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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Dunleavy S, Edelman DS, Wimer G, Karelas G, Hassan A, Clarke CD, Canfield SM, Lebwohl B, Lypson ML, Moise N. Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multi-Year Study. Acad Med 2024:00001888-990000000-00746. [PMID: 38266203 DOI: 10.1097/acm.0000000000005646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multi-year, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. METHOD The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. RESULTS Across 3 cohorts, 405 of 420 (96.4%) of students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty (P < .001), more positive attitudes toward public health broadly (P < .001), and increased knowledge of public health content (P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. CONCLUSIONS Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.
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Affiliation(s)
- Spencer Dunleavy
- S. Dunleavy is a family medicine resident, University of Pennsylvania, Philadelphia, Pennsylvania. https://orcid.org/0000-0002-0196-2143
| | - David S Edelman
- D.S. Edelman is chief resident, primary care and social internal medicine, Montefiore Medical Center, New York, New York. ORCID: https://orcid.org/0000-0003-3627-9149
| | - Gabrielle Wimer
- G. Wimer is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Gregory Karelas
- G. Karelas is a pediatrics resident, New York Presbyterian - Columbia University, New York, New York
| | - Amir Hassan
- A. Hassan is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cameron D Clarke
- C.D. Clarke is a medical student, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stephen M Canfield
- S.M. Canfield is associate professor of immunology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Lebwohl
- B. Lebwohl is associate professor of gastroenterology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Monica L Lypson
- M.L. Lypson is vice dean for education, Columbia University Vagelos College of Physicians and Surgeons, and professor, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- N. Moise is associate professor, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Adsul P, Shelton RC, Oh A, Moise N, Iwelunmor J, Griffith DM. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science. Annu Rev Public Health 2024; 45. [PMID: 38166498 DOI: 10.1146/annurev-publhealth-060922-034822] [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: 01/04/2024]
Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, we synthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA;
- Cancer Control and Population Science Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - April Oh
- National Cancer Institute, Rockville, Maryland, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Juliet Iwelunmor
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Kronish IM, Phillips E, Alcántara C, Carter E, Schwartz JE, Shimbo D, Serafini M, Boyd R, Chang M, Wang X, Razon D, Patel A, Moise N. A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring: The EMBRACE Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2334646. [PMID: 37747734 PMCID: PMC10520739 DOI: 10.1001/jamanetworkopen.2023.34646] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023] Open
Abstract
Importance Few primary care patients complete guideline-recommended out-of-office blood pressure (BP) monitoring prior to having hypertension diagnosed. Objective To evaluate the effectiveness of a behavioral theory-informed, multifaceted implementation strategy on out-of-office BP monitoring (ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) among patients with new hypertension. Design, Setting, and Participants This 2-group, pre-post cluster randomized trial was conducted within a primary care network of 8 practices (4 intervention practices with 99 clinicians; 4 control practices with 55 clinicians) and 1186 patients (857 intervention; 329 control) with at least 1 visit with elevated office BP and no prior hypertension diagnosis between October 2016 and September 2017 (preimplementation period) or between April 2018 and March 2019 (postimplementation period). Data were analyzed from February to July 2023. Interventions Usual care (control group) or a multifaceted implementation strategy consisting of an accessible ABPM service; electronic health record (EHR) tools to facilitate test ordering; clinician education, reminders, and feedback relevant to out-of-office BP monitoring; nurse training on HBPM; and patient information handouts. Main Outcomes and Measures The primary outcome was patient completion of out-of-office BP monitoring within 6 months of an eligible visit. Secondary outcomes included clinician ordering of out-of-office BP monitoring. Blinded assessors extracted outcomes from the EHR. Results A total of 1186 patients (857 intervention; 329 control) were included, with a mean (SD) age of 54 (16) years; 808 (68%) were female, and 549 (48%) were Spanish speaking; among those with race and ethnicity documented, 123 (10%) were Black or African American, and 368 (31%) were Hispanic. Among intervention practices, the percentage of visits resulting in completed out-of-office BP monitoring increased from 0.6% (0% ABPM; 0.6% HBPM) to 5.7% (3.7% ABPM; 2.0% HBPM) between the preimplementation and postimplementation periods (P = .009). Among control practices, the percentage of visits resulting in completed out-of-office BP monitoring changed from 5.4% (0% ABPM; 5.4% HBPM) to 4.3% (0% ABPM; 4.3% HBPM) during the corresponding period (P = .94). The ratio of relative risks (RRs) of out-of-office BP monitoring in the postimplementation vs preimplementation periods for intervention vs control practices was 10.5 (95% CI, 1.9-58.0; P = .01). The ratio of RRs of out-of-office BP monitoring being ordered was 2.2 (95% CI, 0.8-6.3; P = .12). Conclusions and Relevance This study found that a theory-informed implementation strategy that included access to ABPM modestly increased out-of-office BP monitoring among patients with elevated office BP but no hypertension diagnosis. Trial Registration ClinicalTrials.gov Identifier: NCT03480217.
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Affiliation(s)
- Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | | | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Maria Serafini
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rebekah Boyd
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Melinda Chang
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Xiaohui Wang
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Dominic Razon
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Akash Patel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
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Lee CR, Moise N. Racism Conscious Approaches to Quality Improvement and Implementation Science Cardiovascular Research: Where Do We Go from Here? J Gen Intern Med 2023; 38:2231-2233. [PMID: 37291362 PMCID: PMC10249924 DOI: 10.1007/s11606-023-08260-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Courtney R Lee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Division of General Internal Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Rome D, Sales A, Cornelius T, Malhotra S, Singer J, Ye S, Moise N. Impact of Telemedicine Modality on Quality Metrics in Diverse Settings: Implementation Science-Informed Retrospective Cohort Study. J Med Internet Res 2023; 25:e47670. [PMID: 37494087 PMCID: PMC10413089 DOI: 10.2196/47670] [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: 03/28/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Video-based telemedicine (vs audio only) is less frequently used in diverse, low socioeconomic status settings. Few prior studies have evaluated the impact of telemedicine modality (ie, video vs audio-only visits) on clinical quality metrics. OBJECTIVE The aim of this study was to assess telemedicine uptake and impact of visit modality (in-person vs video and phone visits) on primary care quality metrics in diverse, low socioeconomic status settings through an implementation science lens. METHODS Informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we evaluated telemedicine uptake, assessed targeted primary care quality metrics by visit modality, and described provider-level qualitative feedback on barriers and facilitators to telemedicine implementation. RESULTS We found marginally better quality metrics (ie, blood pressure and depression screening) for in-person care versus video and phone visits; de-adoption of telemedicine was marked within 2 years in our population. CONCLUSIONS Following the widespread implementation of telemedicine during the COVID-19 pandemic, the impact of visit modality on quality outcomes, provider and patient preferences, as well as technological barriers in historically marginalized settings should be considered.
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Affiliation(s)
- Danielle Rome
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Alyssa Sales
- Columbia University, New York, NY, United States
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Sujata Malhotra
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Jessica Singer
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
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Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco LV, Fleisch E, Pieszchata N, Cannone D, Keys McKay C, Whittman E, Edmondson D, Shelton RC, Moise N. Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study. JMIR Form Res 2023; 7:e47264. [PMID: 37440285 PMCID: PMC10375395 DOI: 10.2196/47264] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. OBJECTIVE This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. METHODS As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. RESULTS At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH's telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. CONCLUSIONS Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study.
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Affiliation(s)
- Andrea T Duran
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Adrianna Keener-DeNoia
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | | | - Adina Fraser
- New York Presbyterian Hospital, New York, NY, United States
| | - Luis V Blanco
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Emily Fleisch
- New York Presbyterian Hospital, New York, NY, United States
| | | | - Diane Cannone
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Charles Keys McKay
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Emma Whittman
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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Grauer A, Cornelius T, Abdalla M, Moise N, Kronish IM, Ye S. Impact of early telemedicine follow-up on 30-Day hospital readmissions. PLoS One 2023; 18:e0282081. [PMID: 37216362 PMCID: PMC10202267 DOI: 10.1371/journal.pone.0282081] [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] [Received: 12/02/2021] [Accepted: 02/08/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Telemedicine is increasing in popularity but the impact of this shift on patient outcomes has not been well described. Prior data has shown that early post-discharge office visits can reduce readmissions. However, it is unknown if routine use of telemedicine visits for this purpose is similarly beneficial. MATERIALS AND METHODS We conducted a retrospective observational study using electronic health records data to assess if the rate of 30-day hospital readmissions differed between modality of visit for primary care or cardiology post-discharge follow-up visits. RESULTS Compared to discharges with completed in-person follow-up visits, the adjusted odds of readmission for those with telemedicine follow-up visits was not significantly different (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.61 to 1.51, P = 0.86). CONCLUSIONS Our study showed that 30-day readmission rate did not differ significantly according to the modality of visit. These results provide reassurance that telemedicine visits are a safe and viable alternative for primary care or cardiology post-hospitalization follow-up.
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Affiliation(s)
- Anne Grauer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Ian M. Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States of America
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, United States of America
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Moise N, Paniagua-Avila A, Barbecho JM, Blanco L, Dauber-Decker K, Simantiris S, McElhiney M, Serafini M, Straussman D, Patel SR, Ye S, Duran AT. A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (The Transform DepCare Study). Implement Sci Commun 2023; 4:10. [PMID: 36698220 PMCID: PMC9875183 DOI: 10.1186/s43058-022-00383-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Few real-world examples exist of how best to select and adapt implementation strategies that promote sustainability. We used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. METHODS Informed by the Dynamic Sustainability Framework, we applied the Behaviour Change Wheel to our prior mixed methods to identify key sustainability behaviors and determinants of sustainability before specifying corresponding intervention functions, behavior change techniques, and implementation strategies that would be acceptable, equitable and promote key tenets of sustainability (i.e., continued improvement, education). Drawing on user-centered design principles, we enlisted 22 national and local stakeholders to operationalize and adapt (e.g., content, functionality, workflow) a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. RESULTS After reviewing the long-term impact of early implementation strategies (i.e., external technical support, quality monitoring, and reimbursement), we identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. The most acceptable, equitable, and feasible intervention functions that would facilitate ongoing improvement included environmental restructuring, education, training, modeling, persuasion, and enablement. We determined that a waiting room delivered shared decision-making and psychoeducation patient tool (DepCare), the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key adaptations in response to dynamic contextual factors included expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system). CONCLUSION We provide a roadmap for designing behavioral theory-informed, implementation strategies that promote sustainability and employing user-centered design principles to adapt strategies to changing mental health landscapes.
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Affiliation(s)
- Nathalie Moise
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Alejandra Paniagua-Avila
- grid.21729.3f0000000419368729Mailman School of Public Health, Columbia University, New York, NY USA
| | - Jennifer Mizhquiri Barbecho
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Luis Blanco
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | | | - Samantha Simantiris
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Martin McElhiney
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA
| | - Maria Serafini
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Darlene Straussman
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Sapana R. Patel
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Siqin Ye
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Andrea T. Duran
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
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Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco LV, Fleisch E, Pieszchata N, Cannone D, McKay CK, Whittman E, Edmondson D, Shelton RC, Moise N. User-centered design of a telehealth-enhanced hybrid cardiac rehabilitation program as hospital quality improvement. Res Sq 2023:rs.3.rs-2475875. [PMID: 36711987 PMCID: PMC9882652 DOI: 10.21203/rs.3.rs-2475875/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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Innovative program designs and strategies are needed to support the widespread uptake of cardiac rehabilitation (CR) programs in the post-COVID19 era. We combined user-centered design (UCD) and implementation science (ImS) principles to design a novel telehealth-enhanced hybrid (home and clinic-based) CR (THCR) program. Methods As part of a New York Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we designed a THCR program using an iterative 3 step UCD process informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research to: 1) identify user and contextual barriers to CR uptake (stakeholder interviews), 2) design an intervention prototype (design workshops and journey mapping), and 3) refine the prototype (usability testing). The process was optimized for usability and implementation outcomes. Results Step 1: Semi-structured interviews with stakeholders (n = 9) at 3 geographically diverse academic medical centers revealed behavioral (e.g., self-efficacy, knowledge) and contextual (e.g., social distancing guidelines, physical space, staffing, reimbursement) barriers to uptake. Step 2: Design workshops (n = 20) and journey-mapping sessions (n = 3) with multi-disciplinary NYPH stakeholders (e.g., digital health team, CR clinicians, creative director) yielded a THCR prototype that leveraged NYPH's investment in their remote patient monitoring (RPM) platform to optimize feasibility of home-based CR sessions. Step 3: Usability testing with CR clinicians (n = 2) administering and CR patients (n = 3) participating in home-based sessions revealed usability challenges (e.g., RPM devices/exercise equipment usability; Wi-Fi/Bluetooth connectivity/syncing; patient safety/knowledge and protocol flexibility). Design workshops (n = 24) and journey-mapping sessions (n = 3) yielded design solutions (e.g., onboarding sessions, safety surveys, fully supervised remote sessions) and a refined THCR prototype. Conclusion Combining UCD and ImS methods while engaging multi-disciplinary stakeholders in an iterative process yielded a theory-informed telehealth-enhanced hybrid CR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process, and guidance for incorporating UCD and ImS methods in early-stage intervention development. THCR may shrink the evidence-to-practice gap in CR implementation. A future hybrid type I effectiveness-implementation trial will determine its feasibility, acceptability, and effectiveness.
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Moise N, Cené CW, Tabak RG, Young DR, Mills KT, Essien UR, Anderson CAM, Lopez-Jimenez F. Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e260-e278. [PMID: 36214131 DOI: 10.1161/cir.0000000000001096] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Reducing cardiovascular disease disparities will require a concerted, focused effort to better adopt evidence-based interventions, in particular, those that address social determinants of health, in historically marginalized populations (ie, communities excluded on the basis of social identifiers like race, ethnicity, and social class and subject to inequitable distribution of social, economic, physical, and psychological resources). Implementation science is centered around stakeholder engagement and, by virtue of its reliance on theoretical frameworks, is custom built for addressing research-to-practice gaps. However, little guidance exists for how best to leverage implementation science to promote cardiovascular health equity. This American Heart Association scientific statement was commissioned to define implementation science with a cardiovascular health equity lens and to evaluate implementation research that targets cardiovascular inequities. We provide a 4-step roadmap and checklist with critical equity considerations for selecting/adapting evidence-based practices, assessing barriers and facilitators to implementation, selecting/using/adapting implementation strategies, and evaluating implementation success. Informed by our roadmap, we examine several organizational, community, policy, and multisetting interventions and implementation strategies developed to reduce cardiovascular disparities. We highlight gaps in implementation science research to date aimed at achieving cardiovascular health equity, including lack of stakeholder engagement, rigorous mixed methods, and equity-informed theoretical frameworks. We provide several key suggestions, including the need for improved conceptualization and inclusion of social and structural determinants of health in implementation science, and the use of adaptive, hybrid effectiveness designs. In addition, we call for more rigorous examination of multilevel interventions and implementation strategies with the greatest potential for reducing both primary and secondary cardiovascular disparities.
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Reuter K, Genao K, Callanan EM, Cannone DE, Giardina EG, Rollman BL, Singer J, Slutzky AR, Ye S, Duran AT, Moise N. Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy. Circ Cardiovasc Qual Outcomes 2022; 15:e009338. [PMID: 36378766 PMCID: PMC9909565 DOI: 10.1161/circoutcomes.122.009338] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression leads to poor health outcomes in patients with coronary heart disease (CHD). Despite guidelines recommending screening and treatment of depressed patients with CHD, few patients receive optimal care. We applied behavioral and implementation science methods to (1) identify generalizable, multilevel barriers to depression screening and treatment in patients with CHD and (2) develop a theory-informed, multilevel implementation strategy for promoting guideline adoption. METHODS We conducted a narrative review of barriers to depression screening and treatment in patients with CHD (ie, medications, exercise, cardiac rehabilitation, or therapy) comprising data from 748 study participants. Informed by the behavior change wheel framework and Expert Recommendations for Implementing Change, we defined multilevel target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multilevel implementation strategy, targeting health care systems/providers and patients. RESULTS We identified implementation barriers at the system/provider level (eg, Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (eg, Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. Expert Recommendations for Implementing Change strategies included learning collaborative, audit, feedback, and educational materials. The final multicomponent strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (electronic shared decision-making) tool with several functions for patients, for example, patient activation, patient treatment selection support. CONCLUSIONS We applied implementation and behavioral science methods to identify implementation barriers and to develop a multilevel implementation strategy for increasing uptake of depression screening and treatment in patients with CHD as a use case. The multilevel implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.
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Affiliation(s)
- Katja Reuter
- Department of Medicine, SUNY Upstate Medical University, New York, USA
| | - Kirali Genao
- Columbia University Irving Medical Center, New York, USA
| | | | | | - Elsa-Grace Giardina
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Bruce L. Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessica Singer
- Columbia University Irving Medical Center, New York, USA
| | - Amy R. Slutzky
- Health Sciences Library, SUNY Upstate Medical University, New York, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, USA
| | | | - Nathalie Moise
- Columbia University Irving Medical Center, New York, USA
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Flatow J, Sanchez J, Singer J, Moise N, Shimbo D, Kronish IM. Abstract 086: Impact Of Ambulatory Blood Pressure Monitoring On Hypertension Diagnosis In Primary Care. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.086] [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]
Abstract
Introduction:
Hypertension (HTN) screening guidelines recommend using ambulatory blood pressure monitoring (ABPM) to exclude white coat HTN prior to newly diagnosing HTN. Yet, little is known about the impact of ABPM testing on HTN diagnosis decisions in primary care. Unfamiliarity with how to interpret ABPM results could lead to overtreatment or diagnostic inertia, the failure to diagnose a disease despite clinical evidence.
Methods:
We examined medical records of primary care patients with elevated office BP (≥140/90 mmHg) who were referred to an ABPM testing service. Patients were eligible for analysis if they were ≥18 years old, had elevated office BP without a HTN diagnosis and not prescribed BP medications, were referred by a primary care clinician from clinics affiliated with Columbia University Medical Center, and completed ABPM testing between 2016-2019. Using mean awake BP of 135/85 mmHg as the threshold for elevated ABPM, we compared the BP testing outcome (white coat HTN, in which only office BP was elevated, or sustained HTN, in which both office and ambulatory BP were elevated) to the physician’s action at the subsequent scheduled primary care visit (diagnosed or did not diagnose HTN per manual review of electronic medical records).
Results:
Overall, 111 patients with newly elevated office BP completed ABPM testing during the analysis period. Patients were referred by 60 physicians (50% trainees) from 6 clinics. Patients had a mean (SD) age of 53 (15) years; 73% were women. Fifty-nine patients (53%) had white coat HTN, and 52 (88%) were not diagnosed with HTN at their next primary care visit. The remaining 52 patients (47%) had sustained HTN, and 44 (85%) were diagnosed with HTN at their next visit. Medication was started for 31 of these 44 (70%). Overall, physicians diagnosed HTN concordantly with ABPM results for 96/111 patients (86%).
Conclusions:
More than half of primary care patients with elevated office BP referred for ABPM had white coat HTN. There was high concordance between ABPM results and physician HTN diagnoses, suggesting that ABPM reduces but does not eliminate overdiagnosis and diagnostic inertia in HTN. More research is needed to understand the reasons for discordance and how to optimize the implementation of ABPM testing into primary care.
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Rome D, Sales A, Leeds R, Usseglio J, Cornelius T, Monk C, Smolderen KG, Moise N. A Narrative Review of the Association Between Depression and Heart Disease Among Women: Prevalence, Mechanisms of Action, and Treatment. Curr Atheroscler Rep 2022; 24:709-720. [PMID: 35751731 PMCID: PMC9398966 DOI: 10.1007/s11883-022-01048-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Sex and gender differences exist with regard to the association between depression and cardiovascular disease (CVD). This narrative review describes the prevalence, mechanisms of action, and management of depression and CVD among women, with a particular focus on coronary heart disease (CHD). RECENT FINDINGS Women versus men with incident and established CHD have a greater prevalence of depression. Comorbid depression and CHD in women may be associated with greater mortality, and treatment inertia. Proposed mechanisms unique to the association among women of depression and CHD include psychosocial, cardiometabolic, behavioral, inflammatory, hormonal, and autonomic factors. The literature supports a stronger association between CHD and the prevalence of depression in women compared to men. It remains unclear whether depression treatment influences cardiovascular outcomes, or if treatment effects differ by sex and/or gender. Further research is needed to establish underlying mechanisms as diagnostic and therapeutic targets.
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Affiliation(s)
- Danielle Rome
- Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian, New York, NY, USA
| | | | - Rebecca Leeds
- Center for Family and Community Medicine, Columbia University Irving Medical Center/New York Presbyterian, New York, NY, USA
| | - John Usseglio
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Catherine Monk
- Departments of OB/GYN and Psychiatry, School of Physicians and Surgeons, Columbia University Vagelos, New York, NY, USA
| | - Kim G Smolderen
- Departments of Internal Medicine and Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Kronish IM, Phillips E, Carter E, Alcantara C, Schwartz JE, Razon DT, Serafini MA, Flatow J, Sanchez J, Shimbo D, Moise N. Abstract P222: Effectiveness Of A Multicomponent Implementation Strategy On Increasing Uptake Of USPSTF Hypertension Screening Recommendations In A Primary Care Network: The Embrace Cluster Randomized Trial. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p222] [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]
Abstract
Background:
In 2015, the US Preventive Services Task Force (USPSTF) updated its primary care screening guidelines to recommend out-of-office BP testing with ABPM or HBPM for confirming the diagnosis of hypertension (HTN) in adult patients with high office BP.
Methods:
We applied the Behavior Change Wheel framework to develop a theory-informed strategy for increasing the uptake of the USPSTF HTN screening guideline. We then conducted a 2-arm cluster randomized trial in which 8 primary care practices (154 clinicians) in an ambulatory care network serving vulnerable communities in New York City were randomized to receive the implementation strategy (4 practices) or a wait-list control (4 practices). The strategy was implemented from October 2017 to March 2018, and consisted of: 1) clinician education about HTN screening recommendations; 2) clinician information on how to order ABPM and HPBM; 3) patient information on ABPM and HBPM; 4) nurse training on how to teach patients to conduct HBPM; 5) access to an ABPM testing service; 6) clinician feedback on out-of-office BP test ordering; and 7) embedded tools in the EHR to facilitate ABPM and HBPM ordering. The primary outcome was change in the proportion of patients completing ABPM or HBPM in the year before versus year after implementation.
Results:
There were 1069 eligible patients (mean age 53±16 years, 67% women) with high office BP but no diagnosis or treatment for HTN. In implementation practices, the proportion of patients with out-of-office BP test ordering increased from 0.5% in the year before implementation to 4.0% in the year after implementation (p<.001) whereas test ordering did not change in control practices (3.1% to 2.8%, p=0.66); p<.001 for interaction. Similarly, out-of-office BP test completion increased from 0.5% to 3.0% (p<.001) in implementation practices whereas test completion did not change in control practices (2.2% to 2.0%, p=0.76); p<.001 for interaction.
Conclusions:
A theory-informed implementation strategy increased out-of-office BP testing in adult primary care patients being screened for HTN. Yet, out-of-office BP testing in the context of HTN screening remained low in both implementation and control practices, suggesting a need for more potent implementation strategies.
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Riehm KE, Davidson KW, Moise N, Margolis KL, Clarke GN, Dolor RJ, Kronish IM. Effectiveness of stepped depression care among patients with screen-identified depression after acute coronary syndromes: A secondary analysis of the CODIACS-QoL randomized clinical trial. Gen Hosp Psychiatry 2022; 78:126-127. [PMID: 35461724 DOI: 10.1016/j.genhosppsych.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kira E Riehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research at Northwell Health, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Greg N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Rowena J Dolor
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Grauer A, Duran AT, Liyanage-Don NA, Torres-Deas LM, Metser G, Moise N, Kronish IM, Ye S. Association between telemedicine use and diabetes risk factor assessment and control in a primary care network. J Endocrinol Invest 2022; 45:1749-1756. [PMID: 35596919 PMCID: PMC9123919 DOI: 10.1007/s40618-022-01814-6] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Our study examined whether telemedicine use in primary care is associated with risk factor assessment and control for patients with diabetes mellitus. METHODS This was a retrospective, 1:1 propensity score matched cohort study conducted in a primary care network between February 2020 and December 2020. Participants included patients with diabetes mellitus, ages 18 to 75. Exposure of interest was any telemedicine visit. We determined whether hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) were assessed for each patient. For each risk factor, we also determined whether the risk factor was controlled when they were assessed (i.e., last HbA1c < 8.0%, BP < 130/80 mmHg, LDL-C < 100 mg/dL). RESULTS After 1:1 propensity score matching, we identified 1,824 patients with diabetes during the study period. Telemedicine use was associated with a lower proportion of patients with all three risk factors assessed (162/912 [18%], versus 408/912 [45%], p < 0.001). However, when individual risk factors were assessed, telemedicine use did not impact risk factor control. When compared with patients with in-person visit only, the odds ratio (OR) for HbA1c < 8% was 1.04 (95% CI 0.74 to 1.46, p = 0.23) for patients with any telemedicine visit. Similarly, the OR for BP < 130/80 mmHg was 1.08 (95% CI 0.85-1.36 p = 0.53), and the OR for LDL-C < 100 mg/dL was 1.14 (95% CI 0.76-1.72, p = 0.52). CONCLUSIONS Telemedicine use was associated with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic, but had limited impact on whether risk factors were controlled.
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Affiliation(s)
- A Grauer
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA.
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
| | - A T Duran
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
| | - N A Liyanage-Don
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
| | - L M Torres-Deas
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
| | - G Metser
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
| | - N Moise
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
- Department of Medicine, Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - I M Kronish
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th street PH 9E-117, New York, NY, 10032, USA
- Department of Medicine, Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - S Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
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Cené CW, Beckie TM, Sims M, Suglia SF, Aggarwal B, Moise N, Jiménez MC, Gaye B, McCullough LD. Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e026493. [PMID: 35924775 PMCID: PMC9496293 DOI: 10.1161/jaha.122.026493] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Social isolation, the relative absence of or infrequency of contact with different types of social relationships, and loneliness (perceived isolation) are associated with adverse health outcomes. Objective To review observational and intervention research that examines the impact of social isolation and loneliness on cardiovascular and brain health and discuss proposed mechanisms for observed associations. Methods We conducted a systematic scoping review of available research. We searched 4 databases, PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health, and Scopus. Findings Evidence is most consistent for a direct association between social isolation, loneliness, and coronary heart disease and stroke mortality. However, data on the association between social isolation and loneliness with heart failure, dementia, and cognitive impairment are sparse and less robust. Few studies have empirically tested mediating pathways between social isolation, loneliness, and cardiovascular and brain health outcomes using appropriate methods for explanatory analyses. Notably, the effect estimates are small, and there may be unmeasured confounders of the associations. Research in groups that may be at higher risk or more vulnerable to the effects of social isolation is limited. We did not find any intervention studies that sought to reduce the adverse impact of social isolation or loneliness on cardiovascular or brain health outcomes. Conclusions Social isolation and loneliness are common and appear to be independent risk factors for worse cardiovascular and brain health; however, consistency of the associations varies by outcome. There is a need to develop, implement, and test interventions to improve cardiovascular and brain health for individuals who are socially isolated or lonely.
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Moise N, Bauer AM. Current and future directions in the application of implementation science to accelerate the adoption of evidence-based practices in behavioral health. Gen Hosp Psychiatry 2022; 77:88-91. [PMID: 35576715 DOI: 10.1016/j.genhosppsych.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
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Affiliation(s)
- Sidney H. Hankerson
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Department of Population Health Sciences & Policy, 1425 Madison Avenue, New York, NY 10029
| | - Nathalie Moise
- Columbia University Irving Medical Center, Department of Medicine, 622 West 168 Street, PH 9, New York, NY 10032
| | - Diane Wilson
- Icahn School of Medicine at Mount Sinai, New York; Department of Medicine Columbia University Irving Medical Center, New York; City University of New York
| | - Bernadine Y. Waller
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Kimberly T. Arnold
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania Center for Public Health Initiatives, University of Pennsylvania Leonard Davis Institute of Health Economics, Penn Presbyterian Medical Center, Andrew Mutch Building, Floor 6, 51 N. 39th Street, Philadelphia, PA 19104
| | - Cristiane Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Claudia Lugo-Candelas
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Myrna M Weissman
- Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 24, New York, New York 10032
| | - Milton Wainberg
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, The Bronx James J. Peters VA Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Ruth Shim
- University of California at Davis, Department of Psychiatry
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Brotzman LE, Shelton RC, Austin JD, Rodriguez CB, Agovino M, Moise N, Tehranifar P. "It's something I'll do until I die": A qualitative examination into why older women in the U.S. continue screening mammography. Cancer Med 2022; 11:3854-3862. [PMID: 35616300 PMCID: PMC9582674 DOI: 10.1002/cam4.4758] [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: 10/23/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Professional guidelines in the U.S. do not recommend routine screening mammography for women ≥75 years with limited life expectancy and/or poor health. Yet, routine mammography remains widely used in older women. We examined older women's experiences, beliefs, and opinions about screening mammography in relation to aging and health. METHODS We performed thematic analysis of transcribed semi-structured interviews with 19 women who had a recent screening visit at a mammography clinic in New York City (average age: 75 years, 63% Hispanic, 53% ≤high school education). RESULTS Three main themes emerged: (1) older women typically perceive mammograms as a positive, beneficial, and routine component of care; (2) participation in routine mammography is reinforced by factors at interpersonal, provider, and healthcare system levels; and (3) older women do not endorse discontinuation of screening mammography due to advancing age or poor health, but some may be receptive to reducing screening frequency. Only a few older women reported having discussed mammography cessation or the potential harms of screening with their providers. A few women reported they would insist on receiving mammography even without a provider recommendation. CONCLUSIONS Older women's positive experiences and views, as well as multilevel and frequently automated cues toward mammography are important drivers of routine screening in older women. These findings suggest a need for synergistic patient, provider, and system level strategies to reduce mammography overuse in older women.
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Affiliation(s)
- Laura E. Brotzman
- Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Rachel C. Shelton
- Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkNew YorkUSA,Herbert Irving Comprehensive Cancer CenterColumbia University Medical CenterNew YorkNew YorkUSA
| | - Jessica D. Austin
- Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkNew YorkUSA,Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Carmen B. Rodriguez
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Mariangela Agovino
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Nathalie Moise
- Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Parisa Tehranifar
- Herbert Irving Comprehensive Cancer CenterColumbia University Medical CenterNew YorkNew YorkUSA,Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
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22
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Moise N, Davidson KW, Clarke GN, Dolor RJ, Margolis KL, Kronish IM. Differences in the Prevalence of Screen-Detected Depression After Acute Coronary Syndrome Between Health Systems in the USA: Findings from CODIACS-QoL Randomized Controlled Trial. J Gen Intern Med 2022; 37:1808-1810. [PMID: 34355350 PMCID: PMC9130360 DOI: 10.1007/s11606-021-07049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Nathalie Moise
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Karina W Davidson
- Feinstein Institutes for Medical Research, Northwell Health, New York, NY, USA
| | | | | | | | - Ian M Kronish
- Department of Medicine, Columbia University Medical Center, New York, NY, USA.
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23
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Boyd R, Carter E, Moise N, Alcántara C, Valadares T, Anstey DE, Kronish IM. Awareness, Knowledge, and Attitudes Toward Screening and Treatment of Masked Hypertension in Primary Care. Am J Hypertens 2021; 34:1322-1327. [PMID: 34279025 DOI: 10.1093/ajh/hpab115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypertension guidelines recommend screening and treatment for masked hypertension (MHT). Yet, few primary care providers (PCPs) screen for MHT, and little is known about PCP awareness, knowledge, and attitudes toward MHT. METHODS Three focus groups involving 30 PCPs from 3 medical centers in New York were conducted. Focus group transcripts were analyzed using thematic content analysis. RESULTS Awareness of MHT varied, and only 2 providers had diagnosed MHT. There was also low knowledge about the prevalence and impact of MHT. While some PCPs were receptive to MHT screening after learning about its significance, others viewed the current evidence as insufficient to change practice. Providers were discomforted by labeling patients with nonelevated office blood pressure (BP) as hypertensive and reluctant to add another screening test to their workload without stronger evidence. There was distrust in the accuracy of home BP monitoring to screen for MHT. There was more confidence in ambulatory BP monitoring (ABPM) for MHT screening, but ABPM was viewed as largely inaccessible. There was broad agreement with lifestyle changes for MHT. There were concerns that antihypertensive medication lacked evidence from randomized trials and could induce harmful side effects. CONCLUSIONS Limited PCP knowledge about MHT, concerns about the accuracy and accessibility of screening tests, overloaded PCPs, and insufficient evidence were major barriers to screening and treatment for MHT. Prior to broad uptake by PCPs, randomized trials demonstrating the net benefits of MHT screening and treatment may be needed, along with increased dissemination of knowledge about MHT and improved access to ABPM.
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Affiliation(s)
- Rebekah Boyd
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Thais Valadares
- Department of Medicine, Staten Island University Hospital, Northwell Health, New York, New York, USA
| | - D Edmund Anstey
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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24
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. Implementation Research and Practice 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington, USA
- Georgetown University, Center for Men’s Health Equity, Washington, USA
- Department of Health Systems Administration at the School of Nursing & Health Studies, Georgetown University, Washington, USA
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25
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Hardy ST, Chen L, Cherrington AL, Moise N, Jaeger BC, Foti K, Sakhuja S, Wozniak G, Abdalla M, Muntner P. Racial and Ethnic Differences in Blood Pressure Among US Adults, 1999-2018. Hypertension 2021; 78:1730-1741. [PMID: 34719937 DOI: 10.1161/hypertensionaha.121.18086] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Shakia T Hardy
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | - Ligong Chen
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | | | - Nathalie Moise
- Department of Medicine, Columbia University, New York, NY (N.M., M.A.)
| | - Byron C Jaeger
- Department of Biostatistics (B.C.J.), University of Alabama at Birmingham
| | - Kathryn Foti
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (K.F.)
| | - Swati Sakhuja
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
| | | | - Marwah Abdalla
- Department of Medicine, Columbia University, New York, NY (N.M., M.A.)
| | - Paul Muntner
- Department of Epidemiology (S.T.H., L.C., S.S., P.M.), University of Alabama at Birmingham
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26
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Affiliation(s)
- Nathalie Moise
- Columbia University Irving Medical Center, New York, New York
| | - Sidney Hankerson
- Columbia University Irving Medical Center, New York, New York.,New York State Psychiatric Institute, New York
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27
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Austin JD, Tehranifar P, Rodriguez CB, Brotzman L, Agovino M, Ziazadeh D, Moise N, Shelton RC. A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation. Implement Sci Commun 2021; 2:110. [PMID: 34565481 PMCID: PMC8474751 DOI: 10.1186/s43058-021-00217-7] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse. METHODS This explanatory, sequential, mixed-methods study collected survey data (n= 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n=19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n=5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted a descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process. RESULTS Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not perceive to have experienced overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that reducing overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may contribute to overscreening. Providers identified potential strategies to reduce overscreening including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may receive less health benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop standard processes of care around mammography screening. CONCLUSIONS Multi-level factors contributing to mammography overuse are dynamic, interconnected, and reinforced. To ensure equitable de-implementation, there is a need for more refined and empirical testing of theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laura Brotzman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Danya Ziazadeh
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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28
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Liyanage-Don NA, Cornelius T, Sanchez JE, Trainor A, Moise N, Wainberg M, Kronish IM. Psychological Distress, Persistent Physical Symptoms, and Perceived Recovery After COVID-19 Illness. J Gen Intern Med 2021; 36:2525-2527. [PMID: 33987793 PMCID: PMC8118366 DOI: 10.1007/s11606-021-06855-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Nadia A Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jose E Sanchez
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alison Trainor
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
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29
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Ye S, Anstey DE, Grauer A, Metser G, Moise N, Schwartz J, Kronish I, Abdalla M. The Impact of Telemedicine Visits on Controlling High Blood Pressure Quality Measure During the Covid-19 Pandemic: Observational Study (Preprint). JMIR Form Res 2021; 6:e32403. [PMID: 35138254 PMCID: PMC8945081 DOI: 10.2196/32403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/21/2021] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Siqin Ye
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - D Edmund Anstey
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Anne Grauer
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Gil Metser
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Joseph Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Ian Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Marwah Abdalla
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
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30
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Abstract
Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Since then, various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs. Despite increases in collaborative care implementation and reimbursement, prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb. Meanwhile, primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether, citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available, high false-positive results, and small treatment effects. In this perspective, a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care. In addition, we propose systemic changes to improve the dissemination of mental health treatment in primary care.
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, United States
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
| | - Ravi Navin Shah
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10019, United States
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31
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Ladapo JA, Davidson KW, Moise N, Chen A, Clarke GN, Dolor RJ, Margolis KL, Thanataveerat A, Kronish IM. Economic outcomes of depression screening after acute coronary syndromes: The CODIACS-QoL randomized clinical trial. Gen Hosp Psychiatry 2021; 71:47-54. [PMID: 33933921 PMCID: PMC10784112 DOI: 10.1016/j.genhosppsych.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/13/2021] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of screening for depression in patients with acute coronary syndrome (ACS) and no history of depression. METHODS Cost-effectiveness analysis of a randomized trial enrolling 1500 patients with ACS between 2013 and 2017. Patients were randomized to no screening, screening and notifying the primary care provider (PCP), and screening, notifying the PCP, and providing enhanced depression treatment. Outcomes measured were Healthcare utilization, costs, and incremental cost-effectiveness ratios. RESULTS 7.1% of patients screened positive for depressive symptoms. There was no significant difference in usage of mental health services, cardiovascular tests and procedures, and medications. Mean total costs in No Screen group ($7440), in Screen, Notify, and Treat group ($6745), and in Screen and Notify group ($6204). The difference was only significant in the Screen and Notify group versus the No Screen group (-$1236, 95% confidence interval -$2388 to -$96). Because mean QALYs were higher (+0.003 QALY in Screen and Notify; +0.004 QALYs in Screen, Notify, and Treat) and mean total costs were lower in both intervention groups, these interventions were cost-effective. There was substantial uncertainty because confidence intervals around cost differences were wide and QALY effects were small. CONCLUSION Depression screening strategies for patients with ACS may be modestly cost-effective.
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Affiliation(s)
- Joseph A Ladapo
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| | - Karina W Davidson
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Alexander Chen
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | | | - Rowena J Dolor
- Duke University School of Medicine, Durham, NC, United States of America
| | - Karen L Margolis
- HealthPartners Institute, Minneapolis, MN, United States of America
| | | | - Ian M Kronish
- Columbia University Irving Medical Center, New York, NY, United States of America
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32
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Derby L, Kronish IM, Wood D, Cheung YKK, Cohn E, Duan N, St Onge T, Duer-Hefele J, Davidson KW, Moise N. Using a multistakeholder collaboratory and patient surveys to inform the conduct of personalized (N-of-1) trials. Health Psychol 2021; 40:230-241. [PMID: 33856830 DOI: 10.1037/hea0001058] [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: 11/08/2022]
Abstract
OBJECTIVE Personalized trials have the potential to improve the precision of treatment selection and foster patient involvement in clinical decision making. Little is known about the attitudes of patients with multimorbidities. To address this, stakeholders designed and conducted a national survey that determined general attitudes and features of personalized trials that may increase their use among patients with multimorbidities in clinical and research practice. METHOD A multistakeholder collaboratory of patients, clinicians, scientists, methodologists, statisticians, and research disseminators designed a survey to determine the conditions, symptoms, and design attributes most applicable to personalized trials according to patients. A sample of U.S. patients with two or more prespecified personalized-trial-amenable chronic conditions completed the online survey. RESULTS Multimorbid participants (N = 501; M age = 56.1 years) showed that some conditions, symptoms or use cases for personalized trials include pain (57.6%), hypertension (38.8%), diabetes (28.8%), sleep problems (27.4%), and depression (23.0%). Overall, 82.0% of the participants with multimorbidities were interested in participating in personalized trials. The percentage that were interested varied by trial attributes, including physician involvement (86.4%), patient-driven treatment selection (88.0%), clinician blinding (59.2%), placebo treatment options (57.5%), and out-of-pocket costs (41.8%). CONCLUSION Participants with multimorbidities identified prevalent use cases that are suited to personalized trials. Participants also identified design features of such trials, including patient-driven treatment selection, active comparators, and nonblinding. This study demonstrates that eliciting input from a collaboratory and patients with multimorbidities can inform research priorities for this rapidly growing patient population and increase adoption by researchers and clinicians alike. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Ye S, Hiura G, Fleck E, Garcia A, Geleris J, Lee P, Liyanage-Don N, Moise N, Schluger N, Singer J, Sobieszczyk M, Sun Y, West H, Kronish IM. Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness. J Gen Intern Med 2021; 36:722-729. [PMID: 33443699 PMCID: PMC7808120 DOI: 10.1007/s11606-020-06340-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 05/17/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. OBJECTIVE To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. DESIGN Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73). LIMITATIONS Single-center study; assignment to remote monitoring was not randomized. CONCLUSIONS During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
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Affiliation(s)
- Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
| | - Grant Hiura
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Fleck
- New York Presbyterian Hospital, New York, NY, USA
| | - Aury Garcia
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Geleris
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Lee
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Neil Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica Singer
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Yifei Sun
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Harry West
- Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA.
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Ye S, Kronish I, Fleck E, Fleischut P, Homma S, Masini D, Moise N. Telemedicine Expansion During the COVID-19 Pandemic and the Potential for Technology-Driven Disparities. J Gen Intern Med 2021; 36:256-258. [PMID: 33105000 PMCID: PMC7586868 DOI: 10.1007/s11606-020-06322-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Siqin Ye
- Columbia University Irving Medical Center, New York, NY, USA.
| | - Ian Kronish
- Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Fleck
- Columbia University Irving Medical Center, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | | | - Shunichi Homma
- Columbia University Irving Medical Center, New York, NY, USA
| | - David Masini
- Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, NY, USA
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Leeds R, Shechter A, Alcantara C, Aggarwal B, Usseglio J, Abdalla M, Moise N. Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease. Gender and the Genome 2020. [DOI: 10.1177/2470289720980018] [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
Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.
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Affiliation(s)
- Rebecca Leeds
- Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Liyanage-Don N, Birk J, Cornelius T, Sanchez G, Moise N, Edmondson D, Kronish I. Medications as Traumatic Reminders in Patients With Stroke/Transient Ischemic Attack-Induced Posttraumatic Stress Disorder. Stroke 2020; 52:321-324. [PMID: 33272128 DOI: 10.1161/strokeaha.120.031109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) symptoms are common after stroke/transient ischemic attack (TIA) and have been associated with medication nonadherence, potentially because medications serve as traumatic reminders of the prior stroke/TIA. This study examined associations between stroke/TIA-induced PTSD and aversive cognitions toward preventive medications. METHODS We enrolled a cohort of patients presenting to the emergency department with suspected stroke/TIA. One month posthospitalization, we assessed PTSD symptoms specific to the index stroke/TIA using the PTSD checklist specific and asked patients how often (1) did thinking about your stroke medication make you feel nervous or anxious?; (2) did thinking about your stroke medication make you think about your risk for future strokes?; and (3) did you skip or avoid taking your stroke medication so you would not have to think about your stroke? Logistic regression models tested the association between PTSD symptoms and each aversive cognition, adjusting for age, sex, ethnicity, and depression. RESULTS Among 408 included patients, 11.0% had elevated PTSD symptoms. These patients were more likely to report that thinking about their stroke medication made them feel nervous or anxious (37.8% versus 9.9%, P<0.001) that thinking about their stroke medication made them think about their risk for future stroke/TIA (60.0% versus 24.0%, P<0.001), and that they skipped or avoided their stroke medication to not think about their prior stroke/TIA (11.1% versus 2.2%, P=0.009). In adjusted analyses, higher PTSD checklist specific scores were associated with increased nervousness/anxiety (odds ratio, 1.33 [95% CI, 1.18-1.50], P<0.001) and thoughts of future stroke (odds ratio, 1.27 [95% CI, 1.14-1.41], P<0.001), with a trend toward significance for skipping medications to avoid reminders of stroke (odds ratio, 1.20 [95% CI, 0.99-1.44], P=0.06). CONCLUSIONS Medications may serve as traumatic reminders after stroke/TIA-induced PTSD, potentially leading to medication nonadherence.
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Affiliation(s)
- Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Gabriel Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
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Odlum M, Moise N, Kronish IM, Broadwell P, Alcántara C, Davis NJ, Cheung YKK, Perotte A, Yoon S. Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018. JAMA Netw Open 2020; 3:e2025134. [PMID: 33175177 PMCID: PMC7658737 DOI: 10.1001/jamanetworkopen.2020.25134] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/13/2020] [Indexed: 01/17/2023] Open
Abstract
Importance Adults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. Objective To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. Design, Setting, and Participants In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. Exposure The 1999 legislation to reduce racial/ethnic health disparities. Main Outcomes and Measures Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. Results Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (β = -0.40%; P < .001) and physical inactivity (β = -0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (β = 0.88%; P < .001), diabetes (β = 0.52%; P < .001), asthma (β = 0.25%; P < .001), and stroke (β = 0.15%; P < .001) during the last 20 years. The Black-White gap (ie, the change in β between groups) showed improvement (2 trend lines converging) in uninsured status (-0.20%; P < .001) and physical inactivity (-0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (β = -0.28%; P = .02) and perceived poor health (β = -0.22%; P = .001), while they showed overall deterioration in hypertension (β = 0.79%; P < .001) and diabetes (β = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (-0.15%; P < .001), stroke (-0.04%; P < .001), kidney disease (-0.06%; P < .001), asthma (-0.06%; P = .02), arthritis (-0.26%; P < .001), depression (-0.23%; P < .001), and physical inactivity (-0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001). Conclusions and Relevance This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status.
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Affiliation(s)
- Michelle Odlum
- Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ian M. Kronish
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Peter Broadwell
- Center for Interdisciplinary Digital Research, Stanford University, Stanford, California
| | | | - Nicole J. Davis
- Clemson University School of Nursing, Clemson, South Carolina
| | - Ying Kuen K. Cheung
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York
| | - Adler Perotte
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
- Data Science Institute, Columbia University, New York, New York
| | - Sunmoo Yoon
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Data Science Institute, Columbia University, New York, New York
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Bryant KB, Jannat-Khah DP, Cornelius T, Khodneva Y, Richman J, Fleck EM, Torres-Deas LM, Safford MM, Moise N. Time-Varying Depressive Symptoms and Cardiovascular and All-Cause Mortality: Does the Risk Vary by Age or Sex? J Am Heart Assoc 2020; 9:e016661. [PMID: 32981424 PMCID: PMC7792396 DOI: 10.1161/jaha.120.016661] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Depressive symptoms are associated with mortality. Data regarding moderation of this effect by age and sex are inconsistent, however. We aimed to identify whether age and sex modify the association between depressive symptoms and all‐cause and cardiovascular disease (CVD) mortality. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort of Black and White individuals recruited between 2003 and 2007. Associations between time‐varying depressive symptoms (Center for Epidemiologic Studies Depression scale score ≥4 versus <4) and all‐cause and CVD mortality were measured using Cox proportional hazard models adjusting for demographic and clinical risk factors. All results were stratified by age or sex and by self‐reported health status. Of 29 491 participants, 3253 (11%) had baseline elevated depressive symptoms. Mean age was 65 (9.4) years, with 55.1% of participants female, 41.1% Black, and 46.4% had excellent/very good health. Depressive symptoms were measured at baseline, on average 4.9 (SD, 1.5), then 2.1 (SD, 0.4) years later. Neither age nor sex moderated the association between elevated time‐varying depressive symptoms and all‐cause or CVD mortality (all‐cause: age 45–64 years adjusted hazard ratio [aHR], 1.38; 95% CI, 1.18–1.61 versus age ≥65 years aHR,1.36; 95% CI, 1.23–1.50; P=0.05; CVD: age 45–64 years aHR, 1.17; 95% CI, 0.90–1.53 versus age ≥65 years aHR, 1.26; 95% CI, 1.06–1.50; P=0.54; all‐cause: males aHR, 1.46; 95% CI, 1.29–1.64 versus female aHR, 1.34; 95% CI, 1.19–1.50; P=0.35; CVD: male aHR, 1.32; 95% CI, 1.08–1.62 versus female aHR, 1.22; 95% CI, 1.00–1.47; P=0.64). Similar results were observed when stratified by self‐reported health status. Conclusions Depressive symptoms confer mortality risk regardless of age and sex, including individuals who report excellent/very good health.
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Affiliation(s)
- Kelsey B Bryant
- Division of General Medicine Columbia University Irving Medical Center New York NY
| | | | - Talea Cornelius
- Center for Behavioral Cardiovascular Health Columbia University Irving Medical Center New York NY
| | - Yulia Khodneva
- Division of General Medicine University of Alabama at Birmingham AL
| | - Joshua Richman
- Division of General Medicine University of Alabama at Birmingham AL
| | - Elaine M Fleck
- Division of General Medicine Columbia University Irving Medical Center New York NY
| | | | - Monika M Safford
- Division of General Medicine Weill Cornell Medical Center New York NY
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health Columbia University Irving Medical Center New York NY
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Liyanage-Don NA, Schwartz JE, Moise N, Bryant KB, Bono A, Kronish IM. Abstract P156: Improvement In Blood Pressure Using Remote Patient Monitoring During COVID19. Hypertension 2020. [DOI: 10.1161/hyp.76.suppl_1.p156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The coronavirus disease 2019 (COVID19) pandemic required strict social distancing to curb transmission. Unfortunately, these measures severely limited healthcare access and chronic disease management. In response, many health organizations rapidly developed or expanded telemedicine to provide care directly to patients at home. Little has been reported about the impact of such interventions on clinical outcomes during COVID19. We examined whether enrollment in a remote patient monitoring (RPM) program for hypertension (HTN) prior to COVID19 was associated with improved blood pressure during the pandemic.
Methods:
We developed an RPM program that tracked vital signs, medication side effects, and treatment adherence patterns outside of the clinic. Patients were referred by their primary care doctor for uncontrolled HTN or suspected white coat HTN. Patients received a two-way tablet, blood pressure cuff, and virtual nursing support via scheduled video visits. Those referred for uncontrolled HTN who had at least two weeks of data both before and after the onset of COVID19 (defined as the first two weeks of March 2020) were included in the study. A mixed-models analysis that adjusted for serial autocorrelation was used to compare mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) in the pre-/post-COVID19 periods.
Results:
Of 94 patients enrolled in the RPM program to date, 46 had at least two weeks of data both pre-COVID19 and post-COVID19. Mean age was 69.0 ± 10.9 years, 69.6% (32 of 46) were women, 78.3% (36 of 46) were Hispanic, and 63.0% (29 of 46) were Spanish-speaking. Pre-COVID, mean SBP was 132.31 ± 13.99 mmHg, mean DBP was 77.10 ± 9.87 mmHg, and 70% (32 of 46) of patients had uncontrolled BP (>130/80 mmHg per AHA guidelines). Post-COVID, mean SBP was 129.57 ± 13.29 mmHg, mean DBP was 76.00 ± 9.16 mmHg, and 57% (26 of 46) of patients had uncontrolled BP. There was a significant reduction in both mean SBP (β = –2.74, 95% CI –5.21, –0.26, p = 0.03) and mean DBP (β = –1.10, 95% CI –2.22, 0.02, p = 0.05) post-COVID vs. pre-COVID.
Discussion:
Despite the stress and social isolation associated with COVID19, participation in an RPM program that combines home BP monitoring with virtual nursing support can help maintain and even mildly decrease BP.
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Affiliation(s)
| | | | | | | | - Adina Bono
- Columbia Univ Irving Med Cntr, New York, NY
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Moise N, Phillips E, Carter E, Alcantara C, Julian J, Thanataveerat A, Schwartz JE, Ye S, Duran A, Shimbo D, Kronish IM. Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study. Implement Sci 2020; 15:63. [PMID: 32771002 PMCID: PMC7414682 DOI: 10.1186/s13012-020-01017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components. The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis. Methods/design The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics. Conclusions The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs. Trial registration Clinicaltrials.gov, NCT03480217, Registered on 29 March 2018
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, 1320 York Avenue, New York, NY, 10021, USA
| | - Eileen Carter
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.,Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Andrea Duran
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
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Cheung YK, Wood D, Zhang K, Ridenour TA, Derby L, St Onge T, Duan N, Duer-Hefele J, Davidson KW, Kronish I, Moise N. Personal preferences for Personalised Trials among patients with chronic diseases: an empirical Bayesian analysis of a conjoint survey. BMJ Open 2020; 10:e036056. [PMID: 32513886 PMCID: PMC7282396 DOI: 10.1136/bmjopen-2019-036056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe individual patient preferences for Personalised Trials and to identify factors and conditions associated with patient preferences. DESIGN Each participant was presented with 18 conjoint questions via an online survey. Each question provided two choices of Personalised Trials that were defined by up to eight attributes, including treatment types, clinician involvement, study logistics and trial burden on a patient. SETTING Online survey of adults with at least two common chronic conditions in the USA. PARTICIPANTS A nationally representative sample of 501 individuals were recruited from the Chronic Illness Panel by Harris Poll Online. Participants were recruited from several sources, including emails, social media and telephone recruitment of the target population. MAIN OUTCOME MEASURES The choice of Personalised Trial design that the participant preferred with each conjoint question. RESULTS There was large variability in participants' preferences for the design of Personalised Trials. On average, they preferred certain attributes, such as a short time commitment and no cost. Notably, a population-level analysis correctly predicted 62% of the conjoint responses. An empirical Bayesian analysis of the conjoint data, which supported the estimation of individual-level preferences, improved the accuracy to 86%. Based on estimates of individual-level preferences, patients with chronic pain preferred a long study duration (p≤0.001). Asthma patients were less averse to participation burden in terms of data-collection frequency than patients with other conditions (p=0.002). Patients with hypertension were more cost-sensitive (p<0.001). CONCLUSION These analyses provide a framework for elucidating individual-level preferences when implementing novel patient-centred interventions. The data showed that patient preference in Personalised Trials is highly variable, suggesting that individual differences must be accounted for when marketing Personalised Trials. These results have implications for advancing precise interventions in Personalised Trials by indicating when rigorous scientific principles, such as frequent monitoring, is feasible in a substantial subset of patients.
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Affiliation(s)
- Ying Kuen Cheung
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Dallas Wood
- RTI International, Research Triangle Park, North Carolina, USA
| | - Kangkang Zhang
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Ty A Ridenour
- RTI International, Research Triangle Park, North Carolina, USA
| | - Lilly Derby
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Tara St Onge
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Naihua Duan
- Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Joan Duer-Hefele
- Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Karina W Davidson
- Research, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Ian Kronish
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Nathalie Moise
- Center Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
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Jannat-Khah DP, Khodneva Y, Bryant K, Ye S, Richman J, Shah R, Safford M, Moise N. Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants. Ann Epidemiol 2020; 46:31-40.e2. [PMID: 32451197 DOI: 10.1016/j.annepidem.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/30/2020] [Accepted: 04/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (</≥$35,000) moderate the association between TVDS and mortality in a large cohort. METHODS The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models. RESULTS Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]). CONCLUSIONS We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.
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Affiliation(s)
- Deanna P Jannat-Khah
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of Rheumatology, Hospital for Special Surgery, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Yulia Khodneva
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | | | - Siqin Ye
- Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY
| | - Joshua Richman
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Ravi Shah
- Columbia University Medical Center, Psychiatry Faculty Practice Organization, New York, NY
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Nathalie Moise
- Columbia University Medical Center, New York, NY; Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Kronish IM, Moise N, Cheung YK, Clarke GN, Dolor RJ, Duer-Hefele J, Margolis KL, St Onge T, Parsons F, Retuerto J, Thanataveerat A, Davidson KW. Effect of Depression Screening After Acute Coronary Syndromes on Quality of Life: The CODIACS-QoL Randomized Clinical Trial. JAMA Intern Med 2020; 180:45-53. [PMID: 31633746 PMCID: PMC6806435 DOI: 10.1001/jamainternmed.2019.4518] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Patients with acute coronary syndrome (ACS) and elevated depressive symptoms are at increased risk for recurrent cardiovascular events and mortality, worse quality of life, and higher health care costs. These observational findings prompted multiple scientific panels to advise universal depression screening in survivors of ACS prior to evidence from randomized screening trials. OBJECTIVE To determine whether systematically screening for depression in survivors of ACS improves quality of life and depression compared with usual care. DESIGN, SETTING, AND PARTICIPANTS A 3-group multisite randomized trial enrolled 1500 patients with ACS from 4 health care systems between November 1, 2013, and March 31, 2017, with follow-up ending July 31, 2018. Patients were eligible if they had been hospitalized for ACS in the previous 2 to 12 months and had no prior history of depression. All analyses were performed on an intention-to-treat basis. INTERVENTIONS Patients with ACS were randomly assigned 1:1:1 to receive (1) systematic depression screening using the 8-item Patient Health Questionnaire, with notification of primary care clinicians and provision of centralized, patient-preference, stepped depression care for those with positive screening results (8-item Patient Health Questionnaire score ≥10; screen, notify, and treat, n = 499); (2) systematic depression screening, with notification of primary care clinicians for those with positive screening results (screen and notify, n = 501); and (3) usual care (no screening, n = 500). MAIN OUTCOMES AND MEASURES The primary outcome was change in quality-adjusted life-years. The secondary outcome was depression-free days. Adverse effects and mortality were assessed by patient interview and hospital records. RESULTS A total of 1500 patients (424 women and 1076 men; mean [SD] age, 65.9 [11.5] years) were randomized in the 18-month trial. Only 71 of 1000 eligible survivors of ACS (7.1%) had elevated 8-item Patient Health Questionnaire scores indicating depressive symptoms at screening. There were no differences in mean (SD) change in quality-adjusted life-years (screen, notify and treat, -0.06 [0.20]; screen and notify, -0.06 [0.20]; no screen, -0.06 [0.18]; P = .98) or cumulative mean (SD) depression-free days (screen, notify and treat, 343.1 [179.0] days; screen and notify, 351.3 [175.0] days; no screen, 339.0 [176.6] days; P = .63). Harms including death, bleeding, or sleep difficulties did not differ among groups. CONCLUSIONS AND RELEVANCE In patients with ACS without a history of depression, systematic depression screening with or without providing depression treatment did not alter quality-adjusted life-years, depression-free days, or harms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01993017.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | | | - Rowena J Dolor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Joan Duer-Hefele
- Center for Personalized Medicine, Northwell Health, New York, New York
| | | | - Tara St Onge
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Faith Parsons
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jessica Retuerto
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, Birk JL, Brodie D, Cannone DE, Chang B, Claassen J, Cornelius T, Derby L, Dong M, Givens RC, Hochman B, Homma S, Kronish IM, Lee SA, Manzano W, Mayer LE, McMurry CL, Moitra V, Pham P, Rabbani L, Rivera RR, Schwartz A, Schwartz JE, Shapiro PA, Shaw K, Sullivan AM, Vose C, Wasson L, Edmondson D, Abdalla M. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020; 66:1-8. [PMID: 32590254 PMCID: PMC7297159 DOI: 10.1016/j.genhosppsych.2020.06.007] [Citation(s) in RCA: 564] [Impact Index Per Article: 141.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. METHODS This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th-April 24th 2020) at a large medical center in NYC (n = 657). RESULTS Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest. CONCLUSIONS NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences.
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Affiliation(s)
- Ari Shechter
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Franchesca Diaz
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - D. Edmund Anstey
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Siqin Ye
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Sachin Agarwal
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jeffrey L. Birk
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Daniel Brodie
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Diane E. Cannone
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Bernard Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Talea Cornelius
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Lilly Derby
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Melissa Dong
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Raymond C. Givens
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Beth Hochman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Shunichi Homma
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ian M. Kronish
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Sung A.J. Lee
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Wilhelmina Manzano
- NewYork-Presbyterian Hospital, New York, NY, United States of America,School of Nursing, Columbia University, New York, NY, United States of America
| | - Laurel E.S. Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Cara L. McMurry
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Vivek Moitra
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Patrick Pham
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - LeRoy Rabbani
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Reynaldo R. Rivera
- NewYork-Presbyterian Hospital, New York, NY, United States of America,School of Nursing, Columbia University, New York, NY, United States of America
| | - Allan Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, United States of America
| | - Peter A. Shapiro
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Kaitlin Shaw
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Alexandra M. Sullivan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Courtney Vose
- NewYork-Presbyterian Hospital, New York, NY, United States of America,School of Nursing, Columbia University, New York, NY, United States of America
| | - Lauren Wasson
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Donald Edmondson
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Marwah Abdalla
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America.
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46
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Moise N, Davidson KW, Cheung YKK, Clarke GN, Dolor RJ, Duer-Hefele J, Ladapo JA, Margolis KL, St Onge T, Parsons F, Retuerto J, Schmit KM, Thanataveerat A, Kronish IM. Rationale, design, and baseline data for a multicenter randomized clinical trial comparing depression screening strategies after acute coronary syndrome: The comparison of depression identification after acute Coronary Syndromes-Quality of Life and Cost Outcomes (CODIACS-QOL) trial. Contemp Clin Trials 2019; 84:105826. [PMID: 31419605 PMCID: PMC6754099 DOI: 10.1016/j.cct.2019.105826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elevated depressive symptoms among survivors of acute coronary syndromes (ACS) confer recurrent cardiovascular events and mortality, worse quality of life, and higher healthcare costs. While multiple scientific groups advise routine depression screening for ACS survivors, no randomized trials exist to inform this screening recommendation. We aimed to assess the effect of screening for depression on change in quality of life over 18 months among ACS patients. METHODS The Comparison of Depression Identification after Acute Coronary Syndrome on Quality of Life and Cost Outcomes (CODIACS-QoL) trial is a pragmatic, 3-arm trial that randomized ACS patients to 1) systematic depression screening using the 8-item Patient Health Questionnaire (PHQ-8) and if positive screen (PHQ-8 ≥ 10), notification of primary care providers (PCPs) and invitation to participate in centralized, patient-preference, stepped depression care (Screen, Notify, and Treat, N = 499); 2) systematic depression screening and PCP notification only (Screen and Notify, N = 501); and 3) usual care (No Screen, N = 500). Adults hospitalized for ACS in the previous 2-12 months without prior history of depression were eligible for participation. Key outcomes will be quality-adjusted life years (primary), cost of health care utilization, and depression-free days across 18 months. RESULTS A total of 1500 patients were randomized in the CODIACS-QOL trial (28.3% women; 16.3% Hispanic; mean age 65.9 (11.5) years). Only 7% of ACS survivors had elevated depressive symptoms. CONCLUSIONS Using a novel randomization schema and pragmatic design principles, the CODIACS-QoL trial achieved its enrollment target. Eventual results of this trial will inform future depression screening recommendations in cardiac patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT01993017).
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Affiliation(s)
- Nathalie Moise
- Columbia University Medical Center, New York, NY, United States of America.
| | | | - Ying Kuen K Cheung
- Columbia University Medical Center, New York, NY, United States of America
| | - Gregory N Clarke
- Kaiser Permanente Northwest, Portland, OR, United States of America
| | - Rowena J Dolor
- Duke Primary Care Research Consortium, Durham, NC, United States of America
| | | | - Joseph A Ladapo
- University of California Los Angeles, Los Angeles, CA, United States of America
| | | | - Tara St Onge
- Columbia University Medical Center, New York, NY, United States of America
| | - Faith Parsons
- Columbia University Medical Center, New York, NY, United States of America
| | - Jessica Retuerto
- Columbia University Medical Center, New York, NY, United States of America
| | - Kristine M Schmit
- Duke Primary Care Research Consortium, Durham, NC, United States of America
| | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, United States of America
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Fontil V, Gupta R, Moise N, Chen E, Guzman D, McCulloch CE, Bibbins-Domingo K. Adapting and Evaluating a Health System Intervention From Kaiser Permanente to Improve Hypertension Management and Control in a Large Network of Safety-Net Clinics. Circ Cardiovasc Qual Outcomes 2019; 11:e004386. [PMID: 30002140 DOI: 10.1161/circoutcomes.117.004386] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%. METHODS AND RESULTS We adapted Kaiser Permanente's evidence-based treatment protocols in a racially and ethnically diverse population at 12 safety-net clinics in the San Francisco Health Network. The intervention consisted of 4 elements: a hypertension registry, a simplified treatment intensification protocol that included fixed-dose combination medications containing diuretics, standardized BP measurement protocol, and BP check visits led by registered nurse and pharmacist staff. The study population comprised patients with hypertension who made ≥1 primary care visits within the past 24 months (n=15 917) and had a recorded BP measurement within the past 12 months. We conducted a postintervention time series analysis from August 2014 to August 2016 to assess the effect of the intervention on BP control for 24 months for the pilot site and for 15 months for 11 other San Francisco Health Network clinics combined. Secondary outcomes were changes in use of guideline-recommended medication prescribing. Rates of BP control increased at the pilot site (68%-74%; P<0.01) and the 11 other San Francisco Health Network clinic sites (69%-74%; P<0.01). Statistically significant improvements in BP control rates (P<0.01) at the 11 San Francisco Health Network clinic sites occurred in all racial and ethnic groups (blacks, 60%-66%; whites, 69%-75%; Latinos, 67%-72%; Asians, 78%-82%). Use of fixed-dose combination medications increased from 10% to 13% (P<0.01), and the percentage of angiotensin-converting enzyme inhibitor prescriptions dispensed in combination with a thiazide diuretic increased from 36% to 40% (P<0.01). CONCLUSIONS Evidence-based system approaches to improving BP control can be implemented in safety-net settings and could play a pivotal role in achieving improved population BP control and reducing hypertension disparities.
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Affiliation(s)
- Valy Fontil
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.) .,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
| | - Reena Gupta
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.)
| | - Nathalie Moise
- Department of Medicine, Columbia University Medical Center, New York, NY (N.M.)
| | - Ellen Chen
- San Francisco Department of Public Health, CA (E.C.)
| | - David Guzman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.).,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
| | | | - Kirsten Bibbins-Domingo
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital (V.F., R.G., D.G., K.B.-D.).,Department of Epidemiology and Biostatistics (C.E.M., K.B.-D.).,University of California San Francisco. UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital (V.F., D.G., K.B.-D.)
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Kronish IM, Diaz KM, Goldsmith J, Moise N, Schwartz JE. Objectively Measured Adherence to Physical Activity Guidelines After Acute Coronary Syndrome. J Am Coll Cardiol 2019; 69:1205-1207. [PMID: 28254185 DOI: 10.1016/j.jacc.2016.10.087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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Birk JL, Kronish IM, Moise N, Falzon L, Yoon S, Davidson KW. Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychol 2019; 38:802-811. [PMID: 31008648 DOI: 10.1037/hea0000737] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [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: 01/29/2023]
Abstract
OBJECTIVES Depression frequently co-occurs with multiple chronic diseases in complex, costly, and dangerous patterns of multimorbidity. The field of health psychology may benefit from evaluating the temporal characteristics of depression's associations with common diseases, and from determining whether depression is a central connector in multimorbid disease clusters. The present review addresses these issues by focusing on 4 of the most prevalent diseases: hypertension, ischemic heart disease, arthritis, and diabetes. METHOD Study 1 assessed how prior chronic disease diagnoses were associated with current depression in a large, cross-sectional, population-based study. It assessed depression's centrality using network analysis accounting for disease prevalence. Study 2 presents a systematic scoping review evaluating the extent to which depression was prospectively associated with the onset of the 4 prevalent chronic diseases. RESULTS In Study 1 depression had the fourth highest betweenness centrality ranking of 26 network nodes and centrally connected many existing diseases and unhealthy behaviors. In Study 2 depression was associated with subsequent incidence of ischemic heart disease and diabetes across multiple meta-analyses. Insufficient information was available about depression's prospective associations with incident hypertension and arthritis. CONCLUSIONS Depression is central in patterns of multimorbidity and is associated with incident disease for several of the most common chronic diseases, justifying the focus on screening and treatment of depression in those at risk for developing chronic disease. Future research should investigate the mediating and moderating roles of health behaviors in the association between depression and the staggered emergence over time of clusters of multimorbid chronic diseases. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Sunmoo Yoon
- General Medicine, Department of Medicine, Columbia University Irving Medical Center
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
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50
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Abstract
PURPOSE OF REVIEW To review issues regarding the practical implementation of screening strategies for masked hypertension. RECENT FINDINGS Masked hypertension has been associated with an increased risk of cardiovascular disease events and all-cause mortality. Recent guidelines have encouraged practitioners to use out-of-clinic monitoring to detect masked hypertension in some situations. However, it is unclear from these guidelines who should be screened or how to best measure out-of-office blood pressure. In this review, challenges to screening strategies for masked hypertension, and factors that should be considered when deciding to screen using ambulatory or home blood pressure monitoring. Masked hypertension is an important clinical phenotype to detect. Future research is needed in order to develop optimal screening strategies, and to understand population level implications of using ambulatory or home blood pressure monitoring on blood pressure control.
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Affiliation(s)
- D Edmund Anstey
- Division of Cardiology, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY, 10032, USA.
| | - Nathalie Moise
- Division of Cardiology, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY, 10032, USA
| | - Ian Kronish
- Division of Cardiology, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY, 10032, USA
| | - Marwah Abdalla
- Division of Cardiology, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH 9-310, New York, NY, 10032, USA
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