[Show abstract][Hide abstract] ABSTRACT: African American women are one of the least active demographic groups in the US, with only 36% meeting the national physical activity recommendations in comparison to 46% of White women. Physical activity begins to decline in African American women in adolescence and continues to decline into young adulthood. Yet, few interventions have been developed to promote physical activity in African American women during this critical period of life. The purpose of this article was to evaluate the acceptability and feasibility of a culturally-relevant Internet-enhanced physical activity pilot intervention for overweight/obese African American college females and to examine psychosocial and behavioral characteristics associated with intervention adherence and completion.
A 6-month single group pre-posttest design was used. Participants (n = 27) accessed a culturally-relevant Social Cognitive Theory-based physical activity promotion website while engaging in a minimum of four moderate-intensity physical activity sessions each week. Acceptability and feasibility of the intervention was assessed by participant retention and a consumer satisfaction survey completed by participants.
Fifty-six percent of participants (n = 15) completed the intervention. Study completers were more physically active at baseline (P = 0.05) and had greater social support for exercise from family members (P = 0.04). Sixty percent of study completers (n = 9) reported the website as "enjoyable" or "very enjoyable" to use and 60% (n = 9) reported increased motivation from participation in the physical activity program. Moreover, 87% (n = 13) reported they would recommend the website to a friend.
Results provide some preliminary support for the acceptability and feasibility of an Internet-enhanced physical activity program for overweight/obese African American women, while highlighting important limitations of the approach. Successful promotion of physical activity in college aged African American women as they emerge into adulthood may result in the development of life-long healthy physical activity patterns which may ultimately reduce physical activity-related health disparities in this high risk underserved population. Future studies with larger samples are needed to further explore the use of Internet-based programs to promote physical activity in this population.
BMC Research Notes 12/2015; 8(1). DOI:10.1186/s13104-015-1159-z
[Show abstract][Hide abstract] ABSTRACT: To address the low prevention and treatment rates for those at risk of glucocorticoid-induced osteoporosis (GIOP), we evaluated the influence of a direct-to-patient, Internet-based educational video intervention using "storytelling" on rates of antiosteoporosis medication use among chronic glucocorticoid users who were members of an online pharmacy refill service.
We identified members who refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 contiguous days and had no GIOP therapy for ≥ 12 months. Using patient stories, we developed an online video addressing risk factors and treatment options, and delivered it to members refilling a glucocorticoid prescription. The intervention consisted of two 45-day "Video ON" periods, during which the video automatically appeared at the time of refill, and two 45-day "Video OFF" periods, during which there was no video. Members could also "self-initiate" watching the video by going to the video link. We used an interrupted time series design to evaluate the effectiveness of this intervention on GIOP prescription therapies over 6 months.
Among 3017 members (64.8%) exposed to the intervention, 59% had measurable video viewing time, of which 3% "self-initiated" the video. The GIOP prescription rate in the "Video ON" group was 2.9% versus 2.7% for the "Video OFF" group. There was a nonsignificant trend toward greater GIOP prescription in members who self-initiated the video versus automated viewing (5.7% vs 2.9%, p = 0.1).
Among adults at high risk of GIOP, prescription rates were not significantly affected by an online educational video presented at the time of glucocorticoid refill. ClinicalTrials.gov Identifier: NCT01378689.
The Journal of Rheumatology 07/2015; 42(8). DOI:10.3899/jrheum.141238 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes.
To assess clinical operations factors' effects on normalization of uncontrolled BP.
Observational cohort study.
Patients diagnosed with hypertension from a large urban clinical practice (2005-2009).
We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians' appointment volume, overall practice-level PCP staffing, and number of unique PCPs.
Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (P<0.01) than the lowest quintile]. Practice appointment volume negatively affected the likelihood of normalization [episodes starting in months with the most appointments were associated with a 6 percentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization.
Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.
Medical care 06/2015; 53(6):480-4. DOI:10.1097/MLR.0000000000000349 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Engaging community residents and undergraduate Latino students in developing research and community literacies can expose both groups to resources needed to address health disparities. The bidirectional learning process described in this article developed these literacies through an ethnographic mapping fieldwork activity that used a learning-by-doing method in combination with reflection on the research experience. The active efforts of research team members to promote reflection on the research activities were integral for developing research and community literacies. Our findings suggest that, through participating in this field research activity, undergraduate students and community residents developed a better understanding of resources for addressing health disparities. Our research approach assisted community residents and undergraduate students by demystifying research, translating scientific and community knowledge, providing exposure to multiple literacies, and generating increased awareness of research as a tool for change among community residents and their organizations. The commitment of the community and university leadership to this pedagogical method can bring out the full potential of mentoring, both to contribute to the development of the next generation of Latino researchers and to assist community members in their efforts to address health disparities.
[Show abstract][Hide abstract] ABSTRACT: Current approaches to quantifying total posthospital complications and readmissions following surgical procedures are limited because the United States does not have a single health care payer. Patients seek posthospital care in varied locations, yet hospitals can only quantify those returning to the same facility. Seeking information directly from patients about health care utilization following hospital discharge holds promise to provide data that is missing for surgeons and health care systems.
Because total joint replacement (TJR) is the most common and costly elective surgical hospitalization, we examined the concordance between patients' self-report of potential short-term complications and their readmissions and our review of medical records in the initial hospital and surrounding facilities.
Patients undergoing primary total hip or knee replacement from July 1, 2011, through December 3, 2012, at a large site participating in a national cohort of TJR patients were identified. Patients completed a six-month postoperative survey regarding emergency department (ED), day surgery (DS), or inpatient care for possible medical or mechanical post-TJR complications. We reviewed inpatient and outpatient medical records from all regional facilities and examined the sensitivity, specificity, and positive- and negative predictive values for patient self-report and medical records.
There were 413 patients who had 431 surgeries and completed the six-month questionnaire. Patients reported 40 medical encounters (9 percent) including ED, DS or inpatient care, of which 20 percent occurred at hospitals different from the initial surgery. Review of medical records revealed 9 additional medical encounters that patients had not mentioned including five hospitalizations following surgery and four ED visits. Overall patient self-report of ED, DS, and inpatient care for possible complications was both sensitive (82 percent) and specific (100 percent). The positive predictive value was 100 percent and negative predictive value 98 percent.
Patient self-report of posthospital events was accurate. Substantial numbers of patients required care at outlying hospitals (not where the TJR occurred).
Methods that directly engage patients can augment current posthospital utilization surveillance to assure complete data.
[Show abstract][Hide abstract] ABSTRACT: Issues:In 2005, India launched three reformative healthcare policies and programs to improve Maternal and Child Health (MCH) and expand health coverage in rural areas. However, they lack strong support of evidence based findings and have failed to significantly reduce health disparities.
Description:RAHI, led by two medical students from U.S.A., is a joint effort between a charitable Indian tertiary-care hospital and an American academic institution aiming to strengthen the public healthcare system of rural western India through community-based participatory research and advocacy. Leveraging the commitment of founding institutions through funding and in-kind support, RAHI developed an international collaborative platform for faculty and students to work together and with the community to investigate the underlying causes of health disparities and develop innovative solutions. Solutions are likely to succeed when community is engaged in the research process. RAHI’s focus is guided by findings from community health needs assessment (CHNA) through a cross-sectional survey of female community members and discussions with local health ministry and key stakeholders. RAHI’s current research identifies predictors and underlying causes of poor MCH. A community-based trauma outcomes registry and surveillance program will begin in August 2014. Other key areas as identified by CHNA include type-2-diabetes-mellitus and tobacco utilization among adolescents.
Conclusion:The ongoing participation of community, students, and faculty, paired with the engagement of public officials and community stakeholders provides an innovative platform for launching evidence-based, community interventions within existing public health infrastructure. RAHI serves as a model of international and inter-institutional partnership to promote health equity in underserved populations.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: Efforts by the Indian government to improve maternal and child health (MCH) outcomes have failed to have significant impact, calling for a more evidence-based approach. This study stems from an Indo-US collaboration led by two U.S. medical students designed to address critical gaps in knowledge about the underlying causes of adverse MCH outcomes.
Methods: The pilot longitudinal study will enroll 150 pregnant women between the ages of 18-45 and spans from first trimester of a pregnancy to six months post-partum and includes eight visits at a tertiary healthcare center in rural Western India. Participants receive clinical evaluations, ultrasound imaging studies, and serum biomarker measurements. Trained research coordinators manage their visits and conduct standardized interview surveys in the local language.
Results: Currently, 86 participants are enrolled, with enrollment projected to conclude in May 2014. To date, 53 participants reported a previous pregnancy, with only half (51.6%) resulting in a live childbirth. Of the participants, 76.7% were anemic (Hgb < 12g/dL) and 41.1% were Vitamin B12 deficient (< 120 pmol/L). Only one of the 17 participants who have completed their third trimester visit was aware of the government MCH program.
Conclusions: Preliminary evidence reveals important insight into the nutritional, psychosocial, and clinical problems affecting pregnancy in rural Western India. Additionally, our findings suggest lack of patient engagement in large government-operated MCH programs. Findings from the full data set will guide future interventions to be developed by ongoing cohorts of medical students in collaboration with academic partners and the existing local public health infrastructure.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Objective
To assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms; (2) changes in depression symptoms and anxiety symptoms; and, (3) rates of mental health treatment.
Sixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Short-Form 12 (SF-12) weekly until delivery or discharge, and once postpartum.
Average length of total hospital stay was 8.3 ± 7.6 days for women who completed an initial admission survey (n = 62) and 16.3 ± 8.9 (n = 34), 25.4 ± 10.2 (n = 17) and 35 ± 10.9 days (n = 9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥ 10 in 27% (n = 17) and GAD-7 was ≥ 10 in 13% (n = 8) of participants at initial survey. Mean anxiety (4.2 ± 6.5 vs. 5.2 ± 5.1, p = 0.011) and depression (4.4 ± 5.6 vs. 6.9 ± 4.8, p = 0.011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms (OR = 4.54; 95% CI 1.91-7.17) and anxiety symptoms (OR = 5.95; 95% CI 3.04-8.86) at initial survey; however, 21% (n = 10) with no diagnostic history had EPDS ≥ 10. Five percent (n = 3) received mental health treatment during pregnancy.
Hospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥ 10, > 50% did not report a past mental health diagnosis.
General Hospital Psychiatry 11/2014; 36(6). DOI:10.1016/j.genhosppsych.2014.07.011 · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
The aim of this study was to evaluate screening questions for estimating nonsteroidal anti-inflammatory drug (NSAID) risk knowledge.
Cross-sectional data from a telephone interview of NSAID users 50 years or older from 39 physician practices in Alabama were used. Patient-reported awareness of prescription NSAID risk and health literacy were the independent variables, and a cumulative index score of objectively tested knowledge of 4 prominent NSAID risks was the dependent variable. General linearized latent and mixed model ordered logistic regression was used to estimate associations among the independent variables, covariates, and objectively tested NSAID risk knowledge. Population-averaged probabilities for levels of objectively tested NSAID risk knowledge were subsequently estimated.
Subjective awareness of any prescription NSAID risk (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.55-3.74), adequate health literacy (AOR, 1.71; 95% CI, 1.04-2.83), and physician counseling about 1 or more NSAID risks (AOR, 1.69; 95% CI, 1.09-2.61) were significantly and positively associated with NSAID risk knowledge. The probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions was 70% in the absence of any subjective risk awareness and in less than adequate health literacy. Whereas the probability of correctly answering at least 1 of the 4 NSAID risk knowledge questions increased to 86% in the presence of subjective awareness of any prescription NSAID risk and adequate health literacy.
Screening questions for subjective NSAID risk awareness and health literacy are predictive of objectively tested NSAID knowledge and can be used to triage patients as well as subsequently initiate and direct a conversation about NSAID risk.
Journal of Patient Safety 10/2014; Publish Ahead of Print. DOI:10.1097/PTS.0000000000000143 · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This research team has designed and implemented 2 culturally relevant, Internet-enhanced physical activity (PA) interventions for overweight/obese African-American female college students. Presumably, these are the only prospectively designed, culturally relevant interventions using the Internet to promote PA among African-American women. Due to the limited research on this topic, the experiences associated the design and implementation of these studies were syntesized and 5 key lessons learned from this research were formulated. Findings provide insight for researchers to consider when developing Internet-based PA promotion interventions for African-American women. Lessons learned included: 1) Elicit and incorporate feedback from the target population throughout development of an Internet-based PA promotion tool; 2) Incorporate new and emerging technologies into Internet-enhanced PA programs; 3) Maintain frequent participant contact and provide frequent incentives to promote participant engagement; 4) Supplement Internet-based efforts with face-to-face interactions; 5) Include diverse images of African-American women and culturally relevant PA-related information in Internet-based PA promotion materials.
Journal of National Black Nurses' Association: JNBNA 07/2014; 25(1):42-47.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening. OBJECTIVE:: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral). RESEARCH DESIGN:: Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG). SUBJECTS:: Women aged 65 years and older without a DXA in past 5 years. MEASURES:: DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing. RESULTS:: From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0%-24.1% self-referral vs. 4.9%-5.9% UC, P<0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared with UC (P<0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8%-3.4%) but significantly greater among self-referral versus UC in KPNW. CONCLUSIONS:: DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.
Medical Care 06/2014; 52(8). DOI:10.1097/MLR.0000000000000170 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background As the number of primary total knee arthroplasties (TKAs) performed in the United States increases, policymakers have questioned whether the indications and timing of TKA have evolved so that surgery is offered earlier. Questions/purposes We analyzed data from a US national TKA cohort to evaluate variation in surgeon selection criteria for elective unilateral TKA based on preoperative patient-reported pain and function scores. Methods Preoperative SF-36 (Physical Component Summary [PCS]/physical function) scores and Knee Injury and Osteoarthritis Outcome Score (KOOS) (pain, activities of daily living/function) of 4900 patients undergoing elective unilateral TKA enrolled in this national database of prospectively followed patients from 22 states were evaluated. The 25th, 50th, and 75th percentile pain and function scores for patients cared for in 24 orthopaedic offices with 20 or more patients in the database were compared to assess whether consistent preoperative criteria are used in selecting patients undergoing TKA across settings. Results The preoperative global function (PCS median, 32.6; national norm, 50; SD, 10) and knee-specific function (KOOS median, 51.5; maximum score, 100; SD, 17) percentile scores represented substantial patient disability, because both values approached 2 SDs below ideal. Consistency in patients across 24 surgeon offices, and more than 100 surgeons, was noted because site-specific medians varied from the national median by less than the minimum clinically important change. Conclusions These data suggest that despite the rapidly growing use of TKA, surgeons in the participating sites use consistent patient criteria in scheduling TKA. Today’s patients report significant pain and disability, supporting the need for TKA.
Clinical Orthopaedics and Related Research 06/2014; 473(1). DOI:10.1007/s11999-014-3716-5 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study evaluated a culturally relevant, social cognitive theory-based, Internet-enhanced physical activity (PA) pilot intervention developed for overweight/obese African American (AA) female college students.
Using a 3-month, single group, pretest-posttest design, participants accessed a culturally relevant PA promotion website and engaged in four moderate-intensity PA sessions each week.
Study completers (n = 25, mean age = 21.9 years) reported a decrease in sedentary screen time (p < .0001); however, no changes in moderate-to-vigorous PA were reported (p = .150). A significant increase in self-regulation for PA (p < .0001) and marginally significant increases in social support (p = .052) and outcome expectations (p = .057) for PA were observed. No changes in body mass index (p = .162), PA enjoyment (p = .151), or exercise self-efficacy (p = .086) were reported.
Findings of this exploratory study show some preliminary support for Internet-enhanced approaches to promote PA among overweight/obese AA women.
Implications for practice:
Future studies with larger samples are needed to further explore culturally relevant Internet-enhanced PA programs in this underserved population.
Journal of Transcultural Nursing 06/2014; DOI:10.1177/1043659614539176 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rationale, aims and objectivesFrequent use and serious adverse effects related to non-steroidal anti-inflammatory drugs (NSAIDs) underscore the need to raise patient awareness about potential risks. Partial success of patient- or provider-based interventions has recently led to interest in combined approaches focusing on both patient and physician. This research tested a shared decision-making intervention for increasing patient-reported awareness of NSAID risk. MethodsA group randomized trial was performed in Alabama from 2005 to 2007. Intervention group doctor practices received continuing medical education (CME) about NSAIDs and patient activation tools promoting risk assessment and communication during visits. Comparison group doctor practices received only CME. Cross-sectional data were collected before and after the intervention. Generalized linear latent and mixed models with logistic link tested relationships among the intervention, study phase, intervention by study phase interaction and patient-reported awareness of risks with either prescription or over-the-counter (OTC) NSAIDs. ResultsThree hundred and forty-seven patients at baseline and 355 patients at follow-up participated in this study. The intervention [adjusted odds ratio (AOR)=0.74, P=0.248], follow-up study phase (AOR=1.31, P=0.300) and intervention by study phase interaction (AOR=0.98, P=0.942) were not significantly associated with patient-reported awareness of any prescription NSAID risk. Follow-up study phase was associated with increased odds of reporting any OTC NSAID risk awareness (AOR=2.99, P<0.001), but the patient activation intervention and intervention by study phase interaction were not significantly associated with patient-reported awareness of any OTC NSAID risk (AOR=0.98, P=0.929; AOR=0.87, P=0.693, respectively). Conclusions
Our point-of-care intervention encouraging shared decision making did not increase NSAID risk awareness.
Journal of Evaluation in Clinical Practice 06/2014; 20(5). DOI:10.1111/jep.12193 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Much of the excessive morbidity and mortality from cardiovascular disease among African Americans results from low adherence to anti-hypertensive medications. Therefore, we examined the association between weight-based discrimination and medication adherence.
We used cross-sectional data from low-income African Americans with hypertension. Ordinal logistic regression estimated the odds of medication non-adherence in relation to weight-based discrimination adjusted for age, sex, education, income, and weight.
Of all participants (n = 780), the mean (SD) age was 53.7 (9.9) years and the mean (SD) weight was 210.1 (52.8) lbs. Reports of weight-based discrimination were frequent (28.2%). Weight-based discrimination (but not weight itself) was associated with medication non-adherence (OR: 1.94; 95% CI: 1.41-2.67). A substantial portion 38.9% (95% CI: 19.0%-79.0%) of the association between weight-based discrimination and medication non-adherence was mediated by medication self-efficacy.
Self-efficacy is a potential explanatory factor for the association between reported weight-based discrimination and medication non-adherence. Future research should develop and test interventions to prevent weight-based discrimination at the societal, provider, and institutional levels.
[Show abstract][Hide abstract] ABSTRACT: We examined pregnant women's interest in using a website or mobile application to help them gain a healthy amount of weight during pregnancy. Pregnant women (N=64) completed a short questionnaire during routine prenatal care at hospital-based obstetric clinics in [STATE] during April-August 2012. Eighty-six percent reported interest in using a website or mobile application to help them gain a healthy amount of weight; interest ranged from 67-100% across demographics, clinical characteristics, and technology use. The Internet is a promising modality for delivering interventions to prevent excessive gestational weight gain and associated maternal and child health consequences.
Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives 05/2014; 5(4). DOI:10.1016/j.srhc.2014.05.002 · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM‐15) was developed with a classic test theory approach; its short version (CTM‐3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure.
Methods and Results
As part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form‐36), CTM‐15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM‐15–, CTM‐3–, and CTM‐IRT–based score using relative validity.
Participants were 79% non‐Hispanic white and 67% male, with an average age of 62 years. The CTM‐15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded “Strongly agree” and 19% responded “Agree” to all items) and limited score variability. These problems were more pronounced for the CTM‐3. The CTM‐15 differentiated between patient groups defined by self‐reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM‐3 was not significantly lower for patients reporting rehospitalization or emergency department visits.
We identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.
Journal of the American Heart Association 04/2014; 3(3). DOI:10.1161/JAHA.114.001053 · 4.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Control rates for blood pressure (BP) are lower in African Americans despite similar or higher treatment rates compared to Whites. This study aims to identify the independent contributions of medication regimen, medication adherence, and selected psychosocial factors to BP control among low-income African American hypertensive patients.
In this cross-sectional study, 699 low-income African American hypertensive patients underwent a face-to-face interview using validated questionnaires to assess 4 measures: medication adherence, readiness for change, medication adherence self-efficacy, and participatory decision-making. The medical record was reviewed for prescribed medications and office BP. The primary outcome, BP control, was analyzed using multivariable logistic regression.
The majority of the study participants were middle-aged (53.8 ± 9.9 years) African American woman (n=505, 72.2%) with an annual income less than $12,000 (n=231, 35.5%). BP was controlled in 24% of participants, with the use of 1.9 ± 1.0 antihypertensive medications. Morisky medication adherence scores were low with more than half of participants self-reporting not taking their antihypertensive medication as prescribed. However, participants with uncontrolled and controlled BP were similar in relation to the psychosocial factors and adherence. Medication classification, on the other hand, significantly predicted BP control. Hydrochlorothiazide was prescribed in 64.8% of the controlled participants compared to 57.6% in uncontrolled participants (p<0.01).
In this cohort of low-income African Americans, prescriber practices and not patient adherence was associated with BP control. Overall BP control was very poor in our study population, and almost half of the antihypertensive medication regimens lacked a diuretic. Our findings highlight the importance of the medical regimen in controlling the BP of low-income African Americans.
UAB Health Disparities Research Symposium 2012. Integrating Social and Biological Factors in Health Disparities Research, Double Tree Hotel . 808 20th Street South . Birmingham, AL 35; 03/2014