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Pack A, O'Conor R, Curran Y, Huang W, Zuleta A, Zuleta R, Herman MP, Kymes SM, Bailey SC. Delayed opportunities for patient-provider communication about medication overuse headache: Mixed methods perspectives from patients and neurologists. Prev Med Rep 2024; 40:102659. [PMID: 38435414 PMCID: PMC10906507 DOI: 10.1016/j.pmedr.2024.102659] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives Medication overuse headache (MOH) is a common, debilitating condition occurring when migraine patients overuse pain relief medications. We conducted a convergent mixed methods study examining patient-provider communication on MOH. Methods Migraine patients were identified from one academic health center via electronic health records. Research staff recruited patients and administered a remote survey on MOH awareness, knowledge, and communication; descriptive and bivariate analyses were conducted. Neurologists from the same health center were invited to participate in qualitative interviews; analysis drew from the Rapid Identification of Themes from Audio Recordings procedures. A side-by-side comparison of results followed. Results Participants included 200 patients and 13 neurologists. More than one third of patients (39.5 %) had never heard of 'medication overuse headache.' Among those who had, 38.4 % learned about MOH ≥ 5 years after their migraine diagnosis. Neurologists similarly reported limited patient awareness of MOH and suggested communication was provider-initiated, reactive to patient-reported symptoms and behaviors. Participants agreed MOH was described as a 'consequence' of frequent medication taking, though specific terminology varied with neurologists suggesting they choose terms they perceive to be easier to understand and less stigmatizing to patients. Neurologists felt they lacked effective patient education resources. Conclusions Findings reveal delayed opportunities to inform patients about MOH. Standardized education supporting early preventive communication is needed, perhaps in primary care where many patients seek initial care for migraine symptoms.
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Affiliation(s)
- Allison Pack
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Yvonne Curran
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wei Huang
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Andrea Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rodolfo Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | | | | | - Stacy C. Bailey
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Rocque GB, Patel MI, Wallner LP, Bailey SC, Schear R, Gunn CM, Rivers J, Wilson R, Freeman EC, Buckingham TL, May SG, Kamal AH. Patient-Centered Decision-Making in Metastatic Breast Cancer Care Delivery: A Call to Action. J Natl Compr Canc Netw 2024; 22:e237113. [PMID: 38394778 DOI: 10.6004/jnccn.2023.7113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Gabrielle B Rocque
- Divisions of Hematology & Oncology and Gerontology, Geriatrics, & Palliative Care, University of Alabama, Birmingham, Alabama
| | - Manali I Patel
- Department of Medicine, Stanford University, Stanford, CA, and Medical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Lauren P Wallner
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Christine M Gunn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine; Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Jamil Rivers
- The Chrysalis Initiative, Philadelphia, Pennsylvania
| | | | | | | | | | - Arif H Kamal
- American Cancer Society, Charlotte, North Carolina
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Pack AP, Rusca P, Llaneza J, Wismer G, Huang W, Zuleta R, Bailey SC. Optimizing Telehealth Services: A Mixed-Methods Needs Assessment Conducted Among Community Health Center Patients. Med Care 2024; 62:30-36. [PMID: 37796220 PMCID: PMC10840924 DOI: 10.1097/mlr.0000000000001932] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased telehealth services in federally funded community health centers (CHCs). Yet little is known about common determinants of use among CHC patients. OBJECTIVE We examined the use of telehealth among patient participants at 1 large CHC network providing care to underserved populations at urban and suburban sites in the Midwest. METHODS We conducted a mixed-methods study utilizing a sequential explanatory design. Participants were English and/or Spanish-speaking adults who attended ≥1 visits for themselves or their child over a 12-month period at any practice location. Research staff conducted a structured phone survey of eligible adults. The results subsequently facilitated purposive sampling of telehealth "users" and "nonusers" for qualitative phone interviews. RESULTS The survey participants included 500 adults. Most had access to the resources needed to utilize telehealth, including a smartphone (90.4%) and home internet (83.0%). About half (50.8%) "rarely or never" had problems with internet speed, reliability, or quality. Most (81.1%) were aware of the patient portal and 59.8% had utilized video visits. Participants who were Spanish-speaking and with limited English proficiency faced some of the greatest barriers. Qualitative interview participants included 12 users and 12 nonusers of telehealth. Users found telehealth convenient and efficient, while nonusers lacked awareness about how telehealth services could be beneficial or needed assistance to sign up, join, or use telehealth. CONCLUSIONS Most participants had the resources and awareness necessary to use telehealth services. Those who use them appreciate the convenience and efficiency. Nevertheless, additional support may be needed to prevent telehealth from exacerbating health inequities.
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Affiliation(s)
- Allison P. Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paula Rusca
- Erie Family Health Centers, Chicago, IL, USA
| | | | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wei Huang
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rodolfo Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stacy C. Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Hernandez J, Batio S, Lovett RM, Wolf MS, Bailey SC. Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study. J Prim Care Community Health 2024; 15:21501319241233869. [PMID: 38400555 PMCID: PMC10893833 DOI: 10.1177/21501319241233869] [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: 12/12/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance. METHODS This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions. RESULTS The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves. CONCLUSION Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.
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O'Brien MJ, Bailey SC, Gregory DL, Owen AL, Khan SS, Ackermann RT, Hassan A, Mohanty N, Bowen ME. Screening for Prediabetes and Diabetes in a National Network of Federally Qualified Health Centers: An Observational Study. J Gen Intern Med 2023; 38:3541-3548. [PMID: 37731136 PMCID: PMC10713898 DOI: 10.1007/s11606-023-08402-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended screening for prediabetes and diabetes among adults aged 35-70 years with overweight or obesity. Studying dysglycemia screening in federally qualified health centers (FQHCs) that serve vulnerable patient populations is needed to understand health equity implications of this recommendation. OBJECTIVE To investigate screening practices among FQHC patients who would be eligible according to the 2021 USPSTF recommendation. DESIGN Retrospective cohort study analyzing electronic health records from a national network of 282 FQHC sites. PARTICIPANTS We included 183,329 patients without prior evidence of prediabetes or diabetes, who had ≥ 1 office visit from 2018-2020. MAIN MEASURES Screening eligibility was based on age and measured body mass index (BMI). The primary outcome, screening completion, was ascertained using hemoglobin A1c or fasting plasma glucose results from 2018-2020. KEY RESULTS Among 89,543 patients who would be eligible according to the 2021 USPSTF recommendation, 53,263 (59.5%) were screened. Those who completed screening had higher BMI values than patients who did not (33.0 ± 6.7 kg/m2 vs. 31.9 ± 6.2 kg/m2, p < 0.001). Adults aged 50-64 years had greater odds of screening completion relative to younger patients (OR 1.13, 95% CI: 1.10-1.17). Patients from racial and ethnic minority groups, as well as those without health insurance, were more likely to complete screening than White patients and insured patients, respectively. Clinical risk factors for diabetes were also associated with dysglycemia screening. Among patients who completed screening, 23,588 (44.3%) had values consistent with prediabetes or diabetes. CONCLUSIONS Over half of FQHC patients who would be eligible according to the 2021 USPSTF recommendation were screened. Screening completion was higher among middle-aged patients, those with greater BMI values, as well as vulnerable groups with a high risk of developing diabetes. Future research should examine adoption of the 2021 USPSTF screening recommendation and its impact on health equity.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, Suite 680, Chicago, IL, 60611, USA.
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, Suite 680, Chicago, IL, 60611, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dyanna L Gregory
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, Suite 680, Chicago, IL, 60611, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew L Owen
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, Suite 680, Chicago, IL, 60611, USA
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Nivedita Mohanty
- AllianceChicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael E Bowen
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bailey SC, Pack AP, Wismer G, Calderon N, Velazquez E, Batio S, Ekong A, Eggleston A, Wallia A, Wolf MS, Schauer JM, Tenfelde S, Liebovitz DM, Grobman WA. Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes. BMJ Open 2023; 13:e078282. [PMID: 37940161 PMCID: PMC10632823 DOI: 10.1136/bmjopen-2023-078282] [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: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care. METHODS AND ANALYSIS We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to 'hardwire' preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18-44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic's assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects. ETHICS AND DISSEMINATION This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04976881).
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Affiliation(s)
- Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison P Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Norma Calderon
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evelyn Velazquez
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Amisha Wallia
- Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob M Schauer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sandi Tenfelde
- Family and Community Health Department, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - David M Liebovitz
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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Pack AP, Masters MC, O’Conor R, Alcantara K, Svoboda S, Smith R, Yeh F, Wismer G, Wallia A, Bailey SC. A Qualitative Exploration of Perceived Medication Adherence Determinants Conducted Among Older Adults with HIV and Type 2 Diabetes Mellitus. Patient Prefer Adherence 2023; 17:2667-2678. [PMID: 37927343 PMCID: PMC10625325 DOI: 10.2147/ppa.s431869] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background People living with HIV (PLWH) are at higher risk of developing type 2 diabetes (T2DM). Both chronic conditions require individuals to adhere to medication regimens, yet few studies have sought to explore medication-taking behaviors among individuals with comorbid HIV and T2DM (HIV+T2DM). Objective This qualitative study sought to: 1) identify and compare perceived determinants of medication adherence for HIV and, separately, for T2DM, and 2) explore how participants prioritize conditions. Methods Between October 2022 and January 2023, we conducted in-depth interviews with individuals aged 50 or older, living with comorbid HIV+T2DM. Participants were prescribed oral medications to treat their conditions and had recent clinical measures indicating probable challenges with medication adherence. Interviews with consented participants from a large academic health center in the Midwest were conducted remotely. Questions largely drew from the Theoretical Domains Framework (TDF), a widely used implementation science framework. Additional questions explored the prioritization of conditions. Analysis employed the Framework Method and a side-by-side comparison of key determinants of medication adherence by condition. Results A total of 19 interviews were audio recorded, transcribed, and analyzed. Participants were an average age of 61, mostly male (89.5%), and Non-Hispanic White (47.4%). Although results revealed many commonalities between perceived determinants of medication adherence for HIV and for T2DM, differences relating to two TDF domains were noted: nature of the behavior (taking medications as prescribed), and motivations and goals. Many participants viewed their conditions as equally important, though they suggested T2DM was more difficult to manage, largely due to lifestyle modifications. Conclusion As individuals with HIV develop chronic conditions, such as T2DM, they may require additional medication adherence support. Attention should be paid to offering support early. Disease perceptions may differ by condition, and as such, one's motivations to take medication as prescribed may also differ by condition.
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Affiliation(s)
- Allison P Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rachel O’Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kenya Alcantara
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sophia Svoboda
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Reneaki Smith
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fangyu Yeh
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amisha Wallia
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Lovett R, Filec S, Bonham M, Yoshino Benavente J, O'Conor R, Russell A, Zheng P, Wismer G, Yoon E, Weiner-Light S, Vogeley A, Morrissey Kwasny M, Lowe S, Curtis LM, Federman A, Bailey SC, Wolf M. Long-term impact of the COVID-19 pandemic on self-management of chronic conditions among high-risk adults in the USA: protocol for the C3 observational cohort study. BMJ Open 2023; 13:e077911. [PMID: 37899164 PMCID: PMC10618985 DOI: 10.1136/bmjopen-2023-077911] [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: 07/20/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION COVID-19 is an unprecedented public health threat in modern times, especially for older adults or those with chronic illness. Beyond the threat of infection, the pandemic may also have longer-term impacts on mental and physical health. The COVID-19 & Chronic Conditions ('C3') study offers a unique opportunity to assess psychosocial and health/healthcare trajectories over 5 years among a diverse cohort of adults with comorbidities well-characterised from before the pandemic, at its onset, through multiple surges, vaccine rollouts and through the gradual easing of restrictions as society slowly returns to 'normal'. METHODS AND ANALYSIS The C3 study is an extension of an ongoing longitudinal cohort study of 'high-risk' adults (aged 23-88 at baseline) with one or more chronic medical conditions during the COVID-19 pandemic. Five active studies with uniform data collection prior to COVID-19 were leveraged to establish the C3 cohort; 673 adults in Chicago were interviewed during the first week of the outbreak. The C3 cohort has since expanded to include 1044 participants across eight survey waves (T1-T8). Four additional survey waves (T9-T12) will be conducted via telephone interviews spaced 1 year apart and supplemented by electronic health record and pharmacy fill data, for a total of 5 years of data post pandemic onset. Measurement will include COVID-19-related attitudes/behaviours, mental health, social behaviour, lifestyle/health behaviours, healthcare use, chronic disease self-management and health outcomes. Mental health trajectories and associations with health behaviours/outcomes will be examined in a series of latent group and mixed effects modelling, while also examining mediating and moderating factors. ETHICS AND DISSEMINATION This study was approved by Northwestern University's Feinberg School of Medicine Institutional Review Board (STU00215360). Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study.
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Affiliation(s)
- Rebecca Lovett
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Filec
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Yoshino Benavente
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel O'Conor
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrea Russell
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pauline Zheng
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guisselle Wismer
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther Yoon
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sophia Weiner-Light
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abigail Vogeley
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary Morrissey Kwasny
- Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Lowe
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura M Curtis
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Stacy C Bailey
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Wolf
- General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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O’Brien MJ, Zhang Y, Bailey SC, Khan SS, Ackermann RT, Ali MK, Bowen ME, Benoit SR, Imperatore G, Holliday CS, McKeever Bullard K. Clinical performance and health equity implications of the American Diabetes Association's 2023 screening recommendation for prediabetes and diabetes. Front Endocrinol (Lausanne) 2023; 14:1279348. [PMID: 37900145 PMCID: PMC10611495 DOI: 10.3389/fendo.2023.1279348] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The American Diabetes Association (ADA) recommends screening for prediabetes and diabetes (dysglycemia) starting at age 35, or younger than 35 years among adults with overweight or obesity and other risk factors. Diabetes risk differs by sex, race, and ethnicity, but performance of the recommendation in these sociodemographic subgroups is unknown. Methods Nationally representative data from the National Health and Nutrition Examination Surveys (2015-March 2020) were analyzed from 5,287 nonpregnant US adults without diagnosed diabetes. Screening eligibility was based on age, measured body mass index, and the presence of diabetes risk factors. Dysglycemia was defined by fasting plasma glucose ≥100mg/dL (≥5.6 mmol/L) or haemoglobin A1c ≥5.7% (≥39mmol/mol). The sensitivity, specificity, and predictive values of the ADA screening criteria were examined by sex, race, and ethnicity. Results An estimated 83.1% (95% CI=81.2-84.7) of US adults were eligible for screening according to the 2023 ADA recommendation. Overall, ADA's screening criteria exhibited high sensitivity [95.0% (95% CI=92.7-96.6)] and low specificity [27.1% (95% CI=24.5-29.9)], which did not differ by race or ethnicity. Sensitivity was higher among women [97.8% (95% CI=96.6-98.6)] than men [92.4% (95% CI=88.3-95.1)]. Racial and ethnic differences in sensitivity and specificity among men were statistically significant (P=0.04 and P=0.02, respectively). Among women, guideline performance did not differ by race and ethnicity. Discussion The ADA screening criteria exhibited high sensitivity for all groups and was marginally higher in women than men. Racial and ethnic differences in guideline performance among men were small and unlikely to have a significant impact on health equity. Future research could examine adoption of this recommendation in practice and examine its effects on treatment and clinical outcomes by sex, race, and ethnicity.
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Affiliation(s)
- Matthew J. O’Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stacy C. Bailey
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ronald T. Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Mohammed K. Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Michael E. Bowen
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stephen R. Benoit
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christopher S. Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Griffin AC, Khairat S, Bailey SC, Chung AE. A chatbot for hypertension self-management support: user-centered design, development, and usability testing. JAMIA Open 2023; 6:ooad073. [PMID: 37693367 PMCID: PMC10491950 DOI: 10.1093/jamiaopen/ooad073] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/02/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Health-related chatbots have demonstrated early promise for improving self-management behaviors but have seldomly been utilized for hypertension. This research focused on the design, development, and usability evaluation of a chatbot for hypertension self-management, called "Medicagent." Materials and Methods A user-centered design process was used to iteratively design and develop a text-based chatbot using Google Cloud's Dialogflow natural language understanding platform. Then, usability testing sessions were conducted among patients with hypertension. Each session was comprised of: (1) background questionnaires, (2) 10 representative tasks within Medicagent, (3) System Usability Scale (SUS) questionnaire, and (4) a brief semi-structured interview. Sessions were video and audio recorded using Zoom. Qualitative and quantitative analyses were used to assess effectiveness, efficiency, and satisfaction of the chatbot. Results Participants (n = 10) completed nearly all tasks (98%, 98/100) and spent an average of 18 min (SD = 10 min) interacting with Medicagent. Only 11 (8.6%) utterances were not successfully mapped to an intent. Medicagent achieved a mean SUS score of 78.8/100, which demonstrated acceptable usability. Several participants had difficulties navigating the conversational interface without menu and back buttons, felt additional information would be useful for redirection when utterances were not recognized, and desired a health professional persona within the chatbot. Discussion The text-based chatbot was viewed favorably for assisting with blood pressure and medication-related tasks and had good usability. Conclusion Flexibility of interaction styles, handling unrecognized utterances gracefully, and having a credible persona were highlighted as design components that may further enrich the user experience of chatbots for hypertension self-management.
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Affiliation(s)
- Ashley C Griffin
- VA Palo Alto Health Care System, Palo Alto, CA 94025, United States
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC 27599, United States
- School of Nursing, UNC, Chapel Hill, NC 27599, United States
| | - Stacy C Bailey
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Arlene E Chung
- Department of Biostatistics & Bioinformatics, Duke School of Medicine, Durham, NC 27710, United States
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11
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Pack A, Russell A, Kircher S, Weldon C, Bailey SC, Lockwood K, Marquart T, Afonso AS, Payakachat N, Wolf M. Current communication practices for biomarker testing in non-small cell lung cancer: Exploring patient and clinician perspectives. Patient Educ Couns 2023; 114:107839. [PMID: 37321114 PMCID: PMC10528088 DOI: 10.1016/j.pec.2023.107839] [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] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/13/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES We qualitatively explored patient and clinician experiences with biomarker testing in one academic health system to identify current communication practices and unmet testing information needs. METHODS We conducted 1:1 in-depth interviews with 15 clinicians (i.e., nurses, oncologists, pathologists) and 12 patients diagnosed with non-small cell lung cancer between January and May 2022. Participants described experiences with biomarker testing as well as associated communication practices and needs. Interviews were audio-recorded and transcribed. Analysis was informed by the Framework Method. RESULTS Patients described challenges retaining information early in their patient journey. While patients were generally aware of biomarkers and their effect on treatment options, they expressed limited knowledge of expected time delays between testing and receiving results. Additionally, many did not know their testing results. Clinicians and patients both noted no standard education material on biomarker testing is currently available. They suggested such materials could support patient knowledge and decision-making. CONCLUSIONS Communication between patients and clinicians about biomarker testing is largely delivered through verbal counseling at a time when patients may be cognitively compromised. All participants supported the idea of delivering standard, tangible education materials on biomarker testing to patients. PRACTICE IMPLICATIONS Education materials may enhance counseling efforts and patient knowledge.
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Affiliation(s)
- Allison Pack
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
| | - Andrea Russell
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Sheetal Kircher
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Christine Weldon
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA; Division of Obstetrics and Gynecology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA; The Center for Business Models in Healthcare, Glencoe, IL, USA
| | - Stacy C Bailey
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | | | | | | | | | - Michael Wolf
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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12
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O'Brien MJ, Zhang Y, Bailey SC, Khan SS, Ackermann RT, Ali MK, Benoit SR, Imperatore G, Holliday CS, Bullard KM. Screening for Prediabetes and Diabetes: Clinical Performance and Implications for Health Equity. Am J Prev Med 2023; 64:814-823. [PMID: 37171231 PMCID: PMC10188199 DOI: 10.1016/j.amepre.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended prediabetes and diabetes screening for asymptomatic adults aged 35-70 years with overweight/obesity, lowering the age from 40 years in its 2015 recommendation. The USPSTF suggested considering earlier screening in racial and ethnic groups with high diabetes risk at younger ages or lower BMI. This study examined the clinical performance of these USPSTF screening recommendations as well as alternative age and BMI cutoffs in the U.S. adult population overall, and separately by race and ethnicity. METHODS Nationally representative data were collected from 3,243 nonpregnant adults without diagnosed diabetes in January 2017-March 2020 and analyzed from 2021 to 2022. Screening eligibility was based on age and measured BMI. Collectively, prediabetes and undiagnosed diabetes were defined by fasting plasma glucose ≥100 mg/dL or hemoglobin A1c ≥5.7%. The sensitivity, specificity, and predictive values of alternate screening criteria were examined overall, and by race and ethnicity. RESULTS The 2021 criteria exhibited marginally higher sensitivity (58.6%, 95% CI=55.5, 61.6 vs 52.9%, 95% CI=49.7, 56.0) and lower specificity (69.3%, 95% CI=65.7, 72.2 vs 76.4%, 95% CI=73.3, 79.2) than the 2015 criteria overall, and within each racial and ethnic group. Screening at lower age and BMI thresholds resulted in even greater sensitivity and lower specificity, especially among Hispanic, non-Hispanic Black, and Asian adults. Screening all adults aged 35-70 years regardless of BMI yielded the most equitable performance across all racial and ethnic groups. CONCLUSIONS The 2021 USPSTF screening criteria will identify more adults with prediabetes and diabetes in all racial and ethnic groups than the 2015 criteria. Screening all adults aged 35-70 years exhibited even higher sensitivity and performed most similarly by race and ethnicity, which may further improve early detection of prediabetes and diabetes in diverse populations.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, Ilinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois.
| | - Yan Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois; Chicago Center for Diabetes Translation Research, Northwestern University Feinberg School of Medicine and University of Chicago Pritzker School of Medicine, Chicago, Ilinois
| | - Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Stephen R Benoit
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher S Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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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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Kim M, Kwasny MJ, Bailey SC, Benavente JY, Zheng P, Bonham M, Luu HQ, Cecil P, Agyare P, O'Conor R, Curtis LM, Hur S, Yeh F, Lovett RM, Russell A, Luo Y, Zee PC, Wolf MS. MidCog study: a prospective, observational cohort study investigating health literacy, self-management skills and cognitive function in middle-aged adults. BMJ Open 2023; 13:e071899. [PMID: 36822802 PMCID: PMC9950895 DOI: 10.1136/bmjopen-2023-071899] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION The lack of definitive means to prevent or treat cognitive impairment or dementia is driving intense efforts to identify causal mechanisms. Recent evidence suggests clinically meaningful declines in cognition might present as early as middle age. Studying cognitive changes in middle adulthood could elucidate modifiable factors affecting later cognitive and health outcomes, yet few cognitive ageing studies include this age group. The purpose of the MidCog study is to begin investigations of less-studied and potentially modifiable midlife determinants of later life cognitive outcomes. METHODS AND ANALYSIS MidCog is a prospective cohort study of adults ages 35-64, with two in-person interviews 2.5 years apart. Data will be collected from interviews, electronic health records and pharmacy fill data. Measurements will include health literacy, self-management skills, cognitive function, lifestyle and health behaviours, healthcare use, health status and chronic disease outcomes. Associations of health literacy and self-management skills with health behaviours and cognitive/health outcomes will be examined in a series of regression models, and moderating effects of modifiable psychosocial factors.Finally, MidCog data will be linked to an ongoing, parallel cohort study of older adults recruited at ages 55-74 in 2008 ('LitCog'; ages 70-90 in 2023), to explore associations between age, health literacy, self-management skills, chronic diseases, health status and cognitive function among adults ages 35-90. ETHICS AND DISSEMINATION The Institutional Review Board at Northwestern University has approved the MidCog study protocol (STU00214736). Results will be published in peer-reviewed journals and summaries will be provided to the funders of the study as well as patients.
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Affiliation(s)
- Minjee Kim
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary J Kwasny
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacy C Bailey
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia Y Benavente
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pauline Zheng
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Morgan Bonham
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Han Q Luu
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick Cecil
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Prophecy Agyare
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel O'Conor
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura M Curtis
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Scott Hur
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Fangyu Yeh
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca M Lovett
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrea Russell
- Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 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, Illinois, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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17
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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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18
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Shaw PA, Sumner AL, Halton CC, Bailey SC, Wolf MS, Andrews EN, Cartwright T. "You're more engaged when you're listening to somebody tell their story": A qualitative exploration into the mechanisms of the podcast 'menopause: unmuted' for communicating health information. Patient Educ Couns 2022; 105:3494-3500. [PMID: 36109275 DOI: 10.1016/j.pec.2022.09.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While health podcasts can be effective in reducing stigma and increasing knowledge, we know little about their mechanisms of action. This qualitative study explored the mechanisms of how women connected with the podcast 'menopause: unmuted', which presented menopause information in a storytelling format. METHODS A diverse sample of 30 women aged 40-60 years were interviewed after listening to the podcast. Interviews covered participant's views and perceptions of the stories presented. Transcripts were analyzed thematically. FINDINGS Two overarching themes were identified. 'Openness and authenticity' describes the value of personal stories told in an authentic way by real experts-by-experience. 'Relatability and representation' explores participants' emotional reaction to the podcast, influenced by the extent to which they identified with the stories and storytellers on the podcast. CONCLUSIONS Authenticity and relatability were identified as key mechanisms through which participants connected with audio stories, consistent with Fisher's narrative theory. These findings have important implications for the application of storytelling in podcasts designed to influence health behaviors. PRACTICE IMPLICATIONS Diverse stories representing a range of demographic characteristics and experiences are needed when creating podcasts about health information to increase listener's relatability and connection.
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Affiliation(s)
- Philippa A Shaw
- School of Social Sciences, University of Westminster, London, United Kingdom.
| | - Amy L Sumner
- School of Social Sciences, University of Westminster, London, United Kingdom.
| | | | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
| | - Emma N Andrews
- US/Global Medical Affairs, Pfizer, Inc., New York, New York, USA.
| | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, United Kingdom.
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19
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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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20
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Maheswaranathan M, Eudy AM, Barr AC, Howe C, Doss J, Sadun RE, Criscione-Schreiber LG, Sun K, Perrin EM, Bailey SC, Hastings SN, Clowse MEB, Rogers JL. Association of Health Literacy and Numeracy With Lupus Knowledge and the Creation of the Lupus Knowledge Assessment Test. J Rheumatol 2022; 49:585-591. [PMID: 35232802 DOI: 10.3899/jrheum.210708] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Limited health literacy and numeracy are associated with worse patient-reported outcomes and higher disease activity in systemic lupus erythematosus (SLE), but which factors may mediate this association is unknown. We sought to determine the association of health literacy and numeracy with SLE knowledge. METHODS Patients with SLE were recruited from an academic center clinic. Participants completed validated assessments of health literacy (Newest Vital Sign [NVS]; n = 96) and numeracy (Numeracy Understanding in Medicine Instrument, Short Version [S-NUMI]; n = 85). They also completed the Lupus Knowledge Assessment Test (LKAT), which consists of 4 questions assessing SLE knowledge that were determined through consensus expert opinion for their wide applicability and importance related to self-management of the disease. Descriptive statistics and multivariable logistic regression modeling were used to analyze the results. RESULTS In our SLE cohort (n = 125), 33% (32/96) had limited health literacy and 76% (65/85) had limited numeracy. The majority correctly identified that hydroxychloroquine prevented SLE flares (91%); however, only 23% of participants correctly answered a numeracy question assessing which urine protein to creatinine (UPC) ratio was > 1000 mg/g. The mean LKAT score was 2.7 out of 4.0. Limited health literacy, but not numeracy, was associated with lower knowledge about SLE as measured by the LKAT, even after adjusting for education. CONCLUSION Patients with SLE with limited health literacy had lower knowledge about SLE. The LKAT could be further refined and/or used as a screening tool to identify patients with knowledge gaps. Further work is needed to improve patients' understanding of proteinuria and investigate whether literacy-sensitive education can improve care.
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Affiliation(s)
- Mithu Maheswaranathan
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina;
| | - Amanda M Eudy
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ann Cameron Barr
- A.C. Barr, MD, Resident, C. Howe, MD, Resident, Department of Medicine, Duke University Hospital, Durham, North Carolina
| | - Catherine Howe
- A.C. Barr, MD, Resident, C. Howe, MD, Resident, Department of Medicine, Duke University Hospital, Durham, North Carolina
| | - Jayanth Doss
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Rebecca E Sadun
- R.E. Sadun, MD, PhD, Assistant Professor, Division of Rheumatology, Departments of Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Lisa G Criscione-Schreiber
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kai Sun
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Eliana M Perrin
- E.M. Perrin, MD, MPH, Professor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Stacy C Bailey
- S.C. Bailey, PhD, MPH, Associate Professor of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois
| | - Susan N Hastings
- S.N. Hastings, MD, Departments of Medicine & Population Health Sciences and Center for the Study of Aging, Duke University, and Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Megan E B Clowse
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer L Rogers
- M. Maheswaranathan, MD, Fellow, A.M. Eudy, PhD, Assistant Professor, J. Doss, MD, Assistant Professor, L.G. Criscione-Schreiber, MD, MEd, Professor, K. Sun, MD, Assistant Professor, M.E.B. Clowse, MD, MPH, Associate Professor, J.L. Rogers, MD, Assistant Professor, Division of Rheumatology & Immunology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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21
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Yoon ES, Hur S, Curtis LM, Wynia AH, Zheng P, Nair SS, Bailey SC, Serper M, Reese PP, Ladner DP, Wolf MS. A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial. JMIR Form Res 2022; 6:e27277. [PMID: 35511225 PMCID: PMC9121227 DOI: 10.2196/27277] [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: 01/19/2021] [Revised: 07/23/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant recipients is common, yet interventions are needed to support patients in sustaining adequate adherence to prescribed regimens and achieving optimal transplant outcomes. OBJECTIVE We examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring strategy known as TAKE IT. METHODS The TAKE IT strategy includes: (1) routine, online, monthly patient self-report adherence assessments; (2) care alerts directed to nurses; (3) quarterly reports monitoring tacrolimus values and adherence trends; (4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at two large transplant centers (N=449). To evaluate the initial fidelity of TAKE IT, we investigated patient uptake of monthly adherence assessments during the course of a 3-month period, whether any disparities emerged, and the nature of any reported adherence concerns. RESULTS Among 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% (164/202) completed an adherence assessment, 73% (148/202) completed at least two, and 57% (116/202) completed all monthly assessments. Overall, 50% (82/164) of kidney transplant recipients reported at least one adherence concern over the 3-month assessment period. The most common barriers were classified as regimen-related (eg, regimen complexity), cognitive (eg, forgetfulness), and medical (eg, side effects). Higher-income participants were more likely to complete all surveys compared to lower-income participants (P=.01). CONCLUSIONS TAKE IT demonstrated 81% (164/202) completion of an adherence assessment, 73% (148/202) completion of at least two, and 57% (116/202) completion of all monthly assessments during this brief, initial observation period. Among those that did respond to the online assessments, the majority demonstrated sustained engagement. Additional monitoring modalities could also be offered to meet patient preferences to ensure all patients' medication use can be properly monitored. TRIAL REGISTRATION ClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868.
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Affiliation(s)
- Esther S Yoon
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Scott Hur
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Laura M Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Aiden H Wynia
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pauline Zheng
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sumi S Nair
- Mayo Clinic Arizona Transplant Center, Mayo Clinic, Pheonix, AZ, United States
| | - Stacy C Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL, United States
| | - Michael S Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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22
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Light SW, Pack A, Vela A, Bailey SC, Zuleta A, O’Conor R, Wolf MS. Perceptions and Motivating Factors Regarding COVID-19 Vaccination in Latinx Older Adults in Chicago: A Local, Qualitative Perspective. Patient Prefer Adherence 2022; 16:2321-2333. [PMID: 36046497 PMCID: PMC9423730 DOI: 10.2147/ppa.s378081] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Historically marginalized communities disproportionately impacted by the pandemic are demonstrating lower uptake of COVID-19 vaccines. To facilitate the development of culturally tailored, language concordant educational materials promoting COVID-19 vaccination, we first explored older Latinx adults' awareness, attitudes, and beliefs about COVID-19 vaccines and factors involved in vaccination decisions within their communities. PATIENTS AND METHODS Individual, semi-structured interviews were conducted with 15 participants who self-identified as Latinx/Hispanic, aged 50 and older, and living in Chicago. Eight interviews were conducted in English and seven in Spanish. Thematic analysis was used to analyze participants' responses. RESULTS Participants revealed four key factors influencing vaccination decisions: 1. protecting oneself and loved ones (against COVID-19 (n=14), or from perceived dangers of the vaccine (n=9)); 2. trust in authorities (trusting information (n=9), or worrying the vaccine is being manipulated (n=5)); 3. access and availability (gratitude to live in a country where vaccines are available (n=5), or fear of going to vaccination sites due to immigration and insurance status (n=4)); and 4. Employment and semblance of normalcy (vaccination to create opportunities (n=6), or concern about missing out due to side effects (n=9)). CONCLUSION Our findings illuminate key factors influencing decisions for COVID-19 vaccination among Latinx older adults in Chicago. Vaccination information aiming to increase vaccination rates among this important population may benefit from leveraging collective pronouns and spirituality, language concordance, low-tech options, building trust, and addressing insurance and immigration doubts. Next steps include developing educational materials based on these themes, followed by dissemination and evaluation. Lessons learned may be of interest to public health experts responding to the ongoing pandemic and other public health crises experienced by historically marginalized communities.
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Affiliation(s)
- Sophia W Light
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Correspondence: Sophia W Light, Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA, Tel +1(312)503-5015, Email
| | - Allison Pack
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacy C Bailey
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea Zuleta
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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23
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Edwards AL, Shaw PA, Halton CC, Bailey SC, Wolf MS, Andrews EN, Cartwright T. "It just makes me feel a little less alone": a qualitative exploration of the podcast Menopause: Unmuted on women's perceptions of menopause. Menopause 2021; 28:1374-1384. [PMID: 34469933 DOI: 10.1097/gme.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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Menopause can negatively impact women's quality of life, with many women reporting inadequate information and support. Podcasts have grown in popularity in recent years and have been found to be accessible methods for increasing knowledge and challenging perceptions of stigmatized topics. The current research aimed to understand the impact of the podcast "menopause: unmuted" on women's menopause-related knowledge, understanding, and communication practices. METHODS A diverse sample of 30 women aged 40 to 60 years listened to the podcast series, which focused on menopause stories, before taking part in semistructured interviews to discuss the impact of the podcast on how they understood and communicated about menopause. The interviews were analyzed thematically. RESULTS Two overarching themes were identified in the data. A "journey of knowledge gain" explores participants' understanding of menopause before listening to the podcast and describes how this is deepened by hearing and connecting with women's stories. "Reframing menopause" describes the impact of the podcast, where women reflect on the value of communication amongst women, challenge and re-evaluate the stigmatization of menopause, and discuss ways to make positive behavioral changes in their lives. CONCLUSIONS The podcast "menopause: unmuted" helped women to learn about the menopause experience, have a greater sense of belonging to a community of women, and feel empowered to make changes in their own lives. Sharing stories via podcasts has potential as an accessible and impactful medium to educate women and reduce the widespread stigma associated with menopause.
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Affiliation(s)
- Amy L Edwards
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Philippa A Shaw
- School of Social Sciences, University of Westminster, London, UK
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | | | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, UK
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24
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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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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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Zhao C, Batio S, Lovett R, Pack AP, Wolf MS, Bailey SC. The Relationship Between COVID-19 Related Stress and Medication Adherence Among High-Risk Adults During the Acceleration Phase of the US Outbreak. Patient Prefer Adherence 2021; 15:1895-1902. [PMID: 34511885 PMCID: PMC8418366 DOI: 10.2147/ppa.s310613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To assess the relationship between stress regarding COVID-19 and medication adherence. PATIENTS AND METHODS Older adults with ≥1 chronic condition(s) were recruited from 4 active, federally funded studies in Chicago to participate in a longitudinal telephone survey. Participants self-reported stress regarding COVID-19 in the last week. Adherence was measured via the ASK-12 survey. RESULTS Most participants reported feeling stressed "some of the time" (54.0%), while 18.2% felt stressed "most" or "all of the time" and 27.8% "never" felt stressed. In bivariate analyses, participants who reported being stressed "most" or "all of the time" had worse medication adherence than participants who reported being stressed "some of the time" or "never" (p < 0.001). In multivariable analyses, participants who reported feeling stressed "most" or "all of the time" had worse adherence than those who "never" felt stressed (Adjusted Least Square Mean (Standard Error): 21.3 (0.6) vs 19.7 (0.6), p=0.01). CONCLUSION Stress due to COVID-19 has significantly impacted medication adherence, which has negative implications for the course of both COVID-19 and comorbid conditions. Healthcare providers should be aware of the potential impact of COVID-19 on patients' mental and physical well-being and consider ways to routinely assess patient experiences.
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Affiliation(s)
- Caroline Zhao
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Stephanie Batio
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rebecca Lovett
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Allison P Pack
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Stacy C Bailey
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
- Correspondence: Stacy C Bailey Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USATel +1 312-503-5595Fax +1 312-503-2777 Email
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Maheswaranathan M, Eudy AM, Bailey SC, Rogers JL, Clowse ME. Low health numeracy is associated with higher disease activity in systemic lupus erythematosus. Lupus 2020; 30:489-494. [PMID: 33323013 DOI: 10.1177/0961203320979044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Abstract
OBJECTIVE Evidence suggests low health literacy is prevalent in the United States and associated with worse clinical outcomes, yet few studies have investigated health literacy in systemic lupus erythematosus (SLE). The objective of this study was to determine the prevalence of low health literacy and numeracy in lupus patients and to examine its association with disease characteristics. METHODS Patients with SLE were recruited from an academic center clinic. Participants completed in-person assessments of health literacy (Rapid Estimate of Adult Literacy in Medicine, REALM) and numeracy (Numeracy Understanding in Medicine Instrument Shortened Version, S-NUMi). Clinical disease activity measures were obtained, including urine protein to creatinine ratio (UPC), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and physician global assessment (PhGA) scores. RESULTS Ninety-five SLE patients participated in the study; 13% had low health literacy and 73% had limited health numeracy. Patients with lower health literacy and numeracy were more likely to be Black, have Medicaid insurance, and earn income <$50 K annually. In linear regression models, patients with limited health numeracy had, on average, PhGA scores 0.31 points higher (95% CI: 0.02, 0.60) than patients with adequate numeracy, after adjusting for race and age. No clinical outcomes were associated with health literacy. CONCLUSION In this exploratory study, we found SLE patients with low numeracy had higher disease activity. Our findings indicate that lower health literacy and numeracy are more common among Black and socioeconomically disadvantaged patients. Additional research will be needed to investigate the impact of health literacy on other outcomes and racial disparities in SLE.
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Affiliation(s)
| | - Amanda M Eudy
- Division of Rheumatology, Duke University, Durham, NC, USA
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA
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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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Mullen RJ, Curtis LM, O'Conor R, Serper M, McCarthy D, Bailey SC, Parker RM, Wolf MS. Visual acuity, literacy, and unintentional misuse of nonprescription medications. Am J Health Syst Pharm 2019; 75:e213-e220. [PMID: 29691264 DOI: 10.2146/ajhp170303] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Results of a study of associations between visual acuity and the risk of misuse of nonprescription acetaminophen products in a sample of community-dwelling adults are reported. METHODS In a study involving English-speaking adults at 4 primary care clinics, the potential for misuse of nonprescription acetaminophen products was measured via a functional assessment of product self-dosing and by testing patients' understanding of the risks of concomitant use (i.e., taking 2 products at the same time when contraindicated). Vision was assessed using the Rosenbaum vision chart and dichotomized as normal (visual acuity of 20/20-20/25) or low (acuity of 20/30-20/100). Bivariable and multivariable analyses were performed to determine the impact of visual acuity on medication misuse outcomes. RESULTS Among the study participants (n = 500), 39% had limited literacy, and 54% were categorized as having low vision. After controlling for age, race, and prior acetaminophen use, low vision was independently associated with an increased risk of self-dosing errors (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.25-2.21; p < 0.001) and misunderstanding of concomitant-use risks (OR, 1.41; 95% CI, 1.00-2.00; p = 0.05). Limited literacy was an independent risk factor for incorrect dosing (OR, 1.71; 95% CI, 1.25-2.35; p = 0.001) and unawareness of concomitant use instructions (OR, 4.14; 95% CI, 2.80-6.12; p < 0.001). CONCLUSION Misunderstanding of nonprescription acetaminophen product information was common among study participants and independently associated with both impaired visual acuity and low literacy skills.
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Affiliation(s)
- Rebecca J Mullen
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura M Curtis
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marina Serper
- Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle McCarthy
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Ruth M Parker
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Russell AM, Smith SG, Bailey SC, Belter LT, Pandit AU, Hedlund LA, Bojarski EA, Rush SR, Wolf MS. Older Adult Preferences of Mobile Application Functionality Supporting Medication Self-Management. J Health Commun 2018; 23:1064-1071. [PMID: 30526400 DOI: 10.1080/10810730.2018.1554728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Health systems and insurers alike are increasingly interested in leveraging mHealth (mobile health) tools to support patient health-related behaviors including medication adherence. However, these tools are not widely used by older patients. This study explores patient preferences for functionality in a smartphone application (app) that supports medication self-management among older adults with multiple chronic conditions. We conducted six discussion groups in Chicago, Miami, and Denver (N = 46). English-speaking older adults (55 and older) who owned smartphones and took five or more prescription medicines were invited to participate. Discussions covered familiarity with and use of current apps and challenges with taking multidrug regimens. Participants reviewed a range of possible mobile app functions and were asked to give feedback regarding the acceptability and desirability of each to support medication management. Very few participants (n = 3) reported current use of a mobile app for medication support, although all were receptive. Challenges to medication use were forgetfulness, fear of adverse events, and managing medication information from multiple sources. Desired features included (1) a list and consolidated schedule of medications, (2) identification and warning of unsafe medication interactions, (3) reminder alerts to take medicine, and (4) the ability record when medications were taken. Features relating to refill ordering, pharmacy information, and comparing costs for medication were not considered to be as important for an app.
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Affiliation(s)
- Andrea M Russell
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Samuel G Smith
- b Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | - Stacy C Bailey
- c Division of Pharmaceutical Outcomes and Policy , UNC Eshelman School of Pharmacy , Chapel Hill , NC , USA
| | - Lisa T Belter
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Anjali U Pandit
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Laurie A Hedlund
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Elizabeth A Bojarski
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Steven R Rush
- d UnitedHealth Group Health Literacy Innovations Program , United HealthCare Services Inc , Minneapolis , MN , USA
| | - Michael S Wolf
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
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Paasche-Orlow MK, Schillinger D, Weiss BD, Bickmore T, Cabral H, Chang P, Bailey SC, Dewalt DA, Fernandez A, Fransen M, Leung A, McCaffery K, Meade CD, McCormack LA, Protheroe J, Parker R, Rothman R, Rubin D, Rudd R, Sørensen K, Von Wagner C, Wolf MS, Yin HS, Ownby RL. Health Literacy and Power. Health Lit Res Pract 2018; 2:e132-e133. [PMID: 31294288 PMCID: PMC6607841 DOI: 10.3928/24748307-20180629-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Michael K. Paasche-Orlow
- Address correspondence to Michael K. Paasche-Orlow, MD, MA, MPH, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118;
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Wolf MS, Smith SG, Pandit AU, Condon DM, Curtis LM, Griffith J, O'Conor R, Rush S, Bailey SC, Kaplan G, Haufle V, Martin D. Development and Validation of the Consumer Health Activation Index. Med Decis Making 2018; 38:334-343. [PMID: 29436308 DOI: 10.1177/0272989x17753392] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy. OBJECTIVE We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients. METHODS Expert opinion, a systematic literature review, focus groups, and cognitive interviews with patients were used to create and revise a potential set of items. Psychometric testing guided by item response theory was then conducted among 301 English-speaking, community-dwelling adults. This included differential item functioning analyses to evaluate item performance across participant health literacy levels. To determine construct validity, CHAI scores were compared to scales measuring similar personality constructs. Associations between the CHAI and physical and mental health established predictive validity. A second study among 9,478 adults was used to confirm CHAI associations with health outcomes. RESULTS Exploratory factor analyses revealed a single-factor solution with a 10-item scale. The CHAI showed good internal consistency (alpha = 0.81) and moderate test-retest reliability (ICC = 0.53). Reading grade level was found to be at the 6th grade. Moderate to strong correlations were found with similar constructs (Multidimensional Health Locus of Control, r = 0.38, P < 0.001; Conscientiousness, r = 0.41, P < 0.001). Predictive validity was demonstrated through associations with functional health status measures (depression, r = -0.28, P < 0.001; anxiety, r = -0.22, P < 0.001; and physical functioning, r = 0.22, P < 0.001). In the validation sample, the CHAI was significantly associated with self-reported physical and mental health ( r = 0.31 and 0.32 respectively; both P < 0.001). CONCLUSIONS The CHAI appears to be a valid, reliable, and easily administered tool that can be used to assess health activation among adults, including those with limited health literacy. Future studies should test the tool in actual use and explore further applications.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.,Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Samuel G Smith
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, UK
| | - Anjali U Pandit
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - David M Condon
- Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - James Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Steven Rush
- UnitedHealthcare and UnitedHealth Group, Minneapolis, MN, USA
| | - Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Gordon Kaplan
- Optum, Consumer Solutions Group, Minneapolis, MN, USA
| | | | - David Martin
- UnitedHealthcare and UnitedHealth Group, Minneapolis, MN, USA
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Gonzalez D, Rao GG, Bailey SC, Brouwer KLR, Cao Y, Crona DJ, Kashuba ADM, Lee CR, Morbitzer K, Patterson JH, Wiltshire T, Easter J, Savage SW, Powell JR. Precision Dosing: Public Health Need, Proposed Framework, and Anticipated Impact. Clin Transl Sci 2017; 10:443-454. [PMID: 28875519 PMCID: PMC5698804 DOI: 10.1111/cts.12490] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gauri G Rao
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kim L R Brouwer
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yanguang Cao
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel J Crona
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Medical Center, Chapel Hill, NC
| | - Angela D M Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kathryn Morbitzer
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Herbert Patterson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tim Wiltshire
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jon Easter
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Scott W Savage
- University of North Carolina Medical Center, Chapel Hill, NC.,Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Robert Powell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
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Curtis LM, Mullen RJ, Russell A, Fata A, Bailey SC, Makoul G, Wolf MS. An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: The role of written and spoken communication. Patient Educ Couns 2016; 99:1489-1495. [PMID: 27444235 PMCID: PMC5300020 DOI: 10.1016/j.pec.2016.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/27/2016] [Accepted: 07/02/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing. METHODS Patients (N=141) receiving a new prescription at one internal medicine clinic were recruited into a 2-arm physician-randomized study. We leveraged an EHR platform to automatically deliver 1-page educational 'MedSheets' to patients after medical encounters. We also assessed if physicians counseled patients via patient self-report immediately following visits. Patients' understanding was objectively measured via phone interview. RESULTS 122 patients completed the trial. Most intervention patients (70%) reported receiving MedSheets. Patients reported physicians frequently counseled on indication and directions for use, but less often for risks. In multivariable analysis, written information (OR 2.78, 95% CI 1.10-7.04) and physician counseling (OR 2.95, 95% CI 1.26-6.91) were independently associated with patient understanding of risk information. Receiving both was most beneficial; 87% of those receiving counseling and MedSheets correctly recalled medication risks compared to 40% receiving neither. CONCLUSION An EHR can be a reliable means to deliver tangible, print medication education to patients, but cannot replace the salience of physician-patient communication. PRACTICE IMPLICATIONS Offering both written and spoken modalities produced a synergistic effect for informing patients.
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Affiliation(s)
- Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA.
| | - Rebecca J Mullen
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Allison Russell
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Aimee Fata
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, USA
| | - Gregory Makoul
- PatientWisdom, New Haven, USA and Connecticut Institute for Primary Care Innovation, Hartford, USA
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
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Oramasionwu CU, Vitko ML, Johnson TL, Sage AJ, Chung AE, Bailey SC. Assessing the Quality and Suitability of Multimedia Resources to Assist Patients With Patient Portal Use. Am J Med Qual 2016; 32:453-455. [PMID: 27577935 DOI: 10.1177/1062860616667212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Adam J Sage
- 1 The University of North Carolina at Chapel Hill, NC
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Greene TK, Lyde RB, Bailey SC, Lambert MP, Zhai L, Sabatino DE, Camire RM, Arruda VR, Poncz M. Apoptotic effects of platelet factor VIII on megakaryopoiesis: implications for a modified human FVIII for platelet-based gene therapy. J Thromb Haemost 2014; 12:2102-12. [PMID: 25287191 DOI: 10.1111/jth.12749] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 06/10/2014] [Accepted: 09/23/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ectopically expressed B-domainless factor VIII in megakaryocytes is stored in α-granules, is effective in a number of murine hemostatic models, and is protected from circulating inhibitors. However, this platelet (p) FVIII has different temporal-spatial availability from plasma FVIII, with limited efficacy in other murine hemostatic models. OBJECTIVES AND METHODS We sought to improve pFVIII hemostatic efficacy by expressing canine (c) FVIII, which has higher stability and activity than human (h) FVIII in FVIII(null) mice. RESULTS AND CONCLUSIONS We found that pcFVIII was more effective than phFVIII at restoring hemostasis, but peak pcFVIII antigen levels were lower and were associated with greater megakaryocyte apoptosis than phFVIII. These new insights suggest that pFVIII gene therapy strategies should focus on enhancing activity rather than levels. We previously showed that modification of the PACE/furin cleavage site in hFVIII resulted in secretion of hFVIII primarily as a single-chain molecule with increased biological activity. In megakaryocytes, this variant was expressed at the same level as phFVIII with a lentiviral bone marrow transplant approach to reconstitute FVIII(null) mice, but was more effective, resulting in near-normal hemostasis in the cremaster laser injury model. These studies may have implications for pFVIII gene therapy in hemophilia A.
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Affiliation(s)
- T K Greene
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Kuntz JL, Safford MM, Singh JA, Phansalkar S, Slight SP, Her QL, Lapointe NA, Mathews R, O'Brien E, Brinkman WB, Hommel K, Farmer KC, Klinger E, Maniam N, Sobko HJ, Bailey SC, Cho I, Rumptz MH, Vandermeer ML, Hornbrook MC. Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. Patient Educ Couns 2014; 97:310-26. [PMID: 25264309 PMCID: PMC5830099 DOI: 10.1016/j.pec.2014.08.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. METHODS We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. RESULTS We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. CONCLUSIONS We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. PRACTICE IMPLICATIONS Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
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Affiliation(s)
- Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
| | - Monika M Safford
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Jasvinder A Singh
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Shobha Phansalkar
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Sarah P Slight
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | | | | | | | | | - Kevin Hommel
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Kevin C Farmer
- The University of Oklahoma College of Pharmacy, Oklahoma City, USA
| | - Elissa Klinger
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | - Heather J Sobko
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Stacy C Bailey
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, USA
| | - Insook Cho
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Maureen H Rumptz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
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Bailey SC, O'Conor R, Bojarski EA, Mullen R, Patzer RE, Vicencio D, Jacobson KL, Parker RM, Wolf MS. Literacy disparities in patient access and health-related use of Internet and mobile technologies. Health Expect 2014; 18:3079-87. [PMID: 25363660 DOI: 10.1111/hex.12294] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use. OBJECTIVE To assess the association between patients' literacy skills and mobile phone ownership, use of text messaging, Internet access, and use of the Internet for health-related purposes. METHODS A secondary analysis utilizing data from 1077 primary care patients enrolled in two, multisite studies from 2011-2013. Patients were administered an in-person, structured interview. RESULTS Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison with patients having marginal or low literacy (mobile phone ownership: 96.8 vs. 95.2 vs. 90.1%, respectively, P < 0.001; smartphone ownership: 70.6 vs. 62.5 vs. 40.1%, P < 0.001) and to report text messaging (78.6 vs. 75.2 vs. 53.1%, P < 0.001). They were also more likely to have access to the Internet from their home (92.1 vs. 74.7 vs. 44.9%, P < 0.001) and to report using the Internet for email (93.0 vs. 75.7 vs. 38.5%, P < 0.001), browsing the web (93.9 vs. 80.2 vs. 44.5%, P < 0.001), accessing health information (86.3 vs. 75.5 vs. 40.8%, P < 0.001), and communicating with providers (54.2 vs. 29.8 vs. 13.0%, P < 0.001). Relationships remained significant in multivariable analyses controlling for relevant covariates. CONCLUSIONS Results reveal that literacy-related disparities in technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the Internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities.
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Affiliation(s)
- Stacy C Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Elizabeth A Bojarski
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rebecca Mullen
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rachel E Patzer
- Emory University School of Medicine, Atlanta, GA, USA.,School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Ruth M Parker
- Emory University School of Medicine, Atlanta, GA, USA
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Wolf MS, Bailey SC, Serper M, Smith M, Davis TC, Russell AL, Manzoor BS, Belter L, Parker RM, Lambert B. Comparative Effectiveness of Patient-centered Strategies to Improve FDA Medication Guides. Med Care 2014; 52:781-9. [DOI: 10.1097/mlr.0000000000000182] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pandit AU, Bailey SC, Curtis LM, Seligman HK, Davis TC, Parker RM, Schillinger D, DeWalt D, Fleming D, Mohr DC, Wolf MS. Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes. J Epidemiol Community Health 2014; 68:557-64. [DOI: 10.1136/jech-2013-203063] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Serper M, McCarthy DM, Patzer RE, King JP, Bailey SC, Smith SG, Parker RM, Davis TC, Ladner DP, Wolf MS. What patients think doctors know: beliefs about provider knowledge as barriers to safe medication use. Patient Educ Couns 2013; 93:306-311. [PMID: 23890725 PMCID: PMC4041129 DOI: 10.1016/j.pec.2013.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 06/20/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We examined patient beliefs about provider awareness of medication use, patient-reported prevalence and nature of provider counseling about medications, and the impact of health literacy on these outcomes. METHODS Structured interviews were conducted at academic general internal medicine clinics and federally qualified health centers with 500 adult patients. Interviewer-administered surveys assessed patients' beliefs, self-reported prevalence and nature of provider counseling for new prescriptions, and medication review. RESULTS Most patients believed their physician was aware of all their prescription and over the counter medications, and all medications prescribed by other doctors; while a minority reported disclosing over the counter and supplement use. Among those receiving new prescriptions (n=190): 51.3% reported physician medication review, 77.4% reported receiving instructions on use from physicians and 43.3% from pharmacists. Side effects were discussed 42.9% of the time by physicians and 25.8% by pharmacists. Significant differences in outcomes were observed by health literacy, age, and clinic type. CONCLUSIONS There is a sizable gap between what patients believe physicians know about their medication regimen and what they report to the physician. PRACTICE IMPLICATIONS Discordance between patient beliefs and physician knowledge of medication regimens could negatively impact patient safety and healthcare quality.
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Affiliation(s)
- Marina Serper
- Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University Feinberg School of Medicine, Chicago, USA.
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Affiliation(s)
- Stacy C. Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Lauren A. McCormack
- Health Communications Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Steven R. Rush
- Health Literacy Innovations Program, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - Michael K. Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Female fertility declines dramatically with age, and childbearing at older maternal ages has significant medical consequences for mother and infant that are well-known to health professionals. Despite this, the average maternal age in the United States continues to rise. Many factors likely contribute to this secular trend; to date, no research has examined whether American women are aware of the complications of deferring conception and how this correlates with health literacy. The purpose of this study was to evaluate women's knowledge of the implications of delaying pregnancy. A structured, in-person interview was administered to 300 women between 20 and 50 years of age attending 1 of 2 gynecologic clinics at a single institution. Demographic information, medical history, and gynecologic history were obtained; and participants answered questions about the implications of aging for fertility and pregnancy outcome. Health literacy and numeracy were assessed. Participants demonstrated knowledge deficits about the implications of aging on fertility and pregnancy, and many were unfamiliar with success rates of infertility treatments. Several demographic factors correlated with knowledge; health literacy and numeracy were both important predictive variables. To the authors' knowledge, this is the first study of women's knowledge about fertility, aging, and their health literacy. Awareness of the importance of health literacy and numeracy should inform future educational efforts about fertility.
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Affiliation(s)
- Dana R. Gossett
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Shweta Nayak
- Department of Obstetrics and Gynecology, Magee Women's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shweta Bhatt
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stacy C. Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
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Abstract
Medication adherence has received a great deal of attention over the past several decades; however, its definition and measurement remain elusive. The authors propose a new definition of medication self-management that is guided by evidence from the field of health literacy. Specifically, a new conceptual model is introduced that deconstructs the tasks associated with taking prescription drugs; including the knowledge, skills and behaviors necessary for patients to correctly take medications and sustain use over time in ambulatory care. This model is then used to review and criticize current adherence measures as well as to offer guidance to future interventions promoting medication self-management, especially among patients with low literacy skills.
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Affiliation(s)
- Stacy C. Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Christine U. Oramasionwu
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Michael S. Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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McCarthy DM, Davis TC, King JP, Mullen RJ, Bailey SC, Serper M, Jacobson KL, Parker RM, Wolf MS. Take-Wait-Stop: a patient-centered strategy for writing PRN medication instructions. J Health Commun 2013; 18 Suppl 1:40-48. [PMID: 24093344 PMCID: PMC3814925 DOI: 10.1080/10810730.2013.825675] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as "Take-Wait-Stop") or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p=.75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p=.03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors.
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Affiliation(s)
- Danielle M. McCarthy
- Department of Emergency Medicine, and the Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Terry C. Davis
- Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA
| | - Jennifer P. King
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rebecca J. Mullen
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stacy C. Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Marina Serper
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kara L. Jacobson
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ruth M. Parker
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S. Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, and Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
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You WB, Wolf MS, Bailey SC, Grobman WA. Improving patient understanding of preeclampsia: a randomized controlled trial. Am J Obstet Gynecol 2012; 206:431.e1-5. [PMID: 22542120 DOI: 10.1016/j.ajog.2012.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/22/2012] [Accepted: 03/09/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We developed a standardized educational tool to inform women about preeclampsia. The objective of this study was to assess whether exposure to this tool led to superior understanding of the syndrome. STUDY DESIGN This was a randomized controlled trial in which 120 women were assigned to (1) a newly developed preeclampsia educational tool, (2) a standard pamphlet addressing preeclampsia that had been created by the American College of Obstetricians and Gynecologists, or (3) no additional information. Preeclampsia knowledge was assessed with the use of a previously validated questionnaire. RESULTS There were no demographic differences among the groups. Patients who received the tool scored significantly better on the preeclampsia questionnaire than those who received the American College of Obstetricians and Gynecologists pamphlet or no additional information (71%, 63%, 49%, respectively; P < .05). This improved understanding was evident equally among women with and without adequate health literacy (interaction: P > .05). CONCLUSION Patients who were exposed to a graphics-based educational tool demonstrated superior preeclampsia-related knowledge, compared with those patients who were exposed to standard materials or no education.
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Affiliation(s)
- Whitney B You
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Davis TC, Arnold CL, Rademaker A, Bailey SC, Platt DJ, Reynolds C, Esparza J, Liu D, Wolf MS. Differences in barriers to mammography between rural and urban women. J Womens Health (Larchmt) 2012; 21:748-55. [PMID: 22519704 DOI: 10.1089/jwh.2011.3397] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have examined differences between rural and urban women in mammography barriers, knowledge, and experiences. Exploring differences can help inform tailored interventions. METHODS Women, aged ≥40, who had not been screened in the past 2 years were recruited from eight federally qualified health centers across Louisiana. They were given a structured interview assessing mammography knowledge, beliefs, barriers, experiences, and literacy. RESULTS Of the 1189 patients who participated, 65.0% were African American, 61.6% were rural, and 44.0% had low literacy. Contrary to guidelines, most believed mammography should be done annually (74.3%) before age 40 (70.5%). Compared to urban women, rural participants were more likely to believe mammography will find small breast lumps early (34.4% vs. 6.5%, p<0.0001) and strongly disagree that mammography is embarrassing (14.6% vs. 8.4%, p=0.0002) or that they are afraid of finding something wrong (21.2% vs.12.3%, p=0.007). Rural women were more likely to report a physician recommendation for mammography (84.3% vs. 76.5%, p=0.006), but they were less likely to have received education (57.2% vs. 63.6%, p=0.06) or to have ever had a mammogram (74.8% vs. 78.1%, p=0.007). In multivariate analyses controlling for race, literacy, and age, all rural/urban differences remained significant, except for receipt of a mammogram. CONCLUSIONS Most participants were unclear about when they should begin mammography. Rural participants reported stronger positive beliefs, higher self-efficacy, fewer barriers, and having a physician recommendation for mammography but were less likely to receive education or screening.
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Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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Abstract
Soft-tissue sarcomas of the digit are uncommon. We herein report on a patient with a de-novo subungual right thumb liposarcoma with subsequent failure in the brain. The pertinent literature and recommendations for management are presented.
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Affiliation(s)
- S C Bailey
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
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Despeyroux D, Walker N, Pearce M, Fisher M, McDonnell M, Bailey SC, Griffiths GD, Watts P. Characterization of ricin heterogeneity by electrospray mass spectrometry, capillary electrophoresis, and resonant mirror. Anal Biochem 2000; 279:23-36. [PMID: 10683227 DOI: 10.1006/abio.1999.4423] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Electrospray mass spectrometry (ES/MS), capillary-zone electrophoresis (CZE), capillary isoelectric focusing (CIEF), and multianalyte resonant mirror are used to evaluate the heterogeneity of samples of ricin toxins extracted from five horticultural varieties of Ricinus communis seeds: R. communis zanzibariensis, carmencita, impala, sanguineus, and gibsonii. The investigation is also extended to the geographical provenance of the beans. Combining mass spectrometry, CE techniques, and resonant mirror results in a powerful analytical tool capable to characterize and differentiate between different varieties of ricin toxins. Each technique complements the others, adding another level of information. This study reveals a large extent of heterogeneity for each cultivar, demonstrating that ricin toxins consist of a series of glycosylated proteins most likely originating from a multigene family. By combining these techniques, it is possible to differentiate between zanzibariensis and the other four varieties, and that variations in the functional characteristics may be observed between the different cultivars. This study demonstrates that knowledge of the variety of R. communis beans used and their geographical provenance is essential before any type of investigation of ricin toxins is carried out. Consequently, any unusual behavior observed can only be attributed to that particular cultivar studied and not automatically extended to include all R. communis varieties.
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Affiliation(s)
- D Despeyroux
- DERA CBD Porton Down, Salisbury, Wiltshire, SP4 0JQ, United Kingdom
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Griffiths GD, Phillips GJ, Bailey SC. Comparison of the quality of protection elicited by toxoid and peptide liposomal vaccine formulations against ricin as assessed by markers of inflammation. Vaccine 1999; 17:2562-8. [PMID: 10418903 DOI: 10.1016/s0264-410x(99)00054-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ricin is a very toxic substance which inhibits protein synthesis and produces severe tissue damage and inflammation. It is very potent when inhaled as an aerosol and protection has been examined in a series of studies using vaccine candidates including a formaldehyde inactivated ricin toxoid and the A chain of ricin, a polypeptide equivalent to half of the toxin molecule. Initially, subcutaneous injections of both compounds were found to protect against inhaled ricin but not without some subsequent adverse signs. Intra-pulmonary vaccination using liposomal formulations of these compounds was investigated with a view to improving lung condition following challenge. Using the humoral and local pulmonary immune responses as indices of vaccine performance, no significant difference between toxoid or peptide vaccines was found. In the third and current study, the quality of lung protection by vaccines was assessed using markers of inflammation. Thus, the profiles of inflammatory cell and protein influx into the lung were determined following intratracheal (i.t.) challenge with ricin of rats treated with liposomal vaccine formulations. Results showed that liposomal ricin toxoid offered a better quality of protection with a significantly lower influx of polymorphonuclear leucocytes (neutrophils) and little pulmonary oedema compared with the A chain/liposome formulation. Further, there was no significant difference between the quality of protection offered by the A chain when administered subcutaneously or locally into the lung by i.t. instillation. Liposomal ricin toxoid is a good candidate vaccine and optimised pulmonary delivery by inhalation should be further examined.
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Affiliation(s)
- G D Griffiths
- Biomedical Sciences Department, DERA, Porton Down, Salisbury, Wiltshire, UK
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