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Goss CW, Maricque BB, Anwuri VV, Cohen RE, Donaldson K, Johnson KJ, Powderly WG, Schechtman KB, Schmidt S, Thompson JJ, Trolard AM, Wang J, Geng EH. SARS-CoV-2 active infection prevalence and seroprevalence in the adult population of St. Louis County. Ann Epidemiol 2022; 71:31-37. [PMID: 35276338 PMCID: PMC8902054 DOI: 10.1016/j.annepidem.2022.03.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The true prevalence of COVID-19 is difficult to estimate due to the absence of random population-based testing. To estimate current and past COVID-19 infection prevalence in a large urban area, we conducted a population-based survey in St. Louis County, Missouri. METHODS The population-based survey of active infection (PCR) and seroprevalence (IgG antibodies) of adults (≥ 18 years) was conducted through random-digit dialing and targeted sampling of St. Louis County residents with oversampling of Black residents. Infection prevalence of residents was estimated using design-based and raking weighting. RESULTS Between August 17 and October 24, 2020, 1,245 residents completed a survey and underwent PCR testing; 1,073 residents completed a survey and underwent PCR and IgG testing or self-reported results. Weighted prevalence estimates of residents with active infection was 1.9% (95% CI, 0.4% to 3.3%) and 5.6% were ever infected (95% CI, 3.3% to 8.0%). Overall infection hospitalization and fatality ratios were 4.9% and 1.4%, respectively. CONCLUSIONS Through October 2020, the percentage of residents that had ever been infected was relatively low. A markedly higher percentage of Black and other minorities compared to White residents were infected with COVID-19. The St. Louis region remained highly vulnerable to widespread infection in late 2020.
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Affiliation(s)
- Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO.
| | - Brett B Maricque
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | | | - Rachel E Cohen
- St. Louis County Department of Public Health, Berkeley, MO
| | - Kate Donaldson
- St. Louis County Department of Public Health, Berkeley, MO
| | | | - William G Powderly
- Institute for Public Health, Washington University, St. Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Spring Schmidt
- St. Louis County Department of Public Health, Berkeley, MO
| | - Jeannette Jackson Thompson
- Health & Behavioral Risk Research Center, University of Missouri School of Medicine Dept. of Health Management & Informatics, Columbia, MO
| | - Anne M Trolard
- Institute for Public Health, Washington University, St. Louis, MO
| | - Jinli Wang
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Fisher EB, Brownson CA, O'Toole ML, Shetty G, Anwuri VV, Fazzone P, Housemann RA, Hampton AD, Kamerow DB, McCormack LA, Burton JA, Orleans CT, Bazzarre TL. The Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Educ 2017; 33:83-4, 86-8, 91-2, passim. [PMID: 17272795 DOI: 10.1177/0145721706297454] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings. METHODS The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination. RESULTS Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care. CONCLUSIONS The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.
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Affiliation(s)
- Edwin B Fisher
- The Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
| | - Carol A Brownson
- National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
| | - Mary L O'Toole
- National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
| | - Gowri Shetty
- National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
| | - Victoria V Anwuri
- National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
| | - Patricia Fazzone
- The Department of Family Health and Community Health Nursing, School of Nursing, Southern Illinois University, Edwardsville, Illinois (Ms Fazzone)
| | - Robyn A Housemann
- The Health Promotion and Exercise Science Department, School for Professional Studies, Western Connecticut State University, Danbury (Dr Housemann)
| | - Andrea D Hampton
- The Health Promotion Department, US Naval Hospital, Okinawa, Japan (Ms Hampton)
| | - Douglas B Kamerow
- Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
| | - Lauren A McCormack
- Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
| | - Joseph A Burton
- Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
| | - C Tracy Orleans
- The Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Orleans and Dr Bazzarre)
| | - Terry L Bazzarre
- The Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Orleans and Dr Bazzarre)
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Engeszer RJ, Olmstadt W, Daley J, Norfolk M, Krekeler K, Rogers M, Colditz G, Anwuri VV, Morris S, Voorhees M, McDonald B, Bernstein J, Schoening P, Williams L. Evolution of an academic-public library partnership. J Med Libr Assoc 2016; 104:62-6. [PMID: 26807055 DOI: 10.3163/1536-5050.104.1.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A partnership to improve access to health information via an urban public library system was established in St. Louis, Missouri, in 2011. A multiyear project was outlined that included an information needs assessment, a training class for public library staff, information kiosks at library branches for delivering printed consumer health materials, and a series of health-related programming. The partnership evolved to include social service and community organizations to carry out project goals and establish a sustainable program that met the health and wellness interests of the community.
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Drake BF, Tannan S, Anwuri VV, Jackson S, Sanford M, Tappenden J, Goodman MS, Colditz GA. A Community-Based Partnership to Successfully Implement and Maintain a Breast Health Navigation Program. J Community Health 2016; 40:1216-23. [PMID: 26077018 PMCID: PMC4626535 DOI: 10.1007/s10900-015-0051-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Indexed: 11/29/2022]
Abstract
Breast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009-2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services.
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Affiliation(s)
- Bettina F Drake
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, St. Louis, MO, USA. .,Institute of Public Health, Washington University, St. Louis, MO, USA.
| | - Shivon Tannan
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Victoria V Anwuri
- Institute of Public Health, Washington University, St. Louis, MO, USA
| | | | - Mark Sanford
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Jennifer Tappenden
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA.,Institute of Public Health, Washington University, St. Louis, MO, USA
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Anwuri VV, Hall LE, Mathews K, Springer BC, Tappenden JR, Farria DM, Jackson S, Goodman MS, Eberlein TJ, Colditz GA. An institutional strategy to increase minority recruitment to therapeutic trials. Cancer Causes Control 2013; 24:1797-809. [PMID: 23846282 DOI: 10.1007/s10552-013-0258-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 08/17/2012] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. METHODS We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators. RESULTS Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians. CONCLUSIONS Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers, an approach that may extend to other clinical and translational research centers.
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Affiliation(s)
- Victoria V Anwuri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Harris JK, Cyr J, Carothers BJ, Mueller NB, Anwuri VV, James AI. Referrals among cancer services organizations serving underserved cancer patients in an urban area. Am J Public Health 2011; 101:1248-52. [PMID: 21566039 DOI: 10.2105/ajph.2010.300017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.
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Affiliation(s)
- Jenine K Harris
- Center for Tobacco Policy Research, Washington University, St Louis, MO, USA.
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Anwuri VV, Hall LE, Mathews K, Springer BC, Tappenden JR, Farria DM, Jackson S, Eberlein TJ, Coldtiz GA. Abstract A40: An institutional strategy to increase minority recruitment to therapeutic trials. Cancer Epidemiol Biomarkers Prev 2010. [DOI: 10.1158/1055-9965.disp-10-a40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet NIH-mandated goals, strategies to increase participation are required. Here, we present a framework for institutional enhancement of minority clinical trial accrual that provides linkages to other interventions. We report implementation of this framework at the Siteman Cancer Center, an NCI-designated Comprehensive Cancer Center.
Methods: We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: 1) leadership support, 2) center-wide policy change, 3) infrastructural process control, data analysis and reporting and 4) follow up with clinical investigators. The Protocol Review and Monitoring Committee (PRMC) reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities (PECaD) leads efforts for proportional accrual, supporting the system through data tracking and web tools.
Results: Following implementation in 2005, minority accrual to trials (therapeutic and nontherapeutic) increased from 13.7% in 2005, to 14.4% in 2006,15.9% in 2007 and 16.8% in 2008. The “rolling average” minority cancer incidence at the Cancer Center during this four-year timeframe was 17.3%. There has been an increase in the number of minorities participating in clinical trials in the years 2005 to 2008 (from 346 to 630,82%) compared to a 43% increase in the number of Caucasians during the same time period. Minority accrual in therapeutic clinical trials increased from 11.4% to 14.6%.
Conclusion: Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring accrual, offers a successful strategy that can be replicated in other cancer centers. This approach may also be extendable to other clinical and translational centers.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A40.
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Affiliation(s)
| | - Lannis E. Hall
- 1Washington University School of Medicine, St. Louis, MO
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Matson Koffman D, Granade SA, Anwuri VV. Strategies for establishing policy, environmental, and systems-level interventions for managing high blood pressure and high cholesterol in health care settings: a qualitative case study. Prev Chronic Dis 2008; 5:A83. [PMID: 18558033 PMCID: PMC2483567] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Policy, environmental, and systems-level interventions are part of a comprehensive approach to managing high blood pressure and high cholesterol, which are key risk factors for heart disease and stroke. In this qualitative case study, we identified clinical practices in health care organizations that used policy, environmental, or systems-level interventions to improve patient outcomes for these conditions. Our 4 objectives were to describe 1) policy, environmental, and systems-level interventions; 2) enabling factors and barriers that affected implementation; 3) methods for evaluating the success of the intervention; and 4) lessons learned from the health care practices that implemented these interventions. METHODS Through literature review and expert guidance, we identified 34 health care practices that used policy, environmental, and systems-level interventions to manage high blood pressure and high cholesterol. In 2003, we conducted case study interviews with key informants for 9 health care practices that 1) demonstrated improved patient outcomes for blood pressure or cholesterol; 2) implemented the interventions for at least 1 year; and 3) remained committed to sustaining or institutionalizing interventions. We taped and transcribed the interviews and used Centers for Disease Control and Prevention EZ-Text software (www.cdc.gov/hiv/software/ez-text.htm) to code, categorize, and analyze the responses. RESULTS The health care practices we studied implemented specialized lipid clinics, disease management programs, physician reminder systems, and participation in the Health Resources and Services Administration's Bureau of Primary Care Health Disparities Collaboratives. All practices used comprehensive systems for patient care that were well-defined, measurable, and linked to desirable patient outcomes. Most relied on data systems to identify patients targeted for the interventions and practice areas that needed improvement, and to track the progress of patients and practitioners in meeting goals. Factors contributing to success included support for patient self-management, interventions integrated into the practice's daily work flow to make implementation easier for staff, leadership and staff commitment, and community involvement. CONCLUSION Comprehensive policy, environmental, and systems-level interventions for patient care can be effective in controlling chronic conditions such as high blood pressure and high cholesterol.
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Affiliation(s)
- Dyann Matson Koffman
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy, NE, Mailstop K-47, Atlanta, GA 30341, USA.
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Fisher EB, Brownson CA, O'Toole ML, Anwuri VV. Ongoing follow-up and support for chronic disease management in the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Educ 2007; 33 Suppl 6:201S-207S. [PMID: 17620402 DOI: 10.1177/0145721707304189] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this article is to identify approaches to providing ongoing follow-up and support for diabetes self-management based on the experience of 14 self-management projects of the Diabetes Initiative of the Robert Wood Johnson Foundation. METHODS This study is a collaboration with grantees of the Diabetes Initiative of the Robert Wood Johnson Foundation, a program focused on diabetes self-management in primary care and community settings. Grantees and national program staff identified key functions that ongoing follow-up and support need to fill and key features of programs that do so. RESULTS Key functions of ongoing follow-up and support include monitoring of status and self-management, encouragement and facilitation of regular clinical care, encouragement and motivation of self-management, and facilitating skills for coping with changes in circumstances or emergent problems. Key features of ongoing follow-up and support to fill these functions are being available on demand; being proactive in maintaining contact and preventing individuals from "falling between the cracks"; having personal, motivational, and consistent key messages; not being limited to diabetes; and being inclusive of a wide range of resources and settings. CONCLUSIONS Initial characterization of key features of ongoing follow-up and support has been accomplished. This should facilitate research to clarify how it may best be provided and systematic approaches to doing so. These should lead to health service and policy initiatives supporting this critical dimension of programs to promote self-management and lifelong healthy living patterns.
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Affiliation(s)
- Edwin B Fisher
- The School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
| | - Carol A Brownson
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri)
| | - Mary L O'Toole
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri)
| | - Victoria V Anwuri
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri)
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Fisher EB, Brownson CA, O'Toole ML, Anwuri VV, Shetty G. Perspectives on self-management from the Diabetes Initiative of the Robert Wood Johnson Foundation. Diabetes Educ 2007; 33 Suppl 6:216S-224S. [PMID: 17620404 DOI: 10.1177/0145721707304124] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE AND METHOD Review and highlight findings from the projects of the Diabetes Initiative of the Robert Wood Johnson Foundation described in this special supplemental issue. RESULTS The broad framework for self-management around which these programs were developed, "Resources and Supports for Self Management," includes individualized assessment, collaborative goal setting, building skills for self-management, ongoing follow-up and support, community resources, and continuity of quality clinical care. Lessons learned include the central role of community health workers in self-management, the importance of ongoing follow-up and support to sustain self-management, varied program approaches to depression and negative emotion, the importance of organizational infrastructure to support self-management programs, and the contributions of clinic-community partnerships. Several emergent themes include the value of providing choices among "good practices" as opposed to one best practice, the role of the physician as part of the self-management team, and the importance of broad efforts in promoting dissemination of self-management programs. Finally, self-management will benefit from replacing categorical distinctions, like good and bad control, proven and unproven treatment, with thinking in terms of key dimensions, like level of control and continued quality improvement. CONCLUSIONS Diabetes Initiative projects have shown that diabetes self-management can be promoted in the "real worlds" of community agencies and primary care settings serving diverse and disadvantaged populations.
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Affiliation(s)
- Edwin B Fisher
- The School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
| | - Carol A Brownson
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Mary L O'Toole
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Victoria V Anwuri
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
| | - Gowri Shetty
- The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
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Matson Koffman DM, Goetzel RZ, Anwuri VV, Shore KK, Orenstein D, LaPier T. Heart healthy and stroke free: successful business strategies to prevent cardiovascular disease. Am J Prev Med 2005; 29:113-21. [PMID: 16389136 DOI: 10.1016/j.amepre.2005.07.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 06/21/2005] [Accepted: 07/12/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart disease and stroke, the principal components of cardiovascular disease (CVD), are the first and third leading causes of death in the United States. In 2002, employers representing 88 companies in the United States paid an average of 18,618 dollars per employee for health and productivity-related costs. A sizable portion of these costs are related to CVD. RESULTS Employers can yield a 3 dollar to 6 dollar return on investment for each dollar invested over a 2 to 5 year period and improve employee cardiovascular health by investing in comprehensive worksite health-promotion programs, and by choosing health plans that provide adequate coverage and support for essential preventive services. The most effective interventions in worksites are those that provide sustained individual follow-up risk factor education and counseling and other interventions within the context of a comprehensive health-promotion program: (1) screening, health risk assessments, and referrals; (2) environmental supports for behavior change (e.g., access to healthy food choices); (3) financial and other incentives; and (4) corporate policies that support healthy lifestyles (e.g., tobacco-free policies). The most effective practices in healthcare settings include systems that use (1) standardized treatment and prevention protocols consistent with national guidelines, (2) multidisciplinary clinical care teams to deliver quality patient care, (3) clinics that specialize in treating/preventing risk factors, (4) physician and patient reminders, and (5) electronic medical records. CONCLUSIONS Comprehensive worksite health-promotion programs, health plans that cover preventive benefits, and effective healthcare systems will have the greatest impact on heart disease and stroke and are likely to reduce employers' health and productivity-related costs.
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Abstract
In the Diabetes Initiative of The Robert Wood Johnson Foundation, an ecological perspective helped identify the following key resources and supports for self-management (RSSM): individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to resources, and continuity of quality clinical care. These RSSM reflect the grounding of diabetes self-management in the context of social and environmental influences. Research supports the value of each of these key resources and supports. Differences among self-management interventions may be seen as complementary, rather than conflicting, ways of providing RSSM. This way of understanding differences among interventions may aid development of varied programs to reach diverse audiences. In contrast to the "5 A's" model of key provider services (Assess, Advise, Agree, Assist, and Arrange), RSSM articulate self-management from the perspective of individuals' needs. Both approaches emphasize identification of goals, teaching of skills, and facilitation and reinforcement of the use of those skills.
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Affiliation(s)
- Edwin B Fisher
- Washington University, Division of Health Behavior Research, 4444 Forest Park Ave, St Louis, MO 63108, USA.
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