacy, and functional skills over the past 15 years. As part of a larger study of the LITCOG cohort assessing decision making for aging-in-place, we assessed self-efficacy using validated PROMIS (Patient-Reported Outcomes Measurement Information System) measures with older adults prior to COVID-19 and during the COVID-19 pandemic. Survey results were obtained from 214 subjects (n=66 pre-COVID and n=148 during COVID). Nearly half of the sample (48.2%) had either marginal (25.5%) or low health literacy (22.7%). PROMIS General Self Efficacy was higher among those assessed during the COVID-19 pandemic (45.8 (7.7) pre-COVID vs 43.7 (8.0), p=0.07). PROMIS Self Efficacy for managing social interactions was higher during the COVID pandemic (45.0 (6.1) pre-COVID-19 vs. 48.7 (8.3) during COVID-19, p=0.02). During the stress and social isolation of the COVID-19 pandemic, older adults exhibited increased levels of self-efficacy. Ongoing longitudinal follow-up will determine how this self-efficacy evolves after the COVID-19 pandemic and impacts the ability to age-in-place.
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Affiliation(s)
- Lee Lindquist
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Amber Miller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ruqayyah Muhammed
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | | | - Alaine Murawski
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Vanessa Ramirez-Zohfeld
- Northwestern University Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Illinois, United States
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O’Conor R, Eifler M, Russell AM, Opsasnick L, Arvanitis M, Pack A, Curtis L, Benavente JY, Wolf MS. Caregiver involvement in managing medications among older adults with multiple chronic conditions. J Am Geriatr Soc 2021; 69:2916-2922. [PMID: 34145570 PMCID: PMC8497389 DOI: 10.1111/jgs.17337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to characterize caregiver medication assistance for older adults with multiple chronic conditions. DESIGN Semi-structured qualitative interviews. SETTING Community and academic-affiliated primary care practices. PARTICIPANTS A total of 25 caregivers to older adults participating in an ongoing cohort study with ≥3 chronic conditions. MEASUREMENTS A semi-structured interview guide, informed by the Medication Self-Management model, aimed to understand health-related and medication-specific assistance caregivers provided. RESULTS Three typologies of caregiver assistance with medications emerged: Actively Involved, Peripherally Involved, and Not Involved. A total of 10 caregivers were Actively Involved, which was defined as when the caregiver perceived a need for and offered assistance, and the patient accepted the assistance. Peripherally Involved (n = 6) was defined as when the caregiver perceived a need and offered assistance; however, the patient rejected this assistance, yet relied on the caregiver as a backup in managing his or her medications. To combat resistance from the patient, caregivers in this typology disguised assistance and deployed workaround strategies to monitor medication-taking behaviors to ensure safety. Lastly, nine caregivers were classified as Not Involved, defined as when the caregiver did not perceive a need to offer assistance with medications, and the patient managed his or her medicines independently. A strong preference toward autonomy in medication management was shared across all three typologies. CONCLUSION These findings suggest that caregivers value independent medication management by their care recipient, up until safety is seriously questioned. Clinicians should not assume caregivers are actively and consistently involved in older adults' medication management; instead, they should initiate conversations with patients and caregivers to better understand and facilitate co-management responsibilities, especially among those whose assistance is rejected by older adults.
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Affiliation(s)
- Rachel O’Conor
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Morgan Eifler
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrea M. Russell
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marina Arvanitis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allison Pack
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Arvanitis M, Opsasnick L, O'Conor R, Curtis LM, Vuyyuru C, Yoshino Benavente J, Bailey SC, Jean-Jacques M, Wolf MS. Factors associated with COVID-19 vaccine trust and hesitancy among adults with chronic conditions. Prev Med Rep 2021; 24:101484. [PMID: 34306998 PMCID: PMC8280610 DOI: 10.1016/j.pmedr.2021.101484] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022] Open
Abstract
In a survey of older adults at higher risk for COVID-19 complications, we sought to describe expectations of trust in the safety and efficacy of a future COVID-19 vaccine, and level of hesitancy about receiving it. We also assessed whether these expectations were associated with known or suspected contributors to vaccine hesitancy, disparities in vaccine receipt, and potential targets for public health outreach. From May 1–22, 2020, we performed telephone surveys of 601 older adults with chronic conditions in metro Chicago about their COVID-19 experiences and levels of vaccine trust and hesitancy. All participants previously completed assessments of demographics, health status, health literacy and activation. Bivariate associations were performed using t-tests or one-way ANOVA, and multivariate analyses using least square means. Younger age (<60), Black race, greater complacency about contracting COVID-19, and lower confidence in state or local government were associated with significantly lower trust in a vaccine’s safety and efficacy. Black race and greater complacency about contracting COVID-19 were associated with a significantly greater vaccine hesitancy. Amongst Black participants, vaccine hesitancy varied significantly by confidence in the federal government. Trust and hesitancy regarding a future COVID-19 vaccine were associated with age, race, complacency regarding contracting COVID-19, and confidence in government response to the pandemic, but not education, health literacy or activation. Therefore, efforts to vaccinate higher risk older adults must aim not only to educate and provide vaccine access, but engender trust in the vaccine development process and vaccination strategies at both the federal and the local level.
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Affiliation(s)
- Marina Arvanitis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura M Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandana Vuyyuru
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stacy C Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Muriel Jean-Jacques
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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21
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O’Conor R, Opsasnick L, Pack A, Yoshino Benavente J, Curtis LM, Lovett RM, Luu H, Wismer G, Kwasny MJ, Federman AD, Bailey SC, Wolf MS. Perceived Adequacy of Tangible Support during Stay-at-Home Orders in Chicago and New York. J Prim Care Community Health 2021; 12:21501327211024411. [PMID: 34109874 PMCID: PMC8202264 DOI: 10.1177/21501327211024411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Physical distancing precautions during the COVID-19 pandemic may challenge the provision of tangible support many middle age and older adults receive in managing their health. We examined the association between unmet tangible support needs and self-management behaviors and mental health status during the stay-at-home orders in Chicago and New York. Methods: We used data from the COVID-19 & Chronic Conditions study collected between May 1st and May 22nd, 2020. A total of 801 middle age and older adults with ≥1 chronic condition in Chicago and New York City completed the telephone interview. Adequacy of tangible social support was measured using a brief, validated scale that determined whether an individual needed assistance managing his or her health, and if yes, whether this need was met. Participants reported their level of difficulty engaging in self-management behaviors using 2 discrete items; they also self-reported medication adherence using the ASK-12 medication adherence scale. Mental health status was measured using the depression and anxiety PROMIS short-form instruments. Results: Participants’ mean age was 63 years; 30% identified as Black, 26% identified as Latino, and 12% identified unmet support needs. Inadequacy of tangible support was associated with greater difficulty managing one’s health and accessing medications due to COVID-19, as well as poorer medication adherence, increased anxiety and depressive symptoms, and poorer overall well-being (P’s < .05). Conclusions: Perceived unmet support needs during stay-at-home orders were associated with greater difficulty engaging in self-management behaviors and poorer overall well-being. Two brief items quickly identified individuals with unmet support needs.
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Affiliation(s)
- Rachel O’Conor
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Rachel O’Conor, Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 10th Floor, Chicago, IL 60611, USA.
| | - Lauren Opsasnick
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison Pack
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura M. Curtis
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca M. Lovett
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Han Luu
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Guisselle Wismer
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary J. Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Stacy C. Bailey
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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22
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Curtis LM, Kwasny MJ, Opsasnick L, O'Conor RM, Yoshino-Benavente J, Eifler M, Federman AD, Altschul D, Wolf MS. Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults. J Gen Intern Med 2021; 36:916-922. [PMID: 33559068 PMCID: PMC8042084 DOI: 10.1007/s11606-020-06423-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual's ability to manage one's health. OBJECTIVES We sought to examine health literacy over time among older adults using three widely used measures. DESIGN A prospective cohort study. PARTICIPANTS Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL. MEASURES Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points. RESULTS In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = - 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = - 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI - 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity. CONCLUSION We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.
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Affiliation(s)
- Laura M Curtis
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Mary J Kwasny
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Rachel M O'Conor
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Julia Yoshino-Benavente
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Morgan Eifler
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mt. Sinai, 17 East 102nd Street, 7th Floor, New York, NY, 10029, USA
| | - Drew Altschul
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Room F2, Psychology Building, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Michael S Wolf
- Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
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23
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Lindquist LA, Muhammad R, Miller-Winder AP, Opsasnick L, Kim KY, Benavente JY, Wolf M, Ramirez-Zohfeld V. Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults. Contemp Clin Trials Commun 2021; 22:100756. [PMID: 33869887 PMCID: PMC8040099 DOI: 10.1016/j.conctc.2021.100756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/06/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Remaining in one's own home and community is a priority for many older adults as they age. Decision-making and planning is critical to ensure successful aging-in-place (AIP), especially when individuals experience age-related changes such as cognitive decline. Objectives: We are testing how decision-making and planning for AIP is impacted by changes in older adults' cognition and function, chronic conditions, social influences, environmental factors and identifying the mediating/moderating interactions between factors. We will also assess whether decision-making and planning for AIP translates into timely adoption of plans and goal concordance between older adults and their surrogate/caregiver decision makers. Methods We will conduct a longitudinal single-group interventional clinical trial of community-dwelling older adults who are enrolled in LitCog, (R01AG03611) and expose them to an online intervention, PlanYourLifespan.org, which facilitates decision-making and planning for AIP. Enrolled participants (n = 398) will complete interviews at baseline, one month, and every six months up to 42 months in conjunction with the LitCog study, where cognitive, social, functional, and health literacy data is collected. Additionally, we will collect data on decision-making, resource use, communication of plans, timing of plan implementation, and goal concordance. Projected outcomes Findings from this study may generate evidence on how age-related changes in older adults may affect decision-making and implementation in relation to AIP as well as the impact of social relationships and support. Ultimately these findings may help shape the design of programs and practices that may improve the lives of older adults and the capacity of institutions to adapt to societal aging and AIP.
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Affiliation(s)
- Lee A Lindquist
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ruqayyah Muhammad
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amber P Miller-Winder
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kwang-Youn Kim
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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24
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O’Conor R, Eifler M, Russell A, Opsasnick L, Benavente JY, Curtis L, Wolf M. Medication Management Among Older Adults With Multiple Chronic Conditions: What Role Do Caregivers Play? Innov Aging 2020. [PMCID: PMC7742769 DOI: 10.1093/geroni/igaa057.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many older adults manage multiple chronic conditions (MCC) that require adherence to complex medication regimens. Few studies have investigated the degree to which caregivers support medication-related behaviors. We conducted semi-structured qualitative interviews with 25 caregivers of older adults with MCC to characterize caregiver medication assistance. Two coders used content and constant comparative analysis to analyze transcripts. The mean age of caregivers was 61 years; the majority were female (68%) and identified as non-white (Black, 52%; Hispanic, 8%). Caregivers were predominantly spouses (n=10), or children (n=11). Older adults were on average 73 years old, managing 5 chronic conditions and prescribed 7 medications. Caregivers acknowledged the importance of medications to the older adult’s health, but their involvement in daily medication management was limited. Some caregivers preferred that the older adult continue these tasks to maintain autonomy, especially when caring for older adults who valued maintaining independence. Caregivers assumed medication responsibilities after older adults experienced sudden changes in health or upon observing non-adherence (e.g. full pill bottles). Older adults with higher medication burden (12+ medicines) adopted inefficient, cumbersome medication management practices; caregivers suggested simplified strategies, but the older adults refused to adopt recommended strategies. To combat resistance from the older adult, caregivers disguised assistance and deployed workaround strategies to monitor medication-taking behaviors. These findings suggest older adults and caregivers share a value of promoting independence of medication management, up until safety is seriously questioned. Additionally, there is a breakdown in communication at the time when older adults may benefit from increased caregiver involvement.
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Affiliation(s)
- Rachel O’Conor
- Northwestern University, Chicago, Illinois, United States
| | - Morgan Eifler
- Northwestern University, Chicago, Illinois, United States
| | - Andrea Russell
- Northwestern University, Chicago, Illinois, United States
| | | | | | - Laura Curtis
- Northwestern University, Chicago, Illinois, United States
| | - Michael Wolf
- Northwestern University, Chicago, Illinois, United States
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25
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Curtis L, Opsasnick L, Benavente JY, Nowinski C, O’Conor R, Stoeger J, Wolf M, Gershon R. Preliminary Results of MyCog, a Brief Assessment for the Detection of Cognitive Impairment in Primary Care. Innov Aging 2020. [PMCID: PMC7740177 DOI: 10.1093/geroni/igaa057.833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Early detection of Cognitive impairment (CI) is imperative to identify potentially treatable underlying conditions or provide supportive services when due to progressive conditions such as Alzheimer’s Disease. While primary care settings are ideal for identifying CI, it frequently goes undetected. We developed ‘MyCog’, a brief technology-enabled, 2-step assessment to detect CI and dementia in primary care settings. We piloted MyCog in 80 participants 65 and older recruited from an ongoing cognitive aging study. Cases were identified either by a documented diagnosis of dementia or mild cognitive impairment (MCI) or based on a comprehensive cognitive battery. Administered via an iPad, Step 1 consists of a single self-report item indicating concern about memory or other thinking problems and Step 2 includes two cognitive assessments from the NIH Toolbox: Picture Sequence Memory (PSM) and Dimensional Change Card Sorting (DCCS). 39%(31/80) participants were considered cognitively impaired. Those who expressed concern in Step 1 (n=52, 66%) resulted in a 37% false positive and 3% false negative rate. With the addition of the PSM and DCCS assessments in Step 2, the paradigm demonstrated 91% sensitivity, 75% specificity and an area under the ROC curve (AUC)=0.82. Steps 1 and 2 had an average administration time of <7 minutes. We continue to optimize MyCog by 1) examining additional items for Step 1 to reduce the false positive rate and 2) creating a self-administered version to optimize use in clinical settings. With further validation, MyCog offers a practical, scalable paradigm for the routine detection of cognitive impairment and dementia.
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Affiliation(s)
- Laura Curtis
- Northwestern University, Chicago, Illinois, United States
| | | | | | - Cindy Nowinski
- Northwestern University, Chicago, Illinois, United States
| | - Rachel O’Conor
- Northwestern University, Chicago, Illinois, United States
| | - Jordan Stoeger
- Northwestern University, Chicago, Illinois, United States
| | - Michael Wolf
- Northwestern University, Chicago, Illinois, United States
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Maroney K, Curtis LM, Opsasnick L, Smith KD, Eifler MR, Moore A, Wedd J, Wolf MS, Patzer RE. eHealth literacy and web-based patient portal usage among kidney and liver transplant recipients. Clin Transplant 2020; 35:e14184. [PMID: 33278846 DOI: 10.1111/ctr.14184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/27/2022]
Abstract
Patient portals promote self-management, but require skills with electronic health information which can be measured by a patient's eHealth literacy. We aimed to describe eHealth literacy among a population of kidney transplant (KT) and liver transplant (LT) recipients and to investigate the relationship between eHealth literacy and Web-based patient portal utilization. We conducted phone surveys (August 2016-March 2017) among 178 KT and 110 LT recipients at two large transplant centers, including the eHealth Literacy Scale (eHEALS) and items assessing routine portal usage. Portal users were defined as routine if usage was every day, weekly, or monthly. The mean eHEALS score was 30.9 (SD: 5.4), and 45.4% routinely used the patient portal more than a few times per month. Routine users had higher eHealth literacy than non-routine users and non-users (31.97 vs. 29.97 vs. 28.20, p < .001). Routine users had higher eHealth literacy scores compared with non-users after adjusting for transplant organ type, age, educational level, employment status, mobile Internet access, and transplant center (OR: 1.10, 95% CI: 1.03-1.17). KT and LT recipients who routinely use patient portals have high eHealth literacy compared with other diseased populations, which should be leveraged by encouraging routine usage to improve post-transplant health and medication adherence.
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Affiliation(s)
- Kieran Maroney
- Division of Transplantation, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA
| | - Laura M Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kayla D Smith
- Division of Transplantation, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA
| | - Morgan R Eifler
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy Moore
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joel Wedd
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA
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27
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Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis L, Benavente JY, Wismer G, Batio S, Eifler M, Zheng P, Russell A, Arvanitis M, Ladner D, Kwasny M, Persell SD, Rowe T, Linder JA, Bailey SC. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med 2020; 173:100-109. [PMID: 32271861 PMCID: PMC7151355 DOI: 10.7326/m20-1239] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. OBJECTIVE To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. DESIGN Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. SETTING 5 academic internal medicine practices and 2 federally qualified health centers. PATIENTS 630 adults aged 23 to 88 years living with 1 or more chronic conditions. MEASUREMENTS Self-reported knowledge, attitudes, and behaviors related to COVID-19. RESULTS A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response. LIMITATION Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. CONCLUSION Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Michael S Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Marina Serper
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (M.S.)
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Rachel M O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Laura Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Guisselle Wismer
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Morgan Eifler
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Pauline Zheng
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Andrea Russell
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Marina Arvanitis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
| | - Daniela Ladner
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois (D.L., M.K., S.D.P., T.R., J.A.L.)
| | - Mary Kwasny
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois (D.L., M.K., S.D.P., T.R., J.A.L.)
| | - Stephen D Persell
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois (D.L., M.K., S.D.P., T.R., J.A.L.)
| | - Theresa Rowe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois (D.L., M.K., S.D.P., T.R., J.A.L.)
| | - Jeffrey A Linder
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois (D.L., M.K., S.D.P., T.R., J.A.L.)
| | - Stacy C Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (M.S.W., L.O., R.M.O., L.C., J.Y.B., G.W., S.B., M.E., P.Z., A.R., M.A., S.C.B.)
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O'Conor R, Arvanitis M, Wismer G, Opsasnick L, Sanchez Muñoz A, Kannry J, Lin JJ, Kaiser D, Kwasny MJ, Persell SD, Parker R, Wood AJJ, Federman AD, Wolf MS. Rationale and design of the regimen education and messaging in diabetes (REMinD) trial. Contemp Clin Trials 2019; 83:46-52. [PMID: 31260791 PMCID: PMC6642855 DOI: 10.1016/j.cct.2019.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half of all patients do not consistently take the dose prescribed for them, and therefore may not receive the full potential therapeutic benefit. Both patient and health system factors contribute to achieving and maintaining medication adherence. To determine if patients with type 2 diabetes who are concurrently managing other chronic conditions could improve their adherence, we devised and are testing a multifaceted, primary care-based strategy to provide health literacy-appropriate and language concordant regimen information, guidance and reminders. OBJECTIVE We are testing the effectiveness of an electronic health record (EHR) based strategy and short message service (SMS) text reminders to help patients with type 2 diabetes adhere to their medications. METHODS We are conducting a 3-arm, multi-site trial to test and compare the effectiveness of the EHR, and EHR + SMS text reminder strategies compared to usual care on medication adherence. Our goal is to enroll a total of 900 English or Spanish-speaking patients with type 2 diabetes and hemoglobin A1C value ≥7.5%. Enrolled participants will complete interviews at baseline and 3 and 6 months following their baseline interview. CONCLUSIONS Our trial is evaluating practical, clinic-based, scalable, evidence-based solutions for patients with type 2 diabetes managing complex medication regimens. Our findings will evaluate strategies that can be implemented broadly in primary care practices, and programmed as defaults within EHRs to support appropriate medication adherence to allow the widespread implementation of those strategies.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Marina Arvanitis
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Lauren Opsasnick
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Angela Sanchez Muñoz
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Darren Kaiser
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Stephen D Persell
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ruth Parker
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Alastair J J Wood
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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