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Bosworth, Hayden Barry

Overview:

Dr. Bosworth is a health services research and Associate Director of the Center for Health Services Research in Primary Care at the Durham VA Medical Center. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 


Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 20 trials resulting in over 250 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Positions:

Professor in Medicine

Medicine, General Internal Medicine
School of Medicine

Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences
School of Medicine

Senior Fellow in the Center for Study of Aging

Center for the Study of Aging and Human Development
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1996

Ph.D. — Pennsylvania State University

Grants:

Improving SCD Care using Web-based Guidelines, Nurse Care Managers and Peer Mentors in Primary Care and Emergency Departments in Central North Carolina

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
August 05, 2016
End Date
June 30, 2022

Urinary Stone Disease Research Network: Scientific Data Research Center

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 01, 2016
End Date
August 31, 2021

Improving Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
July 01, 2016
End Date
June 30, 2021

Disseminating NIH Evidence Based Sickle Cell Recommendations in North Carolina

Administered By
School of Nursing
AwardedBy
Agency for Healthcare Research and Quality
Role
Co Investigator
Start Date
September 30, 2016
End Date
August 31, 2020

A Self-Management Intervention for Women with Breast Cancer and Diabetes

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
American Cancer Society, Inc.
Role
Co Investigator
Start Date
July 01, 2016
End Date
June 30, 2020

Multi-factorial Intervention to Slow Progression of Diabetic Kidney Disease

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
May 15, 2013
End Date
April 30, 2018

IPA-Pamela Gentry

Administered By
Medicine, General Internal Medicine
AwardedBy
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
June 01, 2017
End Date
November 30, 2017

Integrated Population Program for Diabetic Kidney Disease

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
August 01, 2014
End Date
July 31, 2017

New Media Obesity Treatment in Community Health Centers

Administered By
Duke Global Health Institute
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
August 01, 2012
End Date
July 31, 2017

Comparing Acute Pain Management Protocols for Patients with Sickle Cell Disease

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 01, 2014
End Date
June 30, 2017

Duke Training Grant in Nephrology

Administered By
Medicine, Nephrology
AwardedBy
National Institutes of Health
Role
Preceptor
Start Date
September 20, 1995
End Date
June 30, 2017

Praluent Web-Based Content Development

Administered By
Medicine, General Internal Medicine
AwardedBy
Improved Patient Outcomes, Inc.
Role
Principal Investigator
Start Date
November 30, 2016
End Date
May 31, 2017

Developing an Oral Health Intervention for Individuals with Mild Dementia

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
August 01, 2014
End Date
July 31, 2016

Patient and Provider Interventions for Managing Osteoarthritis in Primary Care

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
July 27, 2010
End Date
June 30, 2016

IPO 1000305523

Administered By
Medicine, General Internal Medicine
AwardedBy
Improved Patient Outcomes, Inc.
Role
Principal Investigator
Start Date
September 01, 2015
End Date
June 01, 2016

Evaluating CVD Medication Adherence Program in Low SES

Administered By
Medicine, General Internal Medicine
AwardedBy
PhRMA Foundation
Role
Principal Investigator
Start Date
July 01, 2014
End Date
December 31, 2015

From Clinic to Community: Achieving Health Equity in the Southern United States

Administered By
Duke Clinical Research Institute
AwardedBy
Centers for Medicare & Medicaid Services
Role
Co Investigator
Start Date
July 01, 2012
End Date
September 30, 2015

Improving Adherence to Recommended Surveillance in Breast Cancer Survivors

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2010
End Date
August 31, 2015

Cellphone Intervention Trial for Young Adults (CITY)

Administered By
Medicine, Nephrology
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
August 15, 2009
End Date
May 31, 2015

IPA - Julie Johnson

Administered By
Medicine, General Internal Medicine
AwardedBy
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
May 01, 2013
End Date
April 30, 2014

Tailored Case Management for Diabetes and Hypertension

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
May 01, 2008
End Date
December 30, 2013

A Three-Month RCT to Sustain Weigh-Loss among Obese Persons through Tailored SMS

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co-Sponsor
Start Date
December 01, 2010
End Date
November 30, 2013

Duke Mentored CER Scholar Program

Administered By
Duke Clinical & Translational Science Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Mentor
Start Date
September 30, 2010
End Date
September 29, 2013

A Randomized, Controlled Pilot Study of an Intervention for Medication Adherence

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 29, 2009
End Date
July 31, 2012

Improving Gaucoma Medication Adherence Through Education & Community Partnership

Administered By
Ophthalmology
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 01, 2010
End Date
September 02, 2010

IPA for Pam Gentry

Administered By
Medicine, General Internal Medicine
AwardedBy
Department of Veterans Affairs
Role
Principal Investigator
Start Date
March 01, 2008
End Date
February 28, 2010

Take Control of Your Blood Pressure (TCYB) Study

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
June 01, 2003
End Date
January 31, 2010
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Publications:

Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.

A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes.Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109).10 Duke University Health System community-based primary care clinics.537 outpatients with symptomatic hip or knee osteoarthritis.The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers.The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups.No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care.The study involved 1 health care network. Data on provider referrals were not collected.Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care.National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Authors
Allen, KD; Oddone, EZ; Coffman, CJ; Jeffreys, AS; Bosworth, HB; Chatterjee, R; McDuffie, J; Strauss, JL; Yancy, WS; Datta, SK; Corsino, L; Dolor, RJ
MLA Citation
Allen, KD, Oddone, EZ, Coffman, CJ, Jeffreys, AS, Bosworth, HB, Chatterjee, R, McDuffie, J, Strauss, JL, Yancy, WS, Datta, SK, Corsino, L, and Dolor, RJ. "Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial." Annals of internal medicine 166.6 (March 2017): 401-411.
PMID
28114648
Source
epmc
Published In
Annals of internal medicine
Volume
166
Issue
6
Publish Date
2017
Start Page
401
End Page
411
DOI
10.7326/m16-1245

Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial.

To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans.Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost.Veterans Affairs Medical Center, Durham, North Carolina.Male veterans aged ≥70 years (n = 398).An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly.Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated.The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed.Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.

Authors
Cowper, PA; Peterson, MJ; Pieper, CF; Sloane, RJ; Hall, KS; McConnell, ES; Bosworth, HB; Ekelund, CC; Pearson, MP; Morey, MC
MLA Citation
Cowper, PA, Peterson, MJ, Pieper, CF, Sloane, RJ, Hall, KS, McConnell, ES, Bosworth, HB, Ekelund, CC, Pearson, MP, and Morey, MC. "Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial." Journal of the American Geriatrics Society 65.3 (March 2017): 533-539.
PMID
28152170
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
65
Issue
3
Publish Date
2017
Start Page
533
End Page
539
DOI
10.1111/jgs.14567

Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease.

Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfaction with lipid control and confidence in ability to improve it vary by gender and (2) whether sociodemographic characteristics modify the association.We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia.A total of 428 veterans (15% women) participated. Compared with men, women had higher low-density lipoprotein values at 141.2 versus 121.7 mg/dL, respectively (p < 0.05), higher health literacy, and were less likely to have someone to help track their medications (all p < 0.05). In an adjusted model, women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1-10 Likert scale (p < 0.05). There was no significant difference in confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 versus 7.2 (p < 0.05).Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.

Authors
Goldstein, KM; Stechuchak, KM; Zullig, LL; Oddone, EZ; Olsen, MK; McCant, FA; Bastian, LA; Batch, BC; Bosworth, HB
MLA Citation
Goldstein, KM, Stechuchak, KM, Zullig, LL, Oddone, EZ, Olsen, MK, McCant, FA, Bastian, LA, Batch, BC, and Bosworth, HB. "Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease." Journal of women's health (2002) (February 13, 2017).
PMID
28192012
Source
epmc
Published In
Journal of Women's Health
Publish Date
2017
DOI
10.1089/jwh.2016.5739

Medication adherence: A practical measurement selection guide using case studies.

Medication adherence is a complex problem and can be evaluated using a variety of methods. There is no single or perfect strategy to assess adherence. The "best" measure depends on contextual factors. Our objective is to provide a practical, illustrative guide for selecting the most appropriate measure of medication adherence in common contexts.We present three case studies - from the perspectives of an academic researcher, health care payer, and clinical care provider - to describe common problems and processes for measuring medication adherence, as well as proposing possible solutions.The most appropriate measure will depend on the context (tightly controlled clinical trial setting vs. clinical setting), intended purpose (research vs. clinical), available resources (data, personnel, materials, and funding), time (quick screening vs. comprehensive review), and phase of interest (initiation, implementation, or discontinuation). Framing the problem of medication non-adherence and methods for measuring adherence are discussed using three representative case studies.A simple tool is provided that may help stakeholders interested in medication adherence make decisions regarding the appropriate selection of measures.A medication adherence measure should be selected through the lens of each situation's unique objectives, resources, and needs.

Authors
Zullig, LL; Mendys, P; Bosworth, HB
MLA Citation
Zullig, LL, Mendys, P, and Bosworth, HB. "Medication adherence: A practical measurement selection guide using case studies." Patient education and counseling (February 10, 2017).
PMID
28214168
Source
epmc
Published In
Patient Education and Counseling
Publish Date
2017
DOI
10.1016/j.pec.2017.02.001

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence.

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions.

Authors
Bosworth, HB; Fortmann, SP; Kuntz, J; Zullig, LL; Mendys, P; Safford, M; Phansalkar, S; Wang, T; Rumptz, MH
MLA Citation
Bosworth, HB, Fortmann, SP, Kuntz, J, Zullig, LL, Mendys, P, Safford, M, Phansalkar, S, Wang, T, and Rumptz, MH. "Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence." Journal of general internal medicine 32.1 (January 2017): 93-100.
PMID
27599489
Source
epmc
Published In
Journal of General Internal Medicine
Volume
32
Issue
1
Publish Date
2017
Start Page
93
End Page
100
DOI
10.1007/s11606-016-3851-7

Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes

Authors
Andrews, SM; Sperber, NR; Gierisch, JM; Danus, S; Macy, SL; Bosworth, HB; Edelman, D; Crowley, MJ
MLA Citation
Andrews, SM, Sperber, NR, Gierisch, JM, Danus, S, Macy, SL, Bosworth, HB, Edelman, D, and Crowley, MJ. "Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes." Patient Preference and Adherence Volume 11 (2017): 469-478.
Source
crossref
Published In
Patient Preference and Adherence
Volume
Volume 11
Publish Date
2017
Start Page
469
End Page
478
DOI
10.2147/PPA.S125673

Colorectal Cancer Statistics From the Veterans Affairs Central Cancer Registry.

Colorectal cancer (CRC) is a common and potentially deadly disease. Although the United States has robust cancer data reporting, information from the Department of Veterans Affairs (VA) healthcare system has often been underrepresented in national cancer data sources. We describe veterans with incident CRC in terms of their patient and tumor characteristics and mortality.Patients diagnosed or treated with CRC at any VA institution in the fiscal years 2009 to 2012 were identified using 3 data sources: (1) VA Central Cancer Registry (VACCR); (2) VA Corporate Data Warehouse; and (3) VA Reports and Measures Portal. The CRC frequencies within the VA population and survival curves were examined descriptively and compared with the national projections using Surveillance, Epidemiology, and End Results program data.A total of 12,551 veterans with CRC were included in the present analysis. The median age at diagnosis was 65.5 years. Approximately 97% (n = 12,229) of the CRC cases were diagnosed among men. Approximately 44% (n = 5517) of the patients were diagnosed with localized disease. The 3-year survival rate was associated with age (P < .01) and stage (P < .01) at diagnosis. We identified a possible decrease in VA CRC incidence over time.Although the VA CRC patient population was heavily skewed toward the male gender, the patient and tumor characteristics were similar between the incident CRC cases reported by the VACCR and those reported to the Surveillance, Epidemiology, and End Results program. This suggests that research findings resulting from the VACCR might have applicability beyond the VA healthcare system setting.

Authors
Zullig, LL; Smith, VA; Jackson, GL; Danus, S; Schnell, M; Lindquist, J; Provenzale, D; Weinberger, M; Kelley, MJ; Bosworth, HB
MLA Citation
Zullig, LL, Smith, VA, Jackson, GL, Danus, S, Schnell, M, Lindquist, J, Provenzale, D, Weinberger, M, Kelley, MJ, and Bosworth, HB. "Colorectal Cancer Statistics From the Veterans Affairs Central Cancer Registry." Clinical colorectal cancer 15.4 (December 2016): e199-e204.
PMID
27301717
Source
epmc
Published In
Clinical colorectal cancer
Volume
15
Issue
4
Publish Date
2016
Start Page
e199
End Page
e204
DOI
10.1016/j.clcc.2016.04.005

A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade.

The effect of socioeconomic stressors on the incidence of cardiovascular disease (CVD) is currently open to debate. Using time-series analysis, our study aimed to evaluate the relationship between unemployment rate and hospital admission for acute myocardial infarction (AMI) and stroke in Brazil over a recent 11-year span.Data on monthly hospital admissions for AMI and stroke from March 2002 to December 2013 were extracted from the Brazilian Public Health System Database. The monthly unemployment rate was obtained from the Brazilian Institute for Applied Economic Research, during the same period. The autoregressive integrated moving average (ARIMA) model was used to test the association of temporal series. Statistical significance was set at p<0.05. From March 2002 to December 2013, 778,263 admissions for AMI and 1,581,675 for stroke were recorded. During this time period, the unemployment rate decreased from 12.9% in 2002 to 4.3% in 2013, while admissions due to AMI and stroke increased. However, the adjusted ARIMA model showed a positive association between the unemployment rate and admissions for AMI but not for stroke (estimate coefficient=2.81±0.93; p=0.003 and estimate coefficient=2.40±4.34; p=0.58, respectively).From 2002 to 2013, hospital admissions for AMI and stroke increased, whereas the unemployment rate decreased. However, the adjusted ARIMA model showed a positive association between unemployment rate and admissions due to AMI but not for stroke. Further studies are warranted to validate our findings and to better explore the mechanisms by which socioeconomic stressors, such as unemployment, might impact on the incidence of CVD.

Authors
Katz, M; Bosworth, HB; Lopes, RD; Dupre, ME; Morita, F; Pereira, C; Franco, FGM; Prado, RR; Pesaro, AE; Wajngarten, M
MLA Citation
Katz, M, Bosworth, HB, Lopes, RD, Dupre, ME, Morita, F, Pereira, C, Franco, FGM, Prado, RR, Pesaro, AE, and Wajngarten, M. "A time-series analysis of the relation between unemployment rate and hospital admission for acute myocardial infarction and stroke in Brazil over more than a decade." International journal of cardiology 224 (December 2016): 33-36.
PMID
27611915
Source
epmc
Published In
International Journal of Cardiology
Volume
224
Publish Date
2016
Start Page
33
End Page
36
DOI
10.1016/j.ijcard.2016.08.309

Statin Adherence: Does Gender Matter?

Cardiovascular disease (CVD) continues to be the leading cause of death for men and women in the USA. Statins have contributed significantly to noted declines in cardiovascular-related mortality in the last decade; however, the benefit of statins is inequitable across genders. Women continue to be less likely to take statins and to meet target LDL goals than men. As a possible contributing factor to this disparity, we explore the evidence for gender-based differences in provision of, and adherence to statins.Compared with men, women are less likely to adhere to statins. Potential reasons for this gender difference in use of statins can be observed across all phases of adherence including both intentional and unintentional non-adherence. Notable gender-specific contributing factors for statin non-adherence include decreased provider and patient awareness of CVD risk among women, higher risk of statin intolerance among women, and competing demands associated with family caregiving responsibilities. Similar to limitations in the broader CVD literature, there is inadequate inclusion of gender-specific analyses in statin-related trials. Gender-based disparities in statin adherence can be linked to both provider level, psychosocial, and medication intolerance factors. Interventions designed to improve statin adherence should take gender-specific challenges into consideration such as women being older at the time of increased CVD risk, higher rates of statin intolerance, and potentially greater caregiving responsibilities.

Authors
Goldstein, KM; Zullig, LL; Bastian, LA; Bosworth, HB
MLA Citation
Goldstein, KM, Zullig, LL, Bastian, LA, and Bosworth, HB. "Statin Adherence: Does Gender Matter?." Current atherosclerosis reports 18.11 (November 2016): 63-.
PMID
27696318
Source
epmc
Published In
Current Atherosclerosis Reports
Volume
18
Issue
11
Publish Date
2016
Start Page
63

Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder

Authors
Hall, KS; Gregg, J; Bosworth, HB; Beckham, JC; Hoerster, KD; Sloane, R; Morey, MC
MLA Citation
Hall, KS, Gregg, J, Bosworth, HB, Beckham, JC, Hoerster, KD, Sloane, R, and Morey, MC. "Physical activity counseling promotes physical and psychological resilience in older veterans with posttraumatic stress disorder." Mental Health and Physical Activity 11 (October 2016): 53-59.
Source
crossref
Published In
Mental Health and Physical Activity
Volume
11
Publish Date
2016
Start Page
53
End Page
59
DOI
10.1016/j.mhpa.2016.10.001

Urinary Incontinence and Health-Seeking Behavior Among White, Black, and Latina Women.

Fewer than half of women with urinary incontinence (UI) seek care for their condition. Our objective was to qualitatively assess the themes surrounding treatment-seeking behaviors.We conducted 12 focus groups with women and, using purposive sampling, we stratified by racial or ethnic group (white, black, Latina) and by UI frequency. All sessions were transcribed and coded for common themes. Comparative thematic analysis was used to describe similarities and differences among groups.In total, 113 (39 white, 41 black, and 33 Latina) community-dwelling women participated in focus groups. There were no differences in treatment-seeking themes between groups with different UI frequency. However, certain themes emerged when comparing racial/ethnic groups. Women from all groups shared experiences of embarrassment and isolation because of UI, which were impediments to care seeking. White and black women described discussions with close friends or family that led to normalization of symptoms and prevented care seeking. Latina women maintained more secrecy about UI and reported the longest delays in seeking care. Women articulated a higher likelihood of seeking care if they had knowledge of treatment options, but white women were more likely to seek UI-related knowledge compared with black or Latina women. Physician communication barriers were identified in all groups.Despite similar experiences, there are different perceptions about care seeking among white, black, and Latina women. Culturally relevant educational resources that focus on a range of treatment options may improve knowledge and thus improve care-seeking behaviors in women with UI.

Authors
Siddiqui, NY; Ammarell, N; Wu, JM; Sandoval, JS; Bosworth, HB
MLA Citation
Siddiqui, NY, Ammarell, N, Wu, JM, Sandoval, JS, and Bosworth, HB. "Urinary Incontinence and Health-Seeking Behavior Among White, Black, and Latina Women." Female pelvic medicine & reconstructive surgery 22.5 (September 2016): 340-345.
PMID
27171320
Source
epmc
Published In
Female Pelvic Medicine and Reconstructive Surgery
Volume
22
Issue
5
Publish Date
2016
Start Page
340
End Page
345
DOI
10.1097/spv.0000000000000286

Open-label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics.

Despite the availability of efficacious treatments, only half of patients with hypertension achieve adequate blood pressure (BP) control. This paper describes the protocol and baseline subject characteristics of a 2-arm, 18-month randomized clinical trial of titrated disease management (TDM) for patients with pharmaceutically-treated hypertension for whom systolic blood pressure (SBP) is not controlled (≥140mmHg for non-diabetic or ≥130mmHg for diabetic patients). The trial is being conducted among patients of four clinic locations associated with a Veterans Affairs Medical Center. An intervention arm has a TDM strategy in which patients' hypertension control at baseline, 6, and 12months determines the resource intensity of disease management. Intensity levels include: a low-intensity strategy utilizing a licensed practical nurse to provide bi-monthly, non-tailored behavioral support calls to patients whose SBP comes under control; medium-intensity strategy utilizing a registered nurse to provide monthly tailored behavioral support telephone calls plus home BP monitoring; and high-intensity strategy utilizing a pharmacist to provide monthly tailored behavioral support telephone calls, home BP monitoring, and pharmacist-directed medication management. Control arm patients receive the low-intensity strategy regardless of BP control. The primary outcome is SBP. There are 385 randomized (192 intervention; 193 control) veterans that are predominately older (mean age 63.5years) men (92.5%). 61.8% are African American, and the mean baseline SBP for all subjects is 143.6mmHg. This trial will determine if a disease management program that is titrated by matching the intensity of resources to patients' BP control leads to superior outcomes compared to a low-intensity management strategy.

Authors
Jackson, GL; Weinberger, M; Kirshner, MA; Stechuchak, KM; Melnyk, SD; Bosworth, HB; Coffman, CJ; Neelon, B; Van Houtven, C; Gentry, PW; Morris, IJ; Rose, CM; Taylor, JP; May, CL; Han, B; Wainwright, C; Alkon, A; Powell, L; Edelman, D
MLA Citation
Jackson, GL, Weinberger, M, Kirshner, MA, Stechuchak, KM, Melnyk, SD, Bosworth, HB, Coffman, CJ, Neelon, B, Van Houtven, C, Gentry, PW, Morris, IJ, Rose, CM, Taylor, JP, May, CL, Han, B, Wainwright, C, Alkon, A, Powell, L, and Edelman, D. "Open-label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics." Contemporary clinical trials 50 (September 2016): 5-15.
PMID
27417982
Source
epmc
Published In
Contemporary Clinical Trials
Volume
50
Publish Date
2016
Start Page
5
End Page
15
DOI
10.1016/j.cct.2016.07.009

Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill.

Glaucoma medications reduce the risk of progressive visual field loss, but adherence to these medications is often poor. A better understanding of the appropriate metrics for quantifying glaucoma medication adherence is needed. We describe and compare different means of quantifying glaucoma medication adherence.Adults with glaucoma were enrolled in a prospective 2-site study. Participants completed a self-report instrument and received electronic medication monitors to use for ∼3 months. Pharmacy records were queried regarding requested refills over the monitoring period; medication possession ratio (MPR) was calculated.Of the 137 total participants, those who answered "Very confident" to the question, "How confident are you that you always remember to use your glaucoma medications?" and "No" to the question, "In the past 4 weeks, did you ever forget to take your medicine?" were more likely [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.19-6.52] to take ≥80% of the prescribed doses according to electronic medication monitors. Mean MPR was 1.49, standard deviation (SD) 0.82, range 0.1-5.31. The proportion of participants taking greater than or equal to 80% of the prescribed doses according to the electronic monitors was 59% for participants with MPR <1.2 (n = 27), 63% for participants with MPR 1.2-1.8 (n = 27), and 88% for MPR >1.8 (n = 25).Asking about confidence may be a good method of screening for poor adherence for glaucoma medication. MPR may be an inadequate representation of glaucoma medication adherence.

Authors
Kumar, JB; Bosworth, HB; Sleath, B; Woolson, S; Olsen, M; Danus, S; Muir, KW
MLA Citation
Kumar, JB, Bosworth, HB, Sleath, B, Woolson, S, Olsen, M, Danus, S, and Muir, KW. "Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill." Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics 32.6 (July 2016): 346-354.
PMID
27058842
Source
epmc
Published In
Journal of Ocular Pharmacology and Therapeutics
Volume
32
Issue
6
Publish Date
2016
Start Page
346
End Page
354
DOI
10.1089/jop.2015.0102

Consideration of Out-of-Office Blood Pressure Monitoring in Hypertension Management.

Authors
Goldstein, KM; Zullig, LL; Bosworth, HB; Oddone, EZ
MLA Citation
Goldstein, KM, Zullig, LL, Bosworth, HB, and Oddone, EZ. "Consideration of Out-of-Office Blood Pressure Monitoring in Hypertension Management." Journal of clinical hypertension (Greenwich, Conn.) 18.5 (May 2016): 381-382.
PMID
26541118
Source
epmc
Published In
Journal of Clinical Hypertension
Volume
18
Issue
5
Publish Date
2016
Start Page
381
End Page
382
DOI
10.1111/jch.12729

Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial.

Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment.We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure.At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups.A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.

Authors
Crowley, MJ; Edelman, D; McAndrew, AT; Kistler, S; Danus, S; Webb, JA; Zanga, J; Sanders, LL; Coffman, CJ; Jackson, GL; Bosworth, HB
MLA Citation
Crowley, MJ, Edelman, D, McAndrew, AT, Kistler, S, Danus, S, Webb, JA, Zanga, J, Sanders, LL, Coffman, CJ, Jackson, GL, and Bosworth, HB. "Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial." Telemedicine journal and e-health : the official journal of the American Telemedicine Association 22.5 (May 2016): 376-384.
PMID
26540163
Source
epmc
Published In
Telemedicine Journal and e-Health
Volume
22
Issue
5
Publish Date
2016
Start Page
376
End Page
384
DOI
10.1089/tmj.2015.0145

Health beliefs and desire to improve cholesterol levels among patients with hyperlipidemia.

Because hyperlipidemia is asymptomatic, many veterans affairs (VA) patients may not perceive it seriously. We assessed key Health Belief model concepts to describe patients' cholesterol-related health beliefs and examine associations between patient-level factors and desire to improve cholesterol control.We used baseline data from an ongoing randomized clinical trial. Eligible patients were receiving care at the Durham VA and had CVD risk-total cholesterol levels >130 mg/dL and/or <80% medication adherence in the previous 12 months. A survey assessed patients' health beliefs about high cholesterol and self-reported medication adherence. Multivariable logistic regression examined whether there was an association between desire to control cholesterol and cholesterol status.Approximately 64% (n=155) of patients perceived high cholesterol as 'very serious'. In multivariable logistic regression analysis, patients who perceived high cholesterol as 'very serious' (OR 2. 26, p=0.032) and/or with high self-efficacy (OR 4.70, p<0.001) had increased odds of desiring cholesterol control.The factors most significantly associated with desire to improve cholesterol control were perceiving hyperlipidemia as 'very serious and self-efficacy for cholesterol control.Educating patients, with the goal of appropriately increasing their perceived risk of disease, is likely necessary to impact cholesterol control.

Authors
Zullig, LL; Sanders, LL; Thomas, S; Brown, JN; Danus, S; McCant, F; Bosworth, HB
MLA Citation
Zullig, LL, Sanders, LL, Thomas, S, Brown, JN, Danus, S, McCant, F, and Bosworth, HB. "Health beliefs and desire to improve cholesterol levels among patients with hyperlipidemia." Patient education and counseling 99.5 (May 2016): 830-835.
PMID
26673107
Source
epmc
Published In
Patient Education and Counseling
Volume
99
Issue
5
Publish Date
2016
Start Page
830
End Page
835
DOI
10.1016/j.pec.2015.11.025

Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial.

Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA).This trial compared group-based versus individual physical therapy interventions for management of knee OA.Three hundred twenty patients with knee OA at the VA Medical Center in Durham, North Carolina, (mean age=60 years, 88% male, 58% nonwhite) were randomly assigned to receive either the group intervention (group physical therapy; six 1-hour sessions, typically 8 participants per group) or the individual intervention (individual physical therapy; two 1-hour sessions). Both programs included instruction in home exercise, joint protection techniques, and individual physical therapist evaluation. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range=0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks, and 24 weeks. The secondary outcome measure was the Short Physical Performance Battery (SPPB; range=0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed models assessed the difference in WOMAC scores between arms.At 12 weeks, WOMAC scores were 2.7 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% confidence interval [CI]=-5.9, 0.5; P=.10), indicating no between-group difference. At 24 weeks, WOMAC scores were 1.3 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-4.6, 2.0; P=.44), indicating no significant between-group difference. At 12 weeks, SPPB scores were 0.1 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-0.5, 0.2; P=.53), indicating no difference between groups.This study was conducted in one VA medical center. Outcome assessors were blinded, but participants and physical therapists were not blinded.Group physical therapy was not more effective than individual physical therapy for primary and secondary study outcomes. Either group physical therapy or individual physical therapy may be a reasonable delivery model for health care systems to consider.

Authors
Allen, KD; Bongiorni, D; Bosworth, HB; Coffman, CJ; Datta, SK; Edelman, D; Hall, KS; Lindquist, JH; Oddone, EZ; Hoenig, H
MLA Citation
Allen, KD, Bongiorni, D, Bosworth, HB, Coffman, CJ, Datta, SK, Edelman, D, Hall, KS, Lindquist, JH, Oddone, EZ, and Hoenig, H. "Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial." Physical therapy 96.5 (May 2016): 597-608.
PMID
26586865
Source
epmc
Published In
Physical Therapy
Volume
96
Issue
5
Publish Date
2016
Start Page
597
End Page
608
DOI
10.2522/ptj.20150194

Mobile health devices: will patients actually use them?

Although mobile health (mHealth) devices offer a unique opportunity to capture patient health data remotely, it is unclear whether patients will consistently use multiple devices simultaneously and/or if chronic disease affects adherence. Three healthy and three chronically ill participants were recruited to provide data on 11 health indicators via four devices and a diet app. The healthy participants averaged overall weekly use of 76%, compared to 16% for those with chronic illnesses. Device adherence declined across all participants during the study. Patients with chronic illnesses, with arguably the most to benefit from advanced (or increased) monitoring, may be less likely to adopt and use these devices compared to healthy individuals. Results suggest device fatigue may be a significant problem. Use of mobile technologies may have the potential to transform care delivery across populations and within individuals over time. However, devices may need to be tailored to meet the specific patient needs.

Authors
Shaw, RJ; Steinberg, DM; Bonnet, J; Modarai, F; George, A; Cunningham, T; Mason, M; Shahsahebi, M; Grambow, SC; Bennett, GG; Bosworth, HB
MLA Citation
Shaw, RJ, Steinberg, DM, Bonnet, J, Modarai, F, George, A, Cunningham, T, Mason, M, Shahsahebi, M, Grambow, SC, Bennett, GG, and Bosworth, HB. "Mobile health devices: will patients actually use them?." Journal of the American Medical Informatics Association : JAMIA 23.3 (May 2016): 462-466.
PMID
26911820
Source
epmc
Published In
Journal of American Medical Informatics Association
Volume
23
Issue
3
Publish Date
2016
Start Page
462
End Page
466
DOI
10.1093/jamia/ocv186

Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.

Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings.Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months.Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression.Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.

Authors
Foley, P; Steinberg, D; Levine, E; Askew, S; Batch, BC; Puleo, EM; Svetkey, LP; Bosworth, HB; DeVries, A; Miranda, H; Bennett, GG
MLA Citation
Foley, P, Steinberg, D, Levine, E, Askew, S, Batch, BC, Puleo, EM, Svetkey, LP, Bosworth, HB, DeVries, A, Miranda, H, and Bennett, GG. "Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients." Contemporary clinical trials 48 (May 2016): 12-20.
PMID
26995281
Source
epmc
Published In
Contemporary Clinical Trials
Volume
48
Publish Date
2016
Start Page
12
End Page
20
DOI
10.1016/j.cct.2016.03.006

Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management.

Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications.

Authors
Crowley, MJ; Olsen, MK; Woolson, SL; King, HA; Oddone, EZ; Bosworth, HB
MLA Citation
Crowley, MJ, Olsen, MK, Woolson, SL, King, HA, Oddone, EZ, and Bosworth, HB. "Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management." Journal of clinical hypertension (Greenwich, Conn.) 18.4 (April 2016): 322-328.
PMID
26370918
Source
epmc
Published In
Journal of Clinical Hypertension
Volume
18
Issue
4
Publish Date
2016
Start Page
322
End Page
328
DOI
10.1111/jch.12669

Erratum: Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology.

Authors
Svetkey, LP; Batch, BC; Lin, P-H; Intille, SS; Corsino, L; Tyson, CC; Bosworth, HB; Grambow, SC; Voils, C; Loria, C; Gallis, JA; Schwager, J; Bennett, GG
MLA Citation
Svetkey, LP, Batch, BC, Lin, P-H, Intille, SS, Corsino, L, Tyson, CC, Bosworth, HB, Grambow, SC, Voils, C, Loria, C, Gallis, JA, Schwager, J, and Bennett, GG. "Erratum: Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology." Obesity (Silver Spring, Md.) 24.2 (February 2016): 536-.
PMID
26813533
Source
epmc
Published In
Obesity (Silver Spring, Md.)
Volume
24
Issue
2
Publish Date
2016
Start Page
536
DOI
10.1002/oby.21433

Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis.

Authors
Zullig, LL; Smith, V; Danus, S; Schnell, M; Lindquist, J; Provenzale, DT; Jackson, GL; Weinberger, M; Kelley, MJ; Bosworth, HB
MLA Citation
Zullig, LL, Smith, V, Danus, S, Schnell, M, Lindquist, J, Provenzale, DT, Jackson, GL, Weinberger, M, Kelley, MJ, and Bosworth, HB. "Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis." January 20, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
3
Publish Date
2016

A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial.

Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740).Department of Veterans Affairs Medical Center in Durham, North Carolina.30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, -7.2 to -1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, -5.7 to -1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.The study was conducted in a single Veterans Affairs medical center.The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.Department of Veterans Affairs, Health Services Research and Development Service.

Authors
Allen, KD; Yancy, WS; Bosworth, HB; Coffman, CJ; Jeffreys, AS; Datta, SK; McDuffie, J; Strauss, JL; Oddone, EZ
MLA Citation
Allen, KD, Yancy, WS, Bosworth, HB, Coffman, CJ, Jeffreys, AS, Datta, SK, McDuffie, J, Strauss, JL, and Oddone, EZ. "A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial." Annals of internal medicine 164.2 (January 2016): 73-83.
PMID
26720751
Source
epmc
Published In
Annals of internal medicine
Volume
164
Issue
2
Publish Date
2016
Start Page
73
End Page
83
DOI
10.7326/m15-0378

Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain.The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT.We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence.The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed.To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

Authors
Bosworth, HB; Zullig, LL; Mendys, P; Ho, M; Trygstad, T; Granger, C; Oakes, MM; Granger, BB
MLA Citation
Bosworth, HB, Zullig, LL, Mendys, P, Ho, M, Trygstad, T, Granger, C, Oakes, MM, and Granger, BB. "Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence." JMIR medical informatics 4.1 (January 2016): e9-.
PMID
26980270
Source
epmc
Published In
JMIR Medical Informatics
Volume
4
Issue
1
Publish Date
2016
Start Page
e9
DOI
10.2196/medinform.4326

Behavioral sciences in clinical practice.

Authors
Katz, M; Bosworth, HB
MLA Citation
Katz, M, and Bosworth, HB. "Behavioral sciences in clinical practice." Einstein (Sao Paulo, Brazil) 14.1 (January 2016): vii-xiv.
PMID
27074243
Source
epmc
Published In
Einstein (S�o Paulo, Brazil)
Volume
14
Issue
1
Publish Date
2016
Start Page
vii
End Page
xiv
DOI
10.1590/s1679-45082016ed3647

A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.

Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields.The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science.From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence.

Authors
Zullig, LL; Granger, BB; Bosworth, HB
MLA Citation
Zullig, LL, Granger, BB, and Bosworth, HB. "A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States." Patient preference and adherence 10 (January 2016): 1189-1195.
PMID
27462145
Source
epmc
Published In
Patient Preference and Adherence
Volume
10
Publish Date
2016
Start Page
1189
End Page
1195
DOI
10.2147/ppa.s100844

Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model.

The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education. Among 6,768 patients with diabetes receiving care over 4 years, hemoglobin A1c levels remained stable during the 2-year pre-intervention and post-intervention periods (0.03% and 0% increases, respectively), compared to a 0.42% increase expected based on A1c progression observed in the United Kingdom Prospective Diabetes Study long-term outcomes cohort. The results indicate that an EHR-enabled, team- based, and scalable population health strategy based on the CCM may be effective and efficient for managing population health.

Authors
Kawamoto, K; Anstrom, KJ; Anderson, JB; Bosworth, HB; Lobach, DF; McAdam-Marx, C; Ferranti, JM; Shang, H; Yarnall, KSH
MLA Citation
Kawamoto, K, Anstrom, KJ, Anderson, JB, Bosworth, HB, Lobach, DF, McAdam-Marx, C, Ferranti, JM, Shang, H, and Yarnall, KSH. "Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model." AMIA .. Annual Symposium proceedings. AMIA Symposium 2016 (January 2016): 686-695.
PMID
28269865
Source
epmc
Published In
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
Volume
2016
Publish Date
2016
Start Page
686
End Page
695

Lessons Learned From Implementing Health Coaching in The Heart Healthy Lenoir Hypertension Study

Authors
Donahue, KE; Tillman, J; Halladay, JR; Cené, CW; Hinderliter, A; Cummings, DM; Miller, C; Gizlice, Z; Garcia, BA; Wu, J-R; Quenum, E; Bosworth, HB; Keyserling, TC; DeWalt, D
MLA Citation
Donahue, KE, Tillman, J, Halladay, JR, Cené, CW, Hinderliter, A, Cummings, DM, Miller, C, Gizlice, Z, Garcia, BA, Wu, J-R, Quenum, E, Bosworth, HB, Keyserling, TC, and DeWalt, D. "Lessons Learned From Implementing Health Coaching in The Heart Healthy Lenoir Hypertension Study." Progress in Community Health Partnerships: Research, Education, and Action 10.4 (2016): 559-567.
Source
crossref
Published In
Progress in Community Health Partnerships: Research, Education, and Action
Volume
10
Issue
4
Publish Date
2016
Start Page
559
End Page
567
DOI
10.1353/cpr.2016.0064

Adaptive intervention design in mobile health: Intervention design and development in the Cell Phone Intervention for You trial.

The obesity epidemic has spread to young adults, and obesity is a significant risk factor for cardiovascular disease. The prominence and increasing functionality of mobile phones may provide an opportunity to deliver longitudinal and scalable weight management interventions in young adults. The aim of this article is to describe the design and development of the intervention tested in the Cell Phone Intervention for You study and to highlight the importance of adaptive intervention design that made it possible. The Cell Phone Intervention for You study was a National Heart, Lung, and Blood Institute-sponsored, controlled, 24-month randomized clinical trial comparing two active interventions to a usual-care control group. Participants were 365 overweight or obese (body mass index≥25 kg/m2) young adults.Both active interventions were designed based on social cognitive theory and incorporated techniques for behavioral self-management and motivational enhancement. Initial intervention development occurred during a 1-year formative phase utilizing focus groups and iterative, participatory design. During the intervention testing, adaptive intervention design, where an intervention is updated or extended throughout a trial while assuring the delivery of exactly the same intervention to each cohort, was employed. The adaptive intervention design strategy distributed technical work and allowed introduction of novel components in phases intended to help promote and sustain participant engagement. Adaptive intervention design was made possible by exploiting the mobile phone's remote data capabilities so that adoption of particular application components could be continuously monitored and components subsequently added or updated remotely.The cell phone intervention was delivered almost entirely via cell phone and was always-present, proactive, and interactive-providing passive and active reminders, frequent opportunities for knowledge dissemination, and multiple tools for self-tracking and receiving tailored feedback. The intervention changed over 2 years to promote and sustain engagement. The personal coaching intervention, alternatively, was primarily personal coaching with trained coaches based on a proven intervention, enhanced with a mobile application, but where all interactions with the technology were participant-initiated.The complexity and length of the technology-based randomized clinical trial created challenges in engagement and technology adaptation, which were generally discovered using novel remote monitoring technology and addressed using the adaptive intervention design. Investigators should plan to develop tools and procedures that explicitly support continuous remote monitoring of interventions to support adaptive intervention design in long-term, technology-based studies, as well as developing the interventions themselves.

Authors
Lin, P-H; Intille, S; Bennett, G; Bosworth, HB; Corsino, L; Voils, C; Grambow, S; Lazenka, T; Batch, BC; Tyson, C; Svetkey, LP
MLA Citation
Lin, P-H, Intille, S, Bennett, G, Bosworth, HB, Corsino, L, Voils, C, Grambow, S, Lazenka, T, Batch, BC, Tyson, C, and Svetkey, LP. "Adaptive intervention design in mobile health: Intervention design and development in the Cell Phone Intervention for You trial." Clinical trials (London, England) 12.6 (December 2015): 634-645.
Website
http://hdl.handle.net/10161/10740
PMID
26229119
Source
epmc
Published In
Clinical Trials
Volume
12
Issue
6
Publish Date
2015
Start Page
634
End Page
645
DOI
10.1177/1740774515597222

Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology.

To determine the effect on weight of two mobile technology-based (mHealth) behavioral weight loss interventions in young adults.Randomized, controlled comparative effectiveness trial in 18- to 35-year-olds with BMI ≥ 25 kg/m(2) (overweight/obese), with participants randomized to 24 months of mHealth intervention delivered by interactive smartphone application on a cell phone (CP); personal coaching enhanced by smartphone self-monitoring (PC); or Control.The 365 randomized participants had mean baseline BMI of 35 kg/m(2) . Final weight was measured in 86% of participants. CP was not superior to Control at any measurement point. PC participants lost significantly more weight than Controls at 6 months (net effect -1.92 kg [CI -3.17, -0.67], P = 0.003), but not at 12 and 24 months.Despite high intervention engagement and study retention, the inclusion of behavioral principles and tools in both interventions, and weight loss in all treatment groups, CP did not lead to weight loss, and PC did not lead to sustained weight loss relative to Control. Although mHealth solutions offer broad dissemination and scalability, the CITY results sound a cautionary note concerning intervention delivery by mobile applications. Effective intervention may require the efficiency of mobile technology, the social support and human interaction of personal coaching, and an adaptive approach to intervention design.

Authors
Svetkey, LP; Batch, BC; Lin, P-H; Intille, SS; Corsino, L; Tyson, CC; Bosworth, HB; Grambow, SC; Voils, C; Loria, C; Gallis, JA; Schwager, J; Bennett, GG
MLA Citation
Svetkey, LP, Batch, BC, Lin, P-H, Intille, SS, Corsino, L, Tyson, CC, Bosworth, HB, Grambow, SC, Voils, C, Loria, C, Gallis, JA, Schwager, J, and Bennett, GG. "Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology." Obesity (Silver Spring, Md.) 23.11 (November 2015): 2133-2141.
PMID
26530929
Source
epmc
Published In
Obesity (Silver Spring, Md.)
Volume
23
Issue
11
Publish Date
2015
Start Page
2133
End Page
2141
DOI
10.1002/oby.21226

Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy.

To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors.Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one's doses or stopping medication, and unintentional, such as forgetting to take one's medication, non-adherent behaviors.Participants were 112 women: mean age 64 (SD = 9) years; 81% white; mean time from surgery 40 (SD = 28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD = 29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p = 0.002) and intentional (p = 0.004) non-adherent behaviors. The presence of symptoms (p = 0.03) and lower self-efficacy for physician communication (p = 0.009) were associated with higher levels of intentional non-adherent behaviors.These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.

Authors
Kimmick, G; Edmond, SN; Bosworth, HB; Peppercorn, J; Marcom, PK; Blackwell, K; Keefe, FJ; Shelby, RA
MLA Citation
Kimmick, G, Edmond, SN, Bosworth, HB, Peppercorn, J, Marcom, PK, Blackwell, K, Keefe, FJ, and Shelby, RA. "Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy." Breast (Edinburgh, Scotland) 24.5 (October 2015): 630-636.
PMID
26189978
Source
epmc
Published In
The Breast
Volume
24
Issue
5
Publish Date
2015
Start Page
630
End Page
636
DOI
10.1016/j.breast.2015.06.010

Individual patient data meta-analysis of self-monitoring of blood pressure (BP-SMART)

Authors
Tucker, KL; Sheppard, JP; Stevens, R; Bosworth, HB; Bove, A; Bray, EP; Godwin, M; Green, B; Hebert, P; Hobbs, FDR; Kantola, I; Kerry, S; Magid, DJ; Mant, J; Margolis, KL; McKinstry, B; Omboni, S; Ogedegbe, O; Parati, G; Qamar, N; Varis, J; Verberk, W; Wakefield, BJ; McManus, RJ
MLA Citation
Tucker, KL, Sheppard, JP, Stevens, R, Bosworth, HB, Bove, A, Bray, EP, Godwin, M, Green, B, Hebert, P, Hobbs, FDR, Kantola, I, Kerry, S, Magid, DJ, Mant, J, Margolis, KL, McKinstry, B, Omboni, S, Ogedegbe, O, Parati, G, Qamar, N, Varis, J, Verberk, W, Wakefield, BJ, and McManus, RJ. "Individual patient data meta-analysis of self-monitoring of blood pressure (BP-SMART)." JOURNAL OF HUMAN HYPERTENSION 29.10 (October 2015): 635-635.
Source
wos-lite
Published In
Journal of Human Hypertension
Volume
29
Issue
10
Publish Date
2015
Start Page
635
End Page
635

Individual patient data meta-analysis of self-monitoring of blood pressure (BP-SMART): a protocol.

Self-monitoring of blood pressure is effective in reducing blood pressure in hypertension. However previous meta-analyses have shown a considerable amount of heterogeneity between studies, only part of which can be accounted for by meta-regression. This may be due to differences in design, recruited populations, intervention components or results among patient subgroups. To further investigate these differences, an individual patient data (IPD) meta-analysis of self-monitoring of blood pressure will be performed.We will identify randomised trials that have compared patients with hypertension who are self-monitoring blood pressure with those who are not and invite trialists to provide IPD including clinic and/or ambulatory systolic and diastolic blood pressure at baseline and all follow-up points where both intervention and control groups were measured. Other data requested will include measurement methodology, length of follow-up, cointerventions, baseline demographic (age, gender) and psychosocial factors (deprivation, quality of life), setting, intensity of self-monitoring, self-monitored blood pressure, comorbidities, lifestyle factors (weight, smoking) and presence or not of antihypertensive treatment. Data on all available patients will be included in order to take an intention-to-treat approach. A two-stage procedure for IPD meta-analysis, stratified by trial and taking into account age, sex, diabetes and baseline systolic BP will be used. Exploratory subgroup analyses will further investigate non-linear relationships between the prespecified variables. Sensitivity analyses will assess the impact of trials which have and have not provided IPD.This study does not include identifiable data. Results will be disseminated in a peer-reviewed publication and by international conference presentations.IPD analysis should help the understanding of which self-monitoring interventions for which patient groups are most effective in the control of blood pressure.

Authors
Tucker, KL; Sheppard, JP; Stevens, R; Bosworth, HB; Bove, A; Bray, EP; Godwin, M; Green, B; Hebert, P; Hobbs, FDR; Kantola, I; Kerry, S; Magid, DJ; Mant, J; Margolis, KL; McKinstry, B; Omboni, S; Ogedegbe, O; Parati, G; Qamar, N; Varis, J; Verberk, W; Wakefield, BJ; McManus, RJ
MLA Citation
Tucker, KL, Sheppard, JP, Stevens, R, Bosworth, HB, Bove, A, Bray, EP, Godwin, M, Green, B, Hebert, P, Hobbs, FDR, Kantola, I, Kerry, S, Magid, DJ, Mant, J, Margolis, KL, McKinstry, B, Omboni, S, Ogedegbe, O, Parati, G, Qamar, N, Varis, J, Verberk, W, Wakefield, BJ, and McManus, RJ. "Individual patient data meta-analysis of self-monitoring of blood pressure (BP-SMART): a protocol." BMJ open 5.9 (September 15, 2015): e008532-.
PMID
26373404
Source
epmc
Published In
BMJ Open
Volume
5
Issue
9
Publish Date
2015
Start Page
e008532
DOI
10.1136/bmjopen-2015-008532

Willingness of Patients to Use Computers for Health Communication and Monitoring Following Myocardial Infarction.

We describe the computer use characteristics of 406 post-myocardial infarction (MI) patients and their willingness to engage online for health communication and monitoring. Most participants were computer users (n = 259; 63.8%) and half (n = 209; 51.5%) read health information online at least monthly. However, most participants did not go online to track health conditions (n = 283; 69.7%), look at medical records (n = 287; 70.7%), or e-mail doctors (n = 351; 86.5%). Most participants would consider using a Web site to e-mail doctors (n = 275; 67.7%), share medical information with doctors (n = 302; 74.4%), send biological data to their doctor (n = 308; 75.9%), look at medical records (n = 321; 79.1%), track health conditions (n = 331; 81.5%), and read about health conditions (n = 332; 81.8%). Sharing health information online with family members (n = 181; 44.6%) or for support groups (n = 223; 54.9%) was not of much interest. Most post-MI participants reported they were interested in communicating with their provider and tracking their health conditions online. Because patients with a history of MI tend to be older and are disproportionately minority, researchers and clinicians must be careful to design interventions that embrace post-MI patients of diverse backgrounds that both improve their access to care and health outcomes.

Authors
Shaw, RJ; Zullig, LL; Crowley, MJ; Grambow, SC; Lindquist, JH; Shah, BR; Peterson, E; Bosworth, HB
MLA Citation
Shaw, RJ, Zullig, LL, Crowley, MJ, Grambow, SC, Lindquist, JH, Shah, BR, Peterson, E, and Bosworth, HB. "Willingness of Patients to Use Computers for Health Communication and Monitoring Following Myocardial Infarction." Computers, informatics, nursing : CIN 33.9 (September 2015): 384-389.
PMID
26176640
Source
epmc
Published In
CIN - Computers Informatics Nursing
Volume
33
Issue
9
Publish Date
2015
Start Page
384
End Page
389
DOI
10.1097/cin.0000000000000175

The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis.

There is limited understanding of how comorbid health conditions affect osteoarthritis (OA)-related outcomes. This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes (PROs) among patients with hip and knee OA. Data were from patients (N = 300, 9 % female, mean age = 61.1; SD = 9.2) enrolled in a randomized control trial at the Durham Veterans Affairs Medical Center. Separate multivariable regression models, adjusted for demographic and clinical characteristics, examined the association of each comorbidity measure with baseline PROs: pain, physical function, depressive symptoms, fatigue, and insomnia. Comorbidity measures included the Self-Administered Comorbidity Questionnaire (SACQ), conditions reported as activity-limiting (SACQ-AL), and indicators of depression, diabetes, hypertension, and back pain. Mean (SD) numbers of comorbid conditions and activity-limiting conditions were 3.4 (1.8) and 1.6 (1.4), respectively. Comorbidity scores (SACQ overall and SACQ-AL) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors. Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain, depressive symptoms, fatigue, and insomnia (p values <0.01). Additionally, increasing SACQ-AL scores were associated with worse mean scores for function (p < 0.01). Depression was associated with worse pain (p = 0.03), fatigue, and insomnia (p values <0.01). Diabetes was associated with worse fatigue (p = 0.01), depressive symptoms (p = 0.02), and insomnia (p = 0.03). Back pain was associated with worse pain scores (p = 0.02). Results provide evidence that comorbidity burden, particularly activity-limiting conditions, is associated with worse OA-related PROs. Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes.

Authors
Zullig, LL; Bosworth, HB; Jeffreys, AS; Corsino, L; Coffman, CJ; Oddone, EZ; Yancy, WS; Allen, KD
MLA Citation
Zullig, LL, Bosworth, HB, Jeffreys, AS, Corsino, L, Coffman, CJ, Oddone, EZ, Yancy, WS, and Allen, KD. "The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis." August 2015.
PMID
24916605
Source
epmc
Published In
Clinical Rheumatology
Volume
34
Issue
8
Publish Date
2015
Start Page
1435
End Page
1441
DOI
10.1007/s10067-014-2707-y

What constitutes quality of family experience at the end of life? Perspectives from family members of patients who died in the hospital.

Most palliative care efforts focus on assessing and improving the quality of life and quality of care for patients. Palliative care views the family as the unit of care; therefore, excellent comprehensive palliative care should also address the needs of the family and the caregiver(s). While the recent literature has offered detailed descriptions of caregiving needs in the home setting, it is crucial to describe the needs of family members who provide care for patients with advanced illness in an inpatient setting, where family members serve as the key intermediaries and decision makers. Therefore, we sought to define the relevant aspects of quality of experience for families of hospitalized patients.We convened a series of focus groups to identify the domains important for the quality of experience of dying patients' family members. Participants included bereaved family members of patients who had died at a Veterans Administration (VA) or private academic medical center. We conducted four in-depth follow-up interviews to probe for additional details and validate our interpretation of the focus group findings.Participants (n = 14) ranged in age from 46 to 83, with a mean of 62. All were female; 64% were Caucasian, 21% African American, and 14% did not report their ethnicity. Content analysis yielded 64 attributes of quality of family experience constituting eight domains: completion, symptom impact, decision making, preparation, relationship with healthcare providers, affirmation of the whole person, post-death care, and supportive services.Our data have implications for clinical guidance in assisting family members in the inpatient palliative setting, which often includes patient incapacity for communication and decision making. They suggest the importance of developing corresponding methods to assist families with the tasks involved with life completion, being prepared for a crisis and imminent death, and post-death care. Provider communications and relationships are central to the processes of meeting the clinical needs of family members. Our findings should inform the development of measures to assess family experience.

Authors
Steinhauser, KE; Voils, CI; Bosworth, H; Tulsky, JA
MLA Citation
Steinhauser, KE, Voils, CI, Bosworth, H, and Tulsky, JA. "What constitutes quality of family experience at the end of life? Perspectives from family members of patients who died in the hospital." Palliative & supportive care 13.4 (August 2015): 945-952.
PMID
25003541
Source
epmc
Published In
Palliative & Supportive Care
Volume
13
Issue
4
Publish Date
2015
Start Page
945
End Page
952
DOI
10.1017/s1478951514000807

Self-monitoring and self-titration of antihypertensive medication reduces systolic blood pressure compared with usual care.

Authors
Bosworth, HB; Crowley, MJ
MLA Citation
Bosworth, HB, and Crowley, MJ. "Self-monitoring and self-titration of antihypertensive medication reduces systolic blood pressure compared with usual care." Evidence-based nursing 18.3 (July 2015): 87-.
PMID
25634011
Source
epmc
Published In
Evidence-Based Nursing
Volume
18
Issue
3
Publish Date
2015
Start Page
87
DOI
10.1136/eb-2014-102004

Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts.

Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about "trouble falling asleep" and "restless/disturbed sleep" were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition.

Authors
Ulmer, CS; Bosworth, HB; Germain, A; Lindquist, J; Olsen, M; Brancu, M; Beckham, JC
MLA Citation
Ulmer, CS, Bosworth, HB, Germain, A, Lindquist, J, Olsen, M, Brancu, M, and Beckham, JC. "Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts." Journal of behavioral medicine 38.3 (June 2015): 544-555.
PMID
25813984
Source
epmc
Published In
Journal of Behavioral Medicine
Volume
38
Issue
3
Publish Date
2015
Start Page
544
End Page
555
DOI
10.1007/s10865-015-9627-4

Patient-reported medication adherence barriers among patients with cardiovascular risk factors.

Many patients experience barriers that make it difficult to take cardiovascular disease (CVD)-related medications as prescribed. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) was a tailored behavioral pharmacist-administered and telephone-based intervention for reducing CVD risk.To (a) describe patient-reported barriers to taking their medication as prescribed and (b) evaluate patient-level characteristics associated with reporting medication barriers.We recruited patients receiving care at primary care clinics affiliated with Durham Veterans Affairs Medical Center. Eligible patients were diagnosed with hypertension and/or hyperlipidemia that were poorly controlled (blood pressure of > 150/100 mmHg and/or low-density lipoprotein value > 130 mg/dL). At the time of enrollment, patients completed an interview with 7 questions derived from a validated medication barriers measure. Patient characteristics and individual medication treatment barriers are described. Multivariable linear regression was used to examine the association between a medication barrier score and patient characteristics.Most patients (n = 428) were married or living with their partners (57%) and were men (85%) who were diagnosed with hypertension and hyperlipidemia (64%). The most commonly reported barriers were having too much medication to take (31%) and forgetting whether medication was taken at a particular time (24%). In adjusted analysis, those who were not employed (1.32, 95% CI = 0.50-2.14) or did not have someone to help with tasks, if needed (1.66, 95% CI = 0.42-2.89), reported higher medication barrier scores. Compared with those diagnosed with hypertension and hyperlipidemia, those with only hypertension (0.91, 95% CI = 0.04-1.79) reported higher medication barrier scores.Barriers to medication adherence are common. Evaluating and addressing barriers may increase medication adherence.

Authors
Zullig, LL; Stechuchak, KM; Goldstein, KM; Olsen, MK; McCant, FM; Danus, S; Crowley, MJ; Oddone, EZ; Bosworth, HB
MLA Citation
Zullig, LL, Stechuchak, KM, Goldstein, KM, Olsen, MK, McCant, FM, Danus, S, Crowley, MJ, Oddone, EZ, and Bosworth, HB. "Patient-reported medication adherence barriers among patients with cardiovascular risk factors." Journal of managed care & specialty pharmacy 21.6 (June 2015): 479-485.
PMID
26011549
Source
epmc
Published In
Journal of managed care & specialty pharmacy
Volume
21
Issue
6
Publish Date
2015
Start Page
479
End Page
485

Grip strength and timed get-up-and-go: Associations with symptoms among women taking adjuvant endocrine therapy.

Authors
Sitlinger, AP; Shelby, RA; White, HK; Edmond, SN; Bosworth, HB; Keefe, FJ; Kimmick, GG
MLA Citation
Sitlinger, AP, Shelby, RA, White, HK, Edmond, SN, Bosworth, HB, Keefe, FJ, and Kimmick, GG. "Grip strength and timed get-up-and-go: Associations with symptoms among women taking adjuvant endocrine therapy." May 20, 2015.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
33
Issue
15
Publish Date
2015

Innovative interventions to promote behavioral change in overweight or obese individuals: A review of the literature.

The overweight and obesity trends have risen over the past few decades, placing significant burdens on health care in terms of increased morbidity and cost. Behavioral change therapy is an effective treatment strategy and includes goal setting, self-monitoring, problem solving, and reinforcement tactics. Traditionally, behavior change therapy has been delivered using face-to-face counseling along with paper and pen recording of dietary intake and physical activity. The current advances in technology provide opportunities to deliver interventions using cellphones, internet, and active video games. These new methods to deliver behavior change for the management and prevention of obesity are being developed in order to increase access, improve convenience, decrease cost, and increase participant engagement. In this review, we present new approaches to promote behavior changes in the management of obesity. Currently available data show promising results. However, future research is needed to address study limitations and implementation challenges of these innovative interventions.

Authors
Okorodudu, DE; Bosworth, HB; Corsino, L
MLA Citation
Okorodudu, DE, Bosworth, HB, and Corsino, L. "Innovative interventions to promote behavioral change in overweight or obese individuals: A review of the literature." Annals of medicine 47.3 (May 2015): 179-185. (Review)
PMID
25011006
Source
epmc
Published In
Annals of Medicine (Informa)
Volume
47
Issue
3
Publish Date
2015
Start Page
179
End Page
185
DOI
10.3109/07853890.2014.931102

Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions.To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases.The study was designed as a patient-level randomized controlled trial.Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN.All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention).Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point.Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points.In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Authors
Edelman, D; Dolor, RJ; Coffman, CJ; Pereira, KC; Granger, BB; Lindquist, JH; Neary, AM; Harris, AJ; Bosworth, HB
MLA Citation
Edelman, D, Dolor, RJ, Coffman, CJ, Pereira, KC, Granger, BB, Lindquist, JH, Neary, AM, Harris, AJ, and Bosworth, HB. "Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial." Journal of general internal medicine 30.5 (May 2015): 626-633.
Website
http://hdl.handle.net/10161/10210
PMID
25567758
Source
epmc
Published In
Journal of General Internal Medicine
Volume
30
Issue
5
Publish Date
2015
Start Page
626
End Page
633
DOI
10.1007/s11606-014-3154-9

Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income.

There are wide disparities in breast cancer-specific survival by patient sociodemographic characteristics. Women of lower income, for instance, have higher relapse and death rates from breast cancer. One possible contributing factor for this disparity is low use of adjuvant endocrine therapy-an extremely efficacious therapy in women with early stage, hormone receptor positive breast cancer, the most common subtype of breast cancer. Alone, adjuvant endocrine therapy decreases breast cancer recurrence by 50% and death by 30%. Data suggest that low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome in low-income breast cancer patients.

Authors
Ursem, CJ; Bosworth, HB; Shelby, RA; Hwang, W; Anderson, RT; Kimmick, GG
MLA Citation
Ursem, CJ, Bosworth, HB, Shelby, RA, Hwang, W, Anderson, RT, and Kimmick, GG. "Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income." Journal of women's health (2002) 24.5 (May 2015): 403-408.
PMID
25884292
Source
epmc
Published In
Journal of Women's Health
Volume
24
Issue
5
Publish Date
2015
Start Page
403
End Page
408
DOI
10.1089/jwh.2014.4982

Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients.

Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF.Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point.Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P = .0007).A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Authors
Granger, BB; Ekman, I; Hernandez, AF; Sawyer, T; Bowers, MT; DeWald, TA; Zhao, Y; Levy, J; Bosworth, HB
MLA Citation
Granger, BB, Ekman, I, Hernandez, AF, Sawyer, T, Bowers, MT, DeWald, TA, Zhao, Y, Levy, J, and Bosworth, HB. "Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients." American heart journal 169.4 (April 2015): 539-548.
PMID
25819861
Source
epmc
Published In
American Heart Journal
Volume
169
Issue
4
Publish Date
2015
Start Page
539
End Page
548
DOI
10.1016/j.ahj.2015.01.006

PREVALENCE AND PREDICTORS OF NON-SURGICAL OSTEOARTHRITIS TREATMENT AMONG PATIENTS IN PRIMARY CARE CLINICS

Authors
Allen, KD; Bosworth, HB; Chatterjee, R; Coffman, CJ; Corsino, L; Dolor, R; Jeffreys, AS; Negbenebor, N; Oddone, EZ; Jr, YWS
MLA Citation
Allen, KD, Bosworth, HB, Chatterjee, R, Coffman, CJ, Corsino, L, Dolor, R, Jeffreys, AS, Negbenebor, N, Oddone, EZ, and Jr, YWS. "PREVALENCE AND PREDICTORS OF NON-SURGICAL OSTEOARTHRITIS TREATMENT AMONG PATIENTS IN PRIMARY CARE CLINICS." April 2015.
Source
wos-lite
Published In
Osteoarthritis and Cartilage
Volume
23
Publish Date
2015
Start Page
A200
End Page
A201

A nurse-led email reminder programme on healthy lifestyle can improve cardiovascular risk factors in hypertensive adults.

Implications for practice and research: Individuals receiving a nurse-led reminder programme through email observed improvements in risk factors for cardiovascular disease, relative to a usual care control group. Issues to consider what would further enhance the likelihood of successful implementation of the intervention are discussed.

Authors
Bosworth, H
MLA Citation
Bosworth, H. "A nurse-led email reminder programme on healthy lifestyle can improve cardiovascular risk factors in hypertensive adults." Evidence-based nursing 18.2 (April 2015): 56-.
PMID
25163471
Source
epmc
Published In
Evidence-Based Nursing
Volume
18
Issue
2
Publish Date
2015
Start Page
56
DOI
10.1136/eb-2014-101940

Barriers to urinary incontinence care seeking in White, Black, and Latina women.

We compared barriers to urinary incontinence (UI) healthcare seeking between white, black, and Latina women.This is a cross-sectional study using a convenience sample of white, black, and Latina women. Women completed the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q), the Incontinence Quality of Life Instrument (I-QOL), the Questionnaire for Urinary Incontinence Diagnosis, and the Incontinence Severity Index (ISI). The primary objective was to assess barriers to UI care seeking among groups, as measured by the BICS-Q. Secondary objectives were to assess factors associated with barriers to incontinence care and to compare specific barriers using BICS-Q subscale scores. Regression analyses were used to further assess for differences among groups while adjusting for potential confounding variables.We included a total of 93 subjects, including 30 white, 33 black, and 30 Latina women. Mean I-QOL, Questionnaire for Urinary Incontinence Diagnosis, and ISI scores were not significantly different among our 3 groups. Barriers, based on BICS-Q scores, were lowest in white women and higher in blacks and Latinas (2.9 vs 7.3 vs 10.9, respectively; P < 0.001). When adjusting for potential confounders such as age, income, education, presence of UI, ISI score, and I-QOL score, Latinas continued to demonstrate higher barriers compared with white or black women (β = 7.4; 95% CI, 2.2-12.7; P = 0.006). There were no significant differences between black women compared with other groups in the adjusted analyses.Latinas experience more barriers to UI healthcare seeking compared with white and black women.

Authors
Willis-Gray, MG; Sandoval, JS; Maynor, J; Bosworth, HB; Siddiqui, NY
MLA Citation
Willis-Gray, MG, Sandoval, JS, Maynor, J, Bosworth, HB, and Siddiqui, NY. "Barriers to urinary incontinence care seeking in White, Black, and Latina women." Female pelvic medicine & reconstructive surgery 21.2 (March 2015): 83-86.
PMID
25185610
Source
epmc
Published In
Female Pelvic Medicine and Reconstructive Surgery
Volume
21
Issue
2
Publish Date
2015
Start Page
83
End Page
86
DOI
10.1097/spv.0000000000000100

Improving diabetes medication adherence: successful, scalable interventions.

Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US health care system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population). We identify key characteristics that make these interventions effective and scalable. This information is intended to inform health care systems seeking proven, low resource, cost-effective solutions to improve medication adherence.

Authors
Zullig, LL; Gellad, WF; Moaddeb, J; Crowley, MJ; Shrank, W; Granger, BB; Granger, CB; Trygstad, T; Liu, LZ; Bosworth, HB
MLA Citation
Zullig, LL, Gellad, WF, Moaddeb, J, Crowley, MJ, Shrank, W, Granger, BB, Granger, CB, Trygstad, T, Liu, LZ, and Bosworth, HB. "Improving diabetes medication adherence: successful, scalable interventions." Patient preference and adherence 9 (January 23, 2015): 139-149. (Review)
PMID
25670885
Source
epmc
Published In
Patient Preference and Adherence
Volume
9
Publish Date
2015
Start Page
139
End Page
149
DOI
10.2147/ppa.s69651

Patient-centered priorities for improving medication management and adherence

© 2014 Elsevier Ireland Ltd.Objective: The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment. Methods: Patients, providers, researchers, and other stakeholders (N (28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions. Results: Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not. Conclusion: Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research. Practice Implications: Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.

Authors
McMullen, CK; Safford, MM; Bosworth, HB; Phansalkar, S; Leong, A; Fagan, MB; Trontell, A; Rumptz, M; Vandermeer, ML; Brinkman, WB; Burkholder, R; Frank, L; Hommel, K; Mathews, R; Hornbrook, MC; Seid, M; Fordis, M; Lambert, B; McElwee, N; Singh, JA
MLA Citation
McMullen, CK, Safford, MM, Bosworth, HB, Phansalkar, S, Leong, A, Fagan, MB, Trontell, A, Rumptz, M, Vandermeer, ML, Brinkman, WB, Burkholder, R, Frank, L, Hommel, K, Mathews, R, Hornbrook, MC, Seid, M, Fordis, M, Lambert, B, McElwee, N, and Singh, JA. "Patient-centered priorities for improving medication management and adherence." Patient Education and Counseling 98.1 (January 1, 2015): 102-110.
Source
scopus
Published In
Patient Education and Counseling
Volume
98
Issue
1
Publish Date
2015
Start Page
102
End Page
110
DOI
10.1016/j.pec.2014.09.015

Results of the chronic heart failure intervention to improve medication adherence study: A randomized intervention in high-risk patients

© 2015 Elsevier Inc. All rights reserved.Background Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF. Methods Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point. Results Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P =.0007). Conclusions A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Authors
Granger, BB; Ekman, I; Hernandez, AF; Sawyer, T; Bowers, MT; Dewald, TA; Zhao, Y; Levy, J; Bosworth, HB
MLA Citation
Granger, BB, Ekman, I, Hernandez, AF, Sawyer, T, Bowers, MT, Dewald, TA, Zhao, Y, Levy, J, and Bosworth, HB. "Results of the chronic heart failure intervention to improve medication adherence study: A randomized intervention in high-risk patients." American Heart Journal 169.4 (January 1, 2015): 539-548.
Source
scopus
Published In
American Heart Journal
Volume
169
Issue
4
Publish Date
2015
Start Page
539
End Page
548
DOI
10.1016/j.ahj.2015.01.006

Medication non-adherence after myocardial infarction: an exploration of modifying factors.

Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence.The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease.We performed secondary analysis of baseline data from a randomized trial.The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment.Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with non-adherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence.We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication non-adherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.

Authors
Crowley, MJ; Zullig, LL; Shah, BR; Shaw, RJ; Lindquist, JH; Peterson, ED; Bosworth, HB
MLA Citation
Crowley, MJ, Zullig, LL, Shah, BR, Shaw, RJ, Lindquist, JH, Peterson, ED, and Bosworth, HB. "Medication non-adherence after myocardial infarction: an exploration of modifying factors." Journal of general internal medicine 30.1 (January 2015): 83-90.
PMID
25361685
Source
epmc
Published In
Journal of General Internal Medicine
Volume
30
Issue
1
Publish Date
2015
Start Page
83
End Page
90
DOI
10.1007/s11606-014-3072-x

Patient-centered priorities for improving medication management and adherence.

The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment.Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions.Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not.Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research.Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.

Authors
McMullen, CK; Safford, MM; Bosworth, HB; Phansalkar, S; Leong, A; Fagan, MB; Trontell, A; Rumptz, M; Vandermeer, ML; Brinkman, WB; Burkholder, R; Frank, L; Hommel, K; Mathews, R; Hornbrook, MC; Seid, M; Fordis, M; Lambert, B; McElwee, N; Singh, JA
MLA Citation
McMullen, CK, Safford, MM, Bosworth, HB, Phansalkar, S, Leong, A, Fagan, MB, Trontell, A, Rumptz, M, Vandermeer, ML, Brinkman, WB, Burkholder, R, Frank, L, Hommel, K, Mathews, R, Hornbrook, MC, Seid, M, Fordis, M, Lambert, B, McElwee, N, and Singh, JA. "Patient-centered priorities for improving medication management and adherence." Patient education and counseling 98.1 (January 2015): 102-110.
PMID
25448313
Source
epmc
Published In
Patient Education and Counseling
Volume
98
Issue
1
Publish Date
2015
Start Page
102
End Page
110
DOI
10.1016/j.pec.2014.09.015

Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population.

Our objectives were to: 1) describe patient-reported communication with their provider and explore differences in perceptions of racially diverse adherent versus nonadherent patients; and 2) examine whether the association between unanswered questions and patient-reported medication nonadherence varied as a function of patients' race.We conducted a cross-sectional analysis of baseline in-person survey data from a trial designed to improve postmyocardial infarction management of cardiovascular disease risk factors.Overall, 298 patients (74%) reported never leaving their doctor's office with unanswered questions. Among those who were adherent and nonadherent with their medications, 183 (79%) and 115 (67%) patients, respectively, never left their doctor's office with unanswered questions. In multivariable logistic regression, although the simple effects of the interaction term were different for patients of nonminority race (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.19-3.92) and those of minority race (OR: 1.19; 95% CI: 0.54-2.66), the overall interaction effect was not statistically significant (P=0.24).The quality of patient-provider communication is critical for cardiovascular disease medication adherence. In this study, however, having unanswered questions did not impact medication adherence differently as a function of patients' race. Nevertheless, there were racial differences in medication adherence that may need to be addressed to ensure optimal adherence and health outcomes. Effort should be made to provide training opportunities for both patients and their providers to ensure strong communication skills and to address potential differences in medication adherence in patients of diverse backgrounds.

Authors
Zullig, LL; Shaw, RJ; Shah, BR; Peterson, ED; Lindquist, JH; Crowley, MJ; Grambow, SC; Bosworth, HB
MLA Citation
Zullig, LL, Shaw, RJ, Shah, BR, Peterson, ED, Lindquist, JH, Crowley, MJ, Grambow, SC, and Bosworth, HB. "Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population." Patient preference and adherence 9 (January 2015): 311-318.
Website
http://hdl.handle.net/10161/10311
PMID
25737633
Source
epmc
Published In
Patient Preference and Adherence
Volume
9
Publish Date
2015
Start Page
311
End Page
318
DOI
10.2147/ppa.s75393

Selecting, adapting, and sustaining programs in health care systems.

Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA) Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities.

Authors
Zullig, LL; Bosworth, HB
MLA Citation
Zullig, LL, and Bosworth, HB. "Selecting, adapting, and sustaining programs in health care systems." Journal of multidisciplinary healthcare 8 (January 2015): 199-203.
PMID
25931825
Source
epmc
Published In
Journal of Multidisciplinary Healthcare
Volume
8
Publish Date
2015
Start Page
199
End Page
203
DOI
10.2147/jmdh.s80037

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study.

BACKGROUND: Patient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood. METHODS: We assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence. RESULTS: Based on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of ≤6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention. CONCLUSION: Cognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.

Authors
Marzec, LN; Carey, EP; Lambert-Kerzner, AC; Del Giacco, EJ; Melnyk, SD; Bryson, CL; Fahdi, IE; Bosworth, HB; Fiocchi, F; Ho, PM
MLA Citation
Marzec, LN, Carey, EP, Lambert-Kerzner, AC, Del Giacco, EJ, Melnyk, SD, Bryson, CL, Fahdi, IE, Bosworth, HB, Fiocchi, F, and Ho, PM. "Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study." Patient preference and adherence 9 (January 2015): 745-751.
PMID
26089651
Source
epmc
Published In
Patient Preference and Adherence
Volume
9
Publish Date
2015
Start Page
745
End Page
751
DOI
10.2147/ppa.s75110

Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens.

PURPOSE: Poor adherence to cardioprotective medications after acute coronary syndrome (ACS) hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients' perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients' perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. PATIENTS AND METHODS: Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were analyzed using the constant comparative approach. RESULTS: Participants described their post-ACS event experiences and how they affected their adherence behaviors. Patients reported that adherence decisions were facilitated by mutually respectful and collaborative provider-patient treatment planning. Frequent interactions with providers and medication refill reminder calls supported improved adherence. Additional facilitators included having social support, adherence routines, and positive attitudes toward an ACS event. The majority of patients expressed that being active participants in health care decision-making contributed to their health. CONCLUSION: Our findings demonstrate that respectful collaborative communication can contribute to medication adherence after ACS hospitalization. These results suggest a potential role for training health-care providers, including pharmacists, social workers, registered nurses, etc, to elicit and acknowledge the patients' views regarding medication treatment in order to improve adherence. Future research is needed with providers to understand how they elicit and acknowledge patients' views, particularly in the face of nonadherence, and with patients to understand how to empower them to share their opinions with their providers.

Authors
Lambert-Kerzner, A; Havranek, EP; Plomondon, ME; Fagan, KM; McCreight, MS; Fehling, KB; Williams, DJ; Hamilton, AB; Albright, K; Blatchford, PJ; Mihalko-Corbitt, R; Bryson, CL; Bosworth, HB; Kirshner, MA; Giacco, EJD; Ho, PM
MLA Citation
Lambert-Kerzner, A, Havranek, EP, Plomondon, ME, Fagan, KM, McCreight, MS, Fehling, KB, Williams, DJ, Hamilton, AB, Albright, K, Blatchford, PJ, Mihalko-Corbitt, R, Bryson, CL, Bosworth, HB, Kirshner, MA, Giacco, EJD, and Ho, PM. "Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens." Patient preference and adherence 9 (January 2015): 1053-1059.
PMID
26244013
Source
epmc
Published In
Patient Preference and Adherence
Volume
9
Publish Date
2015
Start Page
1053
End Page
1059
DOI
10.2147/ppa.s84546

Clinic variation in recruitment metrics, patient characteristics and treatment use in a randomized clinical trial of osteoarthritis management.

The Patient and PRovider Interventions for Managing Osteoarthritis (OA) in Primary Care (PRIMO) study is one of the first health services trials targeting OA in a multi-site, primary care network. This multi-site approach is important for assessing generalizability of the interventions. These analyses describe heterogeneity in clinic and patient characteristics, as well as recruitment metrics, across PRIMO study clinics.Baseline data were obtained from the PRIMO study, which enrolled n = 537 patients from ten Duke Primary Care practices. The following items were examined across clinics with descriptive statistics: (1) Practice Characteristics, including primary care specialty, numbers and specialties of providers, numbers of patients age 55+, urban/rural location and county poverty level; (2) Recruitment Metrics, including rates of eligibility, refusal and randomization; (3) Participants' Characteristics, including demographic and clinical data (general and OA-related); and (4) Participants' Self-Reported OA Treatment Use, including pharmacological and non-pharmacological therapies. Intraclass correlation coefficients (ICCs) were computed for participant characteristics and OA treatment use to describe between-clinic variation.Study clinics varied considerably across all measures, with notable differences in numbers of patients age 55+ (1,507-5,400), urban/rural location (ranging from "rural" to "small city"), and proportion of county households below poverty level (12%-26%). Among all medical records reviewed, 19% of patients were initially eligible (10%-31% across clinics), and among these, 17% were randomized into the study (13%-21% across clinics). There was considerable between-clinic variation, as measured by the ICC (>0.01), for the following patient characteristics and OA treatment use variables: age (means: 60.4-66.1 years), gender (66%-88% female), race (16%-61% non-white), low income status (5%-27%), presence of hip OA (26%-68%), presence both knee and hip OA (23%-61%), physical therapy for knee OA (24%-61%) and hip OA (0%-71%), and use of knee brace with metal supports (0%-18%).Although PRIMO study sites were part of one primary care practice network in one health care system, clinic and patient characteristics varied considerably, as did OA treatment use. This heterogeneity illustrates the importance of including multiple, diverse sites in trials for knee and hip OA, to enhance the generalizability and evaluate potential for real-world implementation.NCT 01435109.

Authors
Allen, KD; Bosworth, HB; Chatterjee, R; Coffman, CJ; Corsino, L; Jeffreys, AS; Oddone, EZ; Stanwyck, C; Yancy, WS; Dolor, RJ
MLA Citation
Allen, KD, Bosworth, HB, Chatterjee, R, Coffman, CJ, Corsino, L, Jeffreys, AS, Oddone, EZ, Stanwyck, C, Yancy, WS, and Dolor, RJ. "Clinic variation in recruitment metrics, patient characteristics and treatment use in a randomized clinical trial of osteoarthritis management." BMC musculoskeletal disorders 15 (December 6, 2014): 413-.
PMID
25481809
Source
epmc
Published In
BMC Musculoskeletal Disorders
Volume
15
Publish Date
2014
Start Page
413
DOI
10.1186/1471-2474-15-413

Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control.

Patients with persistent poorly controlled diabetes mellitus (PPDM), defined as an uninterrupted hemoglobin A1c >8.0% for ≥1 year despite standard care, are at high risk for complications. Additional research to define patient factors associated with PPDM could suggest barriers to improvement in this group and inform the development of targeted strategies to address these patients' resistant diabetes.We analyzed patients with type 2 diabetes from a multi-site randomized trial. We characterized patients with PPDM relative to other patients using detailed survey data and multivariable modeling.Of 963 patients, 118 (12%) had PPDM, 265 (28%) were intermittently poorly controlled, and 580 (60%) were well-controlled. Patients with PPDM had younger age, earlier diabetes diagnosis, insulin use, higher antihypertensive burden, higher low-density lipoprotein cholesterol, and lower statin use relative to well-controlled patients. Among patients with objective adherence data (Veterans Affairs patients), a larger oral diabetes medication refill gap was associated with PPDM.Strategies are needed to target-specific barriers to improvement among patients whose diabetes is resistant to standard diabetes care. Our data suggest that strategies for targeting PPDM should accommodate younger patients' lifestyles, include medication management for insulin titration and comorbid disease conditions, and address barriers to self-management adherence.

Authors
Crowley, MJ; Holleman, R; Klamerus, ML; Bosworth, HB; Edelman, D; Heisler, M
MLA Citation
Crowley, MJ, Holleman, R, Klamerus, ML, Bosworth, HB, Edelman, D, and Heisler, M. "Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control." Chronic illness 10.4 (December 2014): 291-302.
PMID
24567193
Source
epmc
Published In
Chronic Illness
Volume
10
Issue
4
Publish Date
2014
Start Page
291
End Page
302
DOI
10.1177/1742395314523653

Validation of a measure of family experience of patients with serious illness: the QUAL-E (Fam).

Family members of seriously ill patients experience significant burden as they advocate with providers and participate in key decisions for loved ones. Most assessments focus on patient experience, yet family members' own quality of experience is central to comprehensive care.This study validated a measure of the quality of family experience, the QUAL-E (Fam), in palliative care.We enrolled family members of terminally ill patients admitted to general medicine services at two hospitals. Items were based on foundational work originally done for the patient instrument, QUAL-E, and interviews of family members of terminally ill patients. Cognitive interviewing was used to refine items, which then underwent formal testing factor analysis. In the first sample, we assessed factor structure. A subsequent sample established predictive validity and test-retest reliability.The initial item pool was reduced to a four-domain, 35-item scale and administered to the validation sample. Further analyses produced a final brief scale comprising 17 items, demonstrating appropriate convergent and divergent validity. Test-retest reliability demonstrated expected levels of stability in a highly changeable population. The scale provides an assessment of family experience and includes subscales assessing relationship with health care provider and completion. Additional scale items assess symptom experience and issues of preparation.The QUAL-E (Fam) is a companion instrument to the patient QUAL-E measure of quality of life at the end of life and is part of a package of assessment tools that can help evaluate the entire patient experience and contribute to quality care.

Authors
Steinhauser, KE; Voils, CI; Bosworth, HB; Tulsky, JA
MLA Citation
Steinhauser, KE, Voils, CI, Bosworth, HB, and Tulsky, JA. "Validation of a measure of family experience of patients with serious illness: the QUAL-E (Fam)." Journal of pain and symptom management 48.6 (December 2014): 1168-1181.
PMID
24858740
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
48
Issue
6
Publish Date
2014
Start Page
1168
End Page
1181
DOI
10.1016/j.jpainsymman.2014.04.006

mHealth interventions for weight loss: a guide for achieving treatment fidelity.

mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs.1F31 NR012599.

Authors
Shaw, RJ; Steinberg, DM; Zullig, LL; Bosworth, HB; Johnson, CM; Davis, LL
MLA Citation
Shaw, RJ, Steinberg, DM, Zullig, LL, Bosworth, HB, Johnson, CM, and Davis, LL. "mHealth interventions for weight loss: a guide for achieving treatment fidelity." Journal of the American Medical Informatics Association : JAMIA 21.6 (November 2014): 959-963.
PMID
24853065
Source
epmc
Published In
Journal of American Medical Informatics Association
Volume
21
Issue
6
Publish Date
2014
Start Page
959
End Page
963
DOI
10.1136/amiajnl-2013-002610

Behavioral interventions to improve hypertension control in the Veterans Affairs healthcare system.

Hypertension is a common and costly disease among US veterans. The Veterans Affairs (VA) healthcare system is the largest integrated healthcare provider in the United States and reviewing hypertension interventions developed in the VA may inform interventions delivered in other integrated healthcare systems. This review describes behavioral interventions to improve hypertension control that have been conducted in the VA since 1970. The authors identified 27 articles representing 15 behavioral interventional trials. Studies were heterogeneous across patients, providers, interventionist, and intervention components. The VA bridges services related to diagnosis, treatment, medication management, and behavioral counseling in a unified approach that supports collaboration and provides infrastructure for hypertension management.

Authors
Zullig, LL; Bosworth, HB
MLA Citation
Zullig, LL, and Bosworth, HB. "Behavioral interventions to improve hypertension control in the Veterans Affairs healthcare system." Journal of clinical hypertension (Greenwich, Conn.) 16.11 (November 2014): 827-837.
PMID
25294103
Source
epmc
Published In
Journal of Clinical Hypertension
Volume
16
Issue
11
Publish Date
2014
Start Page
827
End Page
837
DOI
10.1111/jch.12423

Corrigendum to "Weight loss intervention for young adults using mobile technology: Design and rationale of a randomized controlled trial - Cell phone Intervention for You (CITY)" [Contemp Clin Trials 37/2 (2014) 333-341].

Authors
Batch, BC; Tyson, C; Bagwell, J; Corsino, L; Intille, S; Lin, PH; Lazenka, T; Bennett, G; Bosworth, HB; Voils, C; Grambow, S; Sutton, A; Bordogna, R; Pangborn, M; Schwager, J; Pilewski, K; Caccia, C; Burroughs, J; Svetkey, LP
MLA Citation
Batch, BC, Tyson, C, Bagwell, J, Corsino, L, Intille, S, Lin, PH, Lazenka, T, Bennett, G, Bosworth, HB, Voils, C, Grambow, S, Sutton, A, Bordogna, R, Pangborn, M, Schwager, J, Pilewski, K, Caccia, C, Burroughs, J, and Svetkey, LP. "Corrigendum to "Weight loss intervention for young adults using mobile technology: Design and rationale of a randomized controlled trial - Cell phone Intervention for You (CITY)" [Contemp Clin Trials 37/2 (2014) 333-341]." Contemporary clinical trials 39.2 (November 2014): 351-.
PMID
25488046
Source
epmc
Published In
Contemporary Clinical Trials
Volume
39
Issue
2
Publish Date
2014
Start Page
351
DOI
10.1016/j.cct.2014.10.001

Striking a balance in communicating pharmacogenetic test results: promoting comprehension and minimizing adverse psychological and behavioral response.

Pharmacogenetic (PGx) testing can provide information about a patient's likelihood to respond to a medication or experience an adverse event, and be used to inform medication selection and/or dosing. Promoting patient comprehension of PGx test results will be important to improving engagement and understanding of treatment decisions.The discussion in this paper is based on our experiences and the literature on communication of genetic test results for disease risk and broad risk communication strategies.Clinical laboratory reports often describe PGx test results using standard terminology such as 'poor metabolizer' or 'ultra-rapid metabolizer.' While this type of terminology may promote patient recall with its simple, yet descriptive nature, it may be difficult for some patients to comprehend and/or cause adverse psychological or behavioral responses.The language used to communicate results and their significance to patients will be important to consider in order to minimize confusion and potential psychological consequences such as increased anxiety that can adversely impact medication-taking behaviors.Due to patients' unfamiliarity with PGx testing and the potential for confusion, adverse psychological effects, and decreased medication adherence, health providers need to be cognizant of the language used in discussing PGx test results with patients.

Authors
Haga, SB; Mills, R; Bosworth, H
MLA Citation
Haga, SB, Mills, R, and Bosworth, H. "Striking a balance in communicating pharmacogenetic test results: promoting comprehension and minimizing adverse psychological and behavioral response." Patient education and counseling 97.1 (October 2014): 10-15. (Review)
PMID
24985359
Source
epmc
Published In
Patient Education and Counseling
Volume
97
Issue
1
Publish Date
2014
Start Page
10
End Page
15
DOI
10.1016/j.pec.2014.06.007

Randomized Clinical Trial of Group Vs. Individual Physical Therapy for Knee Osteoarthritis.

Authors
Allen, KD; Bongiorni, D; Bosworth, HB; Coffman, C; Datta, S; Edelman, D; Lindquist, JH; Oddone, E; Hoenig, H
MLA Citation
Allen, KD, Bongiorni, D, Bosworth, HB, Coffman, C, Datta, S, Edelman, D, Lindquist, JH, Oddone, E, and Hoenig, H. "Randomized Clinical Trial of Group Vs. Individual Physical Therapy for Knee Osteoarthritis." ARTHRITIS & RHEUMATOLOGY 66 (October 2014): S394-S394.
Source
wos-lite
Published In
Arthritis and Rheumatology
Volume
66
Publish Date
2014
Start Page
S394
End Page
S394

Randomized Clinical Trial of a Patient and Provider Intervention for Managing Osteoarthritis in Veterans

Authors
Allen, KD; Bosworth, HB; Jeffreys, A; Coffman, C; Datta, S; McDuffie, J; Oddone, E; Strauss, J; Jr, YWS
MLA Citation
Allen, KD, Bosworth, HB, Jeffreys, A, Coffman, C, Datta, S, McDuffie, J, Oddone, E, Strauss, J, and Jr, YWS. "Randomized Clinical Trial of a Patient and Provider Intervention for Managing Osteoarthritis in Veterans." ARTHRITIS & RHEUMATOLOGY 66 (October 2014): S435-S435.
Source
wos-lite
Published In
Arthritis and Rheumatology
Volume
66
Publish Date
2014
Start Page
S435
End Page
S435

A protocol to evaluate the efficacy, perceptions, and cost of a cholesterol packaging approach to improve medication adherence.

PURPOSE: Elevated low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for cardiovascular disease (CVD), a leading cause of death in the United States. Despite clinical practice guidelines aimed at facilitating LDL-C control, many Veterans do not achieve guideline-recommended LDL-C levels. METHODS: We describe a study focused on VA healthcare system users at risk for CVD (i.e., LDL-C level >130 mg/dl and/or <80% cholesterol pill refill adherence in the last 12 months). We are conducting a two and a half year randomized controlled trial (i.e., intervention administered over 12 months) among Veterans with uncontrolled cholesterol receiving care at select VA-affiliated primary care clinics in North Carolina. We anticipate enrolling 250 diverse patients (10% women; 40% African American). Patients are randomized to an educational control group or intervention group. Intervention group participants' medication is provided in special blister packaging labeled for daily use that includes reminders; MeadWestvaco Corporation's pre-filled DosePak® contains standard doses of statins in accordance with the existing prescriptions. CONCLUSIONS: Pre-filled blister packaging may provide an inexpensive solution to improve medication adherence. Our study enrolls a diverse sample and provides information about whether an adherence packaging intervention can: 1) improve medication adherence; 2) improve patients' LDL-C levels; 3) be well received by patients and providers; and 4) provide a cost effective solution to improve medication adherence.

Authors
Zullig, LL; Pathman, J; Melnyk, SD; Brown, JN; Sanders, LL; Koropchak, C; Howard, T; Danus, S; McCant, F; Bosworth, HB
MLA Citation
Zullig, LL, Pathman, J, Melnyk, SD, Brown, JN, Sanders, LL, Koropchak, C, Howard, T, Danus, S, McCant, F, and Bosworth, HB. "A protocol to evaluate the efficacy, perceptions, and cost of a cholesterol packaging approach to improve medication adherence." Contemporary clinical trials 39.1 (September 2014): 106-112.
PMID
25117806
Source
epmc
Published In
Contemporary Clinical Trials
Volume
39
Issue
1
Publish Date
2014
Start Page
106
End Page
112
DOI
10.1016/j.cct.2014.08.003

Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives.

Authors
Hess, PL; Mirro, MJ; Diener, H-C; Eikelboom, JW; Al-Khatib, SM; Hylek, EM; Bosworth, HB; Gersh, BJ; Singer, DE; Flaker, G; Mega, JL; Peterson, ED; Rumsfeld, JS; Steinberg, BA; Kakkar, AK; Califf, RM; Granger, CB
MLA Citation
Hess, PL, Mirro, MJ, Diener, H-C, Eikelboom, JW, Al-Khatib, SM, Hylek, EM, Bosworth, HB, Gersh, BJ, Singer, DE, Flaker, G, Mega, JL, Peterson, ED, Rumsfeld, JS, Steinberg, BA, Kakkar, AK, Califf, RM, and Granger, CB. "Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012." American heart journal 168.3 (September 2014): 239-247.e1.
PMID
25173533
Source
epmc
Published In
American Heart Journal
Volume
168
Issue
3
Publish Date
2014
Start Page
239
End Page
247.e1
DOI
10.1016/j.ahj.2014.04.007

Heart matters: Gender and racial differences cardiovascular disease risk factor control among veterans.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality for U.S. women. Racial minorities are a particularly vulnerable population. The increasing female veteran population has an higher prevalence of certain cardiovascular risk factors compared with non-veteran women; however, little is known about gender and racial differences in cardiovascular risk factor control among veterans. METHODS: We used analysis of variance, adjusting for age, to compare gender and racial differences in three risk factors that predispose to CVD (diabetes, hypertension, and hyperlipidemia) in a cohort of high-risk veterans eligible for enrollment in a clinical trial, including 23,955 men and 1,010 women. FINDINGS: Low-density lipoprotein (LDL) values were higher in women veterans than men with age-adjusted estimated mean values of 111.7 versus 97.6 mg/dL (p < .01). Blood pressures (BPs) were higher among African-American than White female veterans with age-adjusted estimated mean systolic BPs of 136.3 versus 133.5 mmHg, respectively (p < .01), and diastolic BPs of 82.4 versus 78.9 mmHg (p < .01). African-American veterans with diabetes had worse BP, LDL values, and hemoglobin A1c levels, although the differences were only significant among men. CONCLUSIONS: Female veterans have higher LDL cholesterol levels than male veterans and African-American veterans have higher BP, LDL cholesterol, and A1c levels than Whites after adjusting for age. Further examination of CVD gender and racial disparities in this population may help to develop targeted treatments and strategies applicable to the general population.

Authors
Goldstein, KM; Melnyk, SD; Zullig, LL; Stechuchak, KM; Oddone, E; Bastian, LA; Rakley, S; Olsen, MK; Bosworth, HB
MLA Citation
Goldstein, KM, Melnyk, SD, Zullig, LL, Stechuchak, KM, Oddone, E, Bastian, LA, Rakley, S, Olsen, MK, and Bosworth, HB. "Heart matters: Gender and racial differences cardiovascular disease risk factor control among veterans." Women's health issues : official publication of the Jacobs Institute of Women's Health 24.5 (September 2014): 477-483.
PMID
25213741
Source
epmc
Published In
Women's Health Issues
Volume
24
Issue
5
Publish Date
2014
Start Page
477
End Page
483
DOI
10.1016/j.whi.2014.05.005

Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice.A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained.At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values.Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained.

Authors
Lich, KH; Tian, Y; Beadles, CA; Williams, LS; Bravata, DM; Cheng, EM; Bosworth, HB; Homer, JB; Matchar, DB
MLA Citation
Lich, KH, Tian, Y, Beadles, CA, Williams, LS, Bravata, DM, Cheng, EM, Bosworth, HB, Homer, JB, and Matchar, DB. "Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making." Stroke 45.7 (July 2014): 2078-2084.
Website
http://hdl.handle.net/10161/13105
PMID
24923722
Source
epmc
Published In
Stroke
Volume
45
Issue
7
Publish Date
2014
Start Page
2078
End Page
2084
DOI
10.1161/strokeaha.114.004694

The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis

© 2014, Clinical Rheumatology.There is limited understanding of how comorbid health conditions affect osteoarthritis (OA)-related outcomes. This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes (PROs) among patients with hip and knee OA. Data were from patients (N = 300, 9 % female, mean age = 61.1; SD = 9.2) enrolled in a randomized control trial at the Durham Veterans Affairs Medical Center. Separate multivariable regression models, adjusted for demographic and clinical characteristics, examined the association of each comorbidity measure with baseline PROs: pain, physical function, depressive symptoms, fatigue, and insomnia. Comorbidity measures included the Self-Administered Comorbidity Questionnaire (SACQ), conditions reported as activity-limiting (SACQ-AL), and indicators of depression, diabetes, hypertension, and back pain. Mean (SD) numbers of comorbid conditions and activity-limiting conditions were 3.4 (1.8) and 1.6 (1.4), respectively. Comorbidity scores (SACQ overall and SACQ-AL) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors. Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain, depressive symptoms, fatigue, and insomnia (p values <0.01). Additionally, increasing SACQ-AL scores were associated with worse mean scores for function (p < 0.01). Depression was associated with worse pain (p = 0.03), fatigue, and insomnia (p values <0.01). Diabetes was associated with worse fatigue (p = 0.01), depressive symptoms (p = 0.02), and insomnia (p = 0.03). Back pain was associated with worse pain scores (p = 0.02). Results provide evidence that comorbidity burden, particularly activity-limiting conditions, is associated with worse OA-related PROs. Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes.

Authors
Zullig, LL; Bosworth, HB; Jeffreys, AS; Corsino, L; Coffman, CJ; Oddone, EZ; Yancy, WS; Allen, KD
MLA Citation
Zullig, LL, Bosworth, HB, Jeffreys, AS, Corsino, L, Coffman, CJ, Oddone, EZ, Yancy, WS, and Allen, KD. "The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis." Clinical Rheumatology 34.8 (June 12, 2014): 1435-1441.
Source
scopus
Published In
Clinical Rheumatology
Volume
34
Issue
8
Publish Date
2014
Start Page
1435
End Page
1441
DOI
10.1007/s10067-014-2707-y

The changing face of general internal medicine and lessons learned from geriatric medicine.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "The changing face of general internal medicine and lessons learned from geriatric medicine." Journal of general internal medicine 29.6 (June 2014): 824-826.
PMID
24557517
Source
epmc
Published In
Journal of General Internal Medicine
Volume
29
Issue
6
Publish Date
2014
Start Page
824
End Page
826
DOI
10.1007/s11606-014-2799-8

A health literacy pilot intervention to improve medication adherence using Meducation® technology.

OBJECTIVE: To determine whether antihypertensive medication adherence could improve using a Meducation® technology health literacy intervention. METHODS: We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months. RESULTS: There was a 42% enrollment rate (n=23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients' average systolic blood pressure (0.5 mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p>0.05). CONCLUSIONS: A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes. PRACTICE IMPLICATIONS: Health literacy interventions may improve adherence while requiring relatively few resources to implement.

Authors
Zullig, LL; McCant, F; Melnyk, SD; Danus, S; Bosworth, HB
MLA Citation
Zullig, LL, McCant, F, Melnyk, SD, Danus, S, and Bosworth, HB. "A health literacy pilot intervention to improve medication adherence using Meducation® technology." Patient education and counseling 95.2 (May 2014): 288-291.
PMID
24629834
Source
epmc
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
288
End Page
291
DOI
10.1016/j.pec.2014.02.004

A randomised controlled trial of providing personalised cardiovascular risk information to modify health behaviour.

We conducted a feasibility study of a web-based intervention, which provided personalized cardiovascular disease (CVD) risk information, behavioural risk reduction strategies and educational resources. Participants were block-randomized to the 3-month intervention (n = 47) or to usual care (n = 49). Participants in the intervention group were presented with their CVD risk based on the Framingham risk score, and in three subsequent online encounters could select two behavioural/lifestyle modules, giving them an opportunity to complete six modules over the course of the study. Because it was self-guided, participants had differing levels of engagement with intervention materials. Most intervention group participants (77%, n = 36) completed all modules. After 3 months there were no significant differences between the intervention and usual care groups for systolic blood pressure, body-mass index, CVD risk, smoking cessation or medication non-adherence. The study suggests that modest clinical improvements can be achieved by interventions that are entirely web-administered. However, web-based interventions do not replace the need for human interaction to communicate CVD risk and assist with decision-making.

Authors
Zullig, LL; Sanders, LL; Shaw, RJ; McCant, F; Danus, S; Bosworth, HB
MLA Citation
Zullig, LL, Sanders, LL, Shaw, RJ, McCant, F, Danus, S, and Bosworth, HB. "A randomised controlled trial of providing personalised cardiovascular risk information to modify health behaviour." Journal of telemedicine and telecare 20.3 (April 2014): 147-152.
PMID
24647384
Source
epmc
Published In
Journal of Telemedicine and Telecare
Volume
20
Issue
3
Publish Date
2014
Start Page
147
End Page
152
DOI
10.1177/1357633x14528446

Strategies to overcome medication nonadherence--reply.

Authors
Zullig, LL; Peterson, ED; Bosworth, HB
MLA Citation
Zullig, LL, Peterson, ED, and Bosworth, HB. "Strategies to overcome medication nonadherence--reply." JAMA 311.16 (April 2014): 1693-1694.
PMID
24756525
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
311
Issue
16
Publish Date
2014
Start Page
1693
End Page
1694
DOI
10.1001/jama.2014.1607

PHYSICAL ACTIVITY COUNSELING IMPROVES HEALTH IN OLDER VETERANS WITH PTSD

Authors
Hall, KS; Beckham, JC; Bosworth, HB; Hoerster, KD; Jakupcak, M; Sloane, R; Crawford, E; Morey, MC
MLA Citation
Hall, KS, Beckham, JC, Bosworth, HB, Hoerster, KD, Jakupcak, M, Sloane, R, Crawford, E, and Morey, MC. "PHYSICAL ACTIVITY COUNSELING IMPROVES HEALTH IN OLDER VETERANS WITH PTSD." ANNALS OF BEHAVIORAL MEDICINE 47 (April 2014): S129-S129.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
47
Publish Date
2014
Start Page
S129
End Page
S129

HETEROGENEITY OF CLINICAL CHARACTERISTICS AND TREATMENT USE AMONG PATIENTS WITH OSTEOARTHRITIS IN PRIMARY CARE CLINICS

Authors
Allen, KD; Bosworth, HB; Chatterjee, R; Coffman, CJ; Corsino, L; Dolor, R; Jeffreys, AS; Oddone, EZ; Yancy, WS
MLA Citation
Allen, KD, Bosworth, HB, Chatterjee, R, Coffman, CJ, Corsino, L, Dolor, R, Jeffreys, AS, Oddone, EZ, and Yancy, WS. "HETEROGENEITY OF CLINICAL CHARACTERISTICS AND TREATMENT USE AMONG PATIENTS WITH OSTEOARTHRITIS IN PRIMARY CARE CLINICS." April 2014.
Source
wos-lite
Published In
Osteoarthritis and Cartilage
Volume
22
Publish Date
2014
Start Page
S219
End Page
S219

Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?

BACKGROUND: Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after completion of a hypertension self-management trial. METHODS AND RESULTS: This study is a follow-up analysis of an 18-month, 4-arm, hypertension self-management trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 interventions. Clinic-derived systolic blood pressure obtained before, during, and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures, and total expenditures were estimated using generalized estimating equations. The 3 telephone-based interventions were nurse-administered health behavior promotion, provider-administered medication adjustments based on hypertension treatment guidelines, or a combination of both. Intervention calls were triggered by home BP values transmitted via telemonitoring devices. Clinical and economic outcomes were examined 12 months before, 18 months during, and 18 months after trial completion. Compared with usual care, patients randomized to the combined arm had greater improvement in proportion of BP control during and after the 18-month trial and estimated proportion of BP control improved 18 months after trial completion for patients in the behavioral and medication management arms. Among the patients with inadequate baseline BP control, estimated mean systolic BP was significantly lower in the combined arm as compared with usual care during and after the 18-month trial. Utilization and expenditure trends were similar for patients in all 4 arms. CONCLUSIONS: Behavioral and medication management can generate systolic BP improvements that are sustained 18 months after trial completion. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00237692.

Authors
Maciejewski, ML; Bosworth, HB; Olsen, MK; Smith, VA; Edelman, D; Powers, BJ; Kaufman, MA; Oddone, EZ; Jackson, GL
MLA Citation
Maciejewski, ML, Bosworth, HB, Olsen, MK, Smith, VA, Edelman, D, Powers, BJ, Kaufman, MA, Oddone, EZ, and Jackson, GL. "Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?." Circulation. Cardiovascular quality and outcomes 7.2 (March 11, 2014): 269-275.
PMID
24619321
Source
epmc
Published In
Circulation. Cardiovascular quality and outcomes
Volume
7
Issue
2
Publish Date
2014
Start Page
269
End Page
275
DOI
10.1161/circoutcomes.113.000309

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population.To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition.A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014.If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364.

Authors
Batch, BC; Tyson, C; Bagwell, J; Corsino, L; Intille, S; Lin, P-H; Lazenka, T; Bennett, G; Bosworth, HB; Voils, C; Grambow, S; Sutton, A; Bordogna, R; Pangborn, M; Schwager, J; Pilewski, K; Caccia, C; Burroughs, J; Svetkey, LP
MLA Citation
Batch, BC, Tyson, C, Bagwell, J, Corsino, L, Intille, S, Lin, P-H, Lazenka, T, Bennett, G, Bosworth, HB, Voils, C, Grambow, S, Sutton, A, Bordogna, R, Pangborn, M, Schwager, J, Pilewski, K, Caccia, C, Burroughs, J, and Svetkey, LP. "Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY)." Contemporary clinical trials 37.2 (March 2014): 333-341.
Website
http://hdl.handle.net/10161/10732
PMID
24462568
Source
epmc
Published In
Contemporary Clinical Trials
Volume
37
Issue
2
Publish Date
2014
Start Page
333
End Page
341
DOI
10.1016/j.cct.2014.01.003

Characteristics of diabetic patients associated with achieving and maintaining blood pressure targets in the Adherence and Intensification of Medications program.

To determine patient characteristics associated with achieving and sustaining blood pressure (BP) targets in the Adherence and Intensification of Medications program, a program led by pharmacists trained in motivational interviewing and authorized to make BP medication changes.We conducted a retrospective cohort study of patients with diabetes and persistent hypertension in Kaiser Permanente and the Department of Veterans Affairs. Using two-level logistic regression, baseline survey data from 458 program participants were examined to determine patient characteristics associated with (1) discharge from the program with a target BP (short-term success) and (2) maintenance of the target BP over a nine-month period (long-term success).In multivariable analyses, patients who screened positive for depression or had a higher baseline systolic BP were less likely to achieve short-term success (adjusted odds ratio (AOR) 0.42 [95% confidence interval (CI): 0.19-0.93], p = 0.03; AOR 0.94 [0.91-0.97], p < 0.01; respectively). Patients who reported at baseline one or more barriers to medication adherence were less likely to achieve long-term success (AOR 0.50 [0.26-0.94], p = 0.03).Although almost 90% of patients achieved short-term success, only 28% achieved long-term success. Baseline barriers to adherence were associated with lack of long-term success and could be the target of maintenance programs for patients who achieve short-term success.

Authors
Klamerus, ML; Kerr, EA; Bosworth, HB; Schmittdiel, JA; Heisler, M
MLA Citation
Klamerus, ML, Kerr, EA, Bosworth, HB, Schmittdiel, JA, and Heisler, M. "Characteristics of diabetic patients associated with achieving and maintaining blood pressure targets in the Adherence and Intensification of Medications program." Chronic illness 10.1 (March 2014): 60-73.
PMID
23892775
Source
epmc
Published In
Chronic Illness
Volume
10
Issue
1
Publish Date
2014
Start Page
60
End Page
73
DOI
10.1177/1742395313496590

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): rationale for a tailored behavioral and educational pharmacist-administered intervention for achieving cardiovascular disease risk reduction.

Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction.Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors.Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients.The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors.

Authors
Zullig, LL; Melnyk, SD; Stechuchak, KM; McCant, F; Danus, S; Oddone, E; Bastian, L; Olsen, M; Edelman, D; Rakley, S; Morey, M; Bosworth, HB
MLA Citation
Zullig, LL, Melnyk, SD, Stechuchak, KM, McCant, F, Danus, S, Oddone, E, Bastian, L, Olsen, M, Edelman, D, Rakley, S, Morey, M, and Bosworth, HB. "The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): rationale for a tailored behavioral and educational pharmacist-administered intervention for achieving cardiovascular disease risk reduction." Telemedicine journal and e-health : the official journal of the American Telemedicine Association 20.2 (February 2014): 135-143.
PMID
24303930
Source
epmc
Published In
Telemedicine Journal and e-Health
Volume
20
Issue
2
Publish Date
2014
Start Page
135
End Page
143
DOI
10.1089/tmj.2013.0145

Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial.

IMPORTANCE: Adherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor. OBJECTIVE: To test a multifaceted intervention to improve adherence to cardiac medications. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial, 253 patients from 4 Department of Veterans Affairs medical centers located in Denver (Colorado), Seattle (Washington); Durham (North Carolina), and Little Rock (Arkansas) admitted with ACS were randomized to the multifaceted intervention (INT) or usual care (UC) prior to discharge. INTERVENTIONS: The INT lasted for 1 year following discharge and comprised (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and a patient's primary care clinician and/or cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls). MAIN OUTCOMES AND MEASURES: The primary outcome of interest was proportion of patients adherent to medication regimens based on a mean proportion of days covered (PDC) greater than 0.80 in the year after hospital discharge using pharmacy refill data for 4 cardioprotective medications (clopidogrel, β-blockers, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins], and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB]). Secondary outcomes included achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level targets. RESULTS Of 253 patients, 241 (95.3%) completed the study (122 in INT and 119 in UC). In the INT group, 89.3% of patients were adherent compared with 73.9% in the UC group (P = .003). Mean PDC was higher in the INT group (0.94 vs 0.87; P< .001). A greater proportion of intervention patients were adherent to clopidogrel (86.8% vs 70.7%; P = .03), statins (93.2% vs 71.3%; P < .001), and ACEI/ARB (93.1% vs 81.7%; P = .03) but not β-blockers (88.1% vs 84.8%; P = .59). There were no statistically significant differences in the proportion of patients who achieved BP and LDL-C level goals. CONCLUSIONS AND RELEVANCE: A multifaceted intervention comprising pharmacist-led medication reconciliation and tailoring, patient education, collaborative care between pharmacist and patients' primary care clinician and/or cardiologist, and voice messaging increased adherence to medication regimens in the year after ACS hospital discharge without improving BP and LDL-C levels. Understanding the impact of such improvement in adherence on clinical outcomes is needed prior to broader dissemination of the program. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00903032.

Authors
Ho, PM; Lambert-Kerzner, A; Carey, EP; Fahdi, IE; Bryson, CL; Melnyk, SD; Bosworth, HB; Radcliff, T; Davis, R; Mun, H; Weaver, J; Barnett, C; Barón, A; Del Giacco, EJ
MLA Citation
Ho, PM, Lambert-Kerzner, A, Carey, EP, Fahdi, IE, Bryson, CL, Melnyk, SD, Bosworth, HB, Radcliff, T, Davis, R, Mun, H, Weaver, J, Barnett, C, Barón, A, and Del Giacco, EJ. "Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial." JAMA internal medicine 174.2 (February 2014): 186-193.
PMID
24247275
Source
epmc
Published In
JAMA Internal Medicine
Volume
174
Issue
2
Publish Date
2014
Start Page
186
End Page
193
DOI
10.1001/jamainternmed.2013.12944

Using Health Information Technology to Prevent and Treat Diabetes

Authors
Kaufman, N
MLA Citation
Kaufman, N. "Using Health Information Technology to Prevent and Treat Diabetes." Diabetes Technology & Therapeutics 16.S1 (February 2014): S-56-S-67.
Source
crossref
Published In
Diabetes Technology & Therapeutics
Volume
16
Issue
S1
Publish Date
2014
Start Page
S-56
End Page
S-67
DOI
10.1089/dia.2014.1507

A health literacy pilot intervention to improve medication adherence using Meducation® technology

Objective: To determine whether antihypertensive medication adherence could improve using a Meducation® technology health literacy intervention. Methods: We conducted a six-month feasibility study among patients with cardiovascular disease (CVD) risk factors receiving care from hospital-based primary care clinics. All patients received a personalized Meducation® calendar listing CVD-related medications. We evaluated changes in medication adherence and clinical outcomes at six months. Results: There was a 42% enrollment rate (n= 23). Forty percent had low health literacy, defined as less than 9th grade reading level. At three months, self-reported medication adherence improved. At six months, medication possession ratio improved 3.2%. Also, at six months there were decreases in patients' average systolic blood pressure (0.5. mmHg), diastolic blood pressure (1.5 mmHg), and body weight (3.6 pounds) (p> 0.05). Conclusions: A health literacy intervention may be a feasible mechanism to improve cardiovascular-related medication adherence and outcomes. Practice implications: Health literacy interventions may improve adherence while requiring relatively few resources to implement. © 2014.

Authors
Zullig, LL; McCant, F; Melnyk, SD; Danus, S; Bosworth, HB
MLA Citation
Zullig, LL, McCant, F, Melnyk, SD, Danus, S, and Bosworth, HB. "A health literacy pilot intervention to improve medication adherence using Meducation® technology." Patient Education and Counseling 95.2 (January 1, 2014): 288-291.
Source
scopus
Published In
Patient Education and Counseling
Volume
95
Issue
2
Publish Date
2014
Start Page
288
End Page
291
DOI
10.1016/j.pec.2014.02.004

The changing face of general internal medicine and lessons learned from geriatric medicine

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "The changing face of general internal medicine and lessons learned from geriatric medicine." Journal of General Internal Medicine 29.6 (January 1, 2014): 824-826.
Source
scopus
Published In
Journal of General Internal Medicine
Volume
29
Issue
6
Publish Date
2014
Start Page
824
End Page
826
DOI
10.1007/s11606-014-2799-8

Strategic planning to reduce the burden of stroke among veterans: Using simulation modeling to inform decision making

BACKGROUND AND PURPOSE - : Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. METHODS - : A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. RESULTS - : At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35 517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27 856) and hypertension control among diabetics (23 100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. CONCLUSIONS - : Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained. © 2014 American Heart Association, Inc.

Authors
Lich, KH; Tian, Y; Beadles, CA; Williams, LS; Bravata, DM; Cheng, EM; Bosworth, HB; Homer, JB; Matchar, DB
MLA Citation
Lich, KH, Tian, Y, Beadles, CA, Williams, LS, Bravata, DM, Cheng, EM, Bosworth, HB, Homer, JB, and Matchar, DB. "Strategic planning to reduce the burden of stroke among veterans: Using simulation modeling to inform decision making." Stroke 45.7 (January 1, 2014): 2078-2084.
Source
scopus
Published In
Stroke
Volume
45
Issue
7
Publish Date
2014
Start Page
2078
End Page
2084
DOI
10.1161/STROKEAHA.114.004694

Validation of a measure of family experience of patients with serious illness: The QUAL-E (fam)

© 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.Context Family members of seriously ill patients experience significant burden as they advocate with providers and participate in key decisions for loved ones. Most assessments focus on patient experience, yet family members' own quality of experience is central to comprehensive care. Objectives This study validated a measure of the quality of family experience, the QUAL-E (Fam), in palliative care. Methods We enrolled family members of terminally ill patients admitted to general medicine services at two hospitals. Items were based on foundational work originally done for the patient instrument, QUAL-E, and interviews of family members of terminally ill patients. Cognitive interviewing was used to refine items, which then underwent formal testing factor analysis. In the first sample, we assessed factor structure. A subsequent sample established predictive validity and test-retest reliability. Results The initial item pool was reduced to a four-domain, 35-item scale and administered to the validation sample. Further analyses produced a final brief scale comprising 17 items, demonstrating appropriate convergent and divergent validity. Test-retest reliability demonstrated expected levels of stability in a highly changeable population. The scale provides an assessment of family experience and includes subscales assessing relationship with health care provider and completion. Additional scale items assess symptom experience and issues of preparation. Conclusion The QUAL-E (Fam) is a companion instrument to the patient QUAL-E measure of quality of life at the end of life and is part of a package of assessment tools that can help evaluate the entire patient experience and contribute to quality care.

Authors
Steinhauser, KE; Voils, CI; Bosworth, HB; Tulsky, JA
MLA Citation
Steinhauser, KE, Voils, CI, Bosworth, HB, and Tulsky, JA. "Validation of a measure of family experience of patients with serious illness: The QUAL-E (fam)." Journal of Pain and Symptom Management 48.6 (January 1, 2014): 1168-1181.
Source
scopus
Published In
Journal of Pain and Symptom Management
Volume
48
Issue
6
Publish Date
2014
Start Page
1168
End Page
1181
DOI
10.1016/j.jpainsymman.2014.04.006

Striking a balance in communicating pharmacogenetic test results: Promoting comprehension and minimizing adverse psychological and behavioral response

© 2014 Elsevier Ireland Ltd.Objective: Pharmacogenetic (PGx) testing can provide information about a patient's likelihood to respond to a medication or experience an adverse event, and be used to inform medication selection and/or dosing. Promoting patient comprehension of PGx test results will be important to improving engagement and understanding of treatment decisions. Methods: The discussion in this paper is based on our experiences and the literature on communication of genetic test results for disease risk and broad risk communication strategies. Results: Clinical laboratory reports often describe PGx test results using standard terminology such as 'poor metabolizer' or 'ultra-rapid metabolizer.' While this type of terminology may promote patient recall with its simple, yet descriptive nature, it may be difficult for some patients to comprehend and/or cause adverse psychological or behavioral responses. Conclusion: The language used to communicate results and their significance to patients will be important to consider in order to minimize confusion and potential psychological consequences such as increased anxiety that can adversely impact medication-taking behaviors. Practice implications: Due to patients' unfamiliarity with PGx testing and the potential for confusion, adverse psychological effects, and decreased medication adherence, health providers need to be cognizant of the language used in discussing PGx test results with patients.

Authors
Haga, SB; Mills, R; Bosworth, H
MLA Citation
Haga, SB, Mills, R, and Bosworth, H. "Striking a balance in communicating pharmacogenetic test results: Promoting comprehension and minimizing adverse psychological and behavioral response." Patient Education and Counseling 97.1 (January 1, 2014): 10-15. (Review)
Source
scopus
Published In
Patient Education and Counseling
Volume
97
Issue
1
Publish Date
2014
Start Page
10
End Page
15
DOI
10.1016/j.pec.2014.06.007

PTSD is negatively associated with physical performance and physical function in older overweight military Veterans.

This study examines the effect of posttraumatic stress disorder (PTSD) on function and physical performance in older overweight military Veterans with comorbid conditions. This is a secondary data analysis of older Veterans (mean age = 62.9 yr) participating in a physical activity counseling trial. Study participants with PTSD (n = 67) and without PTSD (n = 235) were identified. Self-reported physical function (36-item Short Form Health Survey) and directly measured physical performance (mobility, aerobic endurance, strength) were assessed. Multivariate analyses of variance controlling for demographic factors and psychiatric disorders demonstrated significant physical impairment among those with PTSD. PTSD was negatively associated with self-reported physical function, functioning in daily activities, and general health (p < 0.01). Those with PTSD also performed significantly worse on tests of lower-limb function (p < 0.05). Despite being significantly younger, Veterans with PTSD had comparable scores on gait speed, aerobic endurance, grip strength, and bodily pain compared with Veterans without PTSD. This study provides preliminary data for the negative association between PTSD and physical function in older military Veterans. These data highlight the importance of ongoing monitoring of physical performance among returning Veterans with PTSD and intervening in older overweight Veterans with PTSD, whose physical performance scores are indicative of accelerated risk of premature functional aging.

Authors
Hall, KS; Beckham, JC; Bosworth, HB; Sloane, R; Pieper, CF; Morey, MC
MLA Citation
Hall, KS, Beckham, JC, Bosworth, HB, Sloane, R, Pieper, CF, and Morey, MC. "PTSD is negatively associated with physical performance and physical function in older overweight military Veterans." Journal of rehabilitation research and development 51.2 (January 2014): 285-295.
PMID
24933726
Source
epmc
Published In
Journal of Rehabilitation Research and Development
Volume
51
Issue
2
Publish Date
2014
Start Page
285
End Page
295
DOI
10.1682/jrrd.2013.04.0091

Medication adherence: process for implementation.

Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications.

Authors
Mendys, P; Zullig, LL; Burkholder, R; Granger, BB; Bosworth, HB
MLA Citation
Mendys, P, Zullig, LL, Burkholder, R, Granger, BB, and Bosworth, HB. "Medication adherence: process for implementation." Patient preference and adherence 8 (January 2014): 1025-1034.
PMID
25114513
Source
epmc
Published In
Patient Preference and Adherence
Volume
8
Publish Date
2014
Start Page
1025
End Page
1034
DOI
10.2147/ppa.s65041

Enlisting New Teachers in Clinical Environments (ENTICE); novel ways to engage clinicians.

PURPOSE: To explore the barriers and incentives that affect primary care providers who precept students in outpatient clinics in the US. METHOD: In 2013, leadership of our large primary care group sent a 20-question survey via e-mail to all of the 180 providers within the network. The survey assessed provider demographics, precepting history, learner preferences, and other issues that might affect future decisions about teaching. RESULTS: The response rate was 50% (90 providers). The top reasons for precepting in the past were enjoyment for teaching and personal interaction with learners. The most commonly cited reason for not precepting previously was a perceived lack of time followed by increased productivity demands. When questioned about the future, 65% (59 respondents) indicated that they were likely to precept within the next 6 months. A desired reduction in productivity expectations was the most commonly cited motivator, followed by anticipated monetary compensation and adjusted appointment times. A top barrier to future precepting was a belief that teaching decreases productivity and requires large amounts of time. CONCLUSION: This survey represents an opportunity to study a change in focus for a cohort of busy clinicians who were mostly new to teaching but not new to clinical practice. The survey provides further insight into clinician educators' perceptions regarding the education of a variety of different learners. The results align with data from previous studies in that time pressures and productivity demands transcend specific programs and learner backgrounds. This information is critical for future clerkship directors and hospital administrators in order to understand how to increase support for potential preceptors in medical education.

Authors
Peyser, B; Daily, KA; Hudak, NM; Railey, K; Bosworth, HB
MLA Citation
Peyser, B, Daily, KA, Hudak, NM, Railey, K, and Bosworth, HB. "Enlisting New Teachers in Clinical Environments (ENTICE); novel ways to engage clinicians." Advances in medical education and practice 5 (January 2014): 359-367.
Website
http://hdl.handle.net/10161/12984
PMID
25337001
Source
epmc
Published In
Advances in Medical Education and Practice
Volume
5
Publish Date
2014
Start Page
359
End Page
367
DOI
10.2147/amep.s69063

mHealth interventions for weight loss: a guide for achieving treatment fidelity

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.UNLABELLED: mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs.TRIAL REGISTRATION NUMBER: 1F31 NR012599.

Authors
Shaw, RJ; Steinberg, DM; Zullig, LL; Bosworth, HB; Johnson, CM; Davis, LL
MLA Citation
Shaw, RJ, Steinberg, DM, Zullig, LL, Bosworth, HB, Johnson, CM, and Davis, LL. "mHealth interventions for weight loss: a guide for achieving treatment fidelity." Journal of the American Medical Informatics Association : JAMIA 21.6 (2014): 959-963.
Source
scival
Published In
Journal of the American Medical Informatics Association
Volume
21
Issue
6
Publish Date
2014
Start Page
959
End Page
963
DOI
10.1136/amiajnl-2013-002610

Ingredients of successful interventions to improve medication adherence.

Authors
Zullig, LL; Peterson, ED; Bosworth, HB
MLA Citation
Zullig, LL, Peterson, ED, and Bosworth, HB. "Ingredients of successful interventions to improve medication adherence." JAMA 310.24 (December 25, 2013): 2611-2612.
PMID
24264605
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
310
Issue
24
Publish Date
2013
Start Page
2611
End Page
2612
DOI
10.1001/jama.2013.282818

Health Illiteracy and Cognitive Dysfunction Are Common in Veterans Presenting With Acute Coronary Syndrome: Insights From the MEDICATION Study

Authors
Marzec, LN; Lambert-Kerzner, A; Carey, F; Del Giacco, EJ; Melnyk, SD; Bryson, CL; Fahdi, IE; Bosworth, HB; Fiocchi, F; Ho, M
MLA Citation
Marzec, LN, Lambert-Kerzner, A, Carey, F, Del Giacco, EJ, Melnyk, SD, Bryson, CL, Fahdi, IE, Bosworth, HB, Fiocchi, F, and Ho, M. "Health Illiteracy and Cognitive Dysfunction Are Common in Veterans Presenting With Acute Coronary Syndrome: Insights From the MEDICATION Study." November 26, 2013.
Source
wos-lite
Published In
Circulation
Volume
128
Issue
22
Publish Date
2013

Mobile health messages help sustain recent weight loss

Background Using regulatory focus theory, an intervention of daily weight loss-sustaining messages was developed and tested for acceptability, feasibility, and efficacy on helping people sustain weight loss. Methods Participants (n = 120) were randomized to a promotion, prevention, or an attention-control text message group after completion of a weight loss program. Participants completed baseline assessments, and reported their weight at 1 and 3 months postbaseline. Results Participants found the message content and intervention acceptable and valuable. A minimum of one message per day delivered at approximately 8:00 am was deemed the optimal delivery time and frequency. The sustained weight loss rate at month 3 for the control, promotion, and prevention groups was 90%, 95%, and 100%, respectively. Medium-to-large effects were observed for the promotion and prevention groups at month 1 and for prevention at month 3 relative to controls. The mean weight loss for promotion and prevention was 15 pounds, compared with 10 in the controls at month 3. Conclusion A clinically significant decrease in mean weight, higher rate of sustained weight loss, and medium-to-large effects on sustained weight loss occurred in the promotion and prevention interventions. Tools such as this text message-based intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes. © 2013 Elsevier Inc. All rights reserved.

Authors
Shaw, RJ; Bosworth, HB; Silva, SS; Lipkus, IM; Davis, LL; Sha, RS; Johnson, CM
MLA Citation
Shaw, RJ, Bosworth, HB, Silva, SS, Lipkus, IM, Davis, LL, Sha, RS, and Johnson, CM. "Mobile health messages help sustain recent weight loss." American Journal of Medicine 126.11 (November 1, 2013): 1002-1009.
Source
scopus
Published In
The American Journal of Medicine
Volume
126
Issue
11
Publish Date
2013
Start Page
1002
End Page
1009
DOI
10.1016/j.amjmed.2013.07.001

Mobile health messages help sustain recent weight loss.

BACKGROUND: Using regulatory focus theory, an intervention of daily weight loss-sustaining messages was developed and tested for acceptability, feasibility, and efficacy on helping people sustain weight loss. METHODS: Participants (n = 120) were randomized to a promotion, prevention, or an attention-control text message group after completion of a weight loss program. Participants completed baseline assessments, and reported their weight at 1 and 3 months postbaseline. RESULTS: Participants found the message content and intervention acceptable and valuable. A minimum of one message per day delivered at approximately 8:00 am was deemed the optimal delivery time and frequency. The sustained weight loss rate at month 3 for the control, promotion, and prevention groups was 90%, 95%, and 100%, respectively. Medium-to-large effects were observed for the promotion and prevention groups at month 1 and for prevention at month 3 relative to controls. The mean weight loss for promotion and prevention was 15 pounds, compared with 10 in the controls at month 3. CONCLUSION: A clinically significant decrease in mean weight, higher rate of sustained weight loss, and medium-to-large effects on sustained weight loss occurred in the promotion and prevention interventions. Tools such as this text message-based intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.

Authors
Shaw, RJ; Bosworth, HB; Silva, SS; Lipkus, IM; Davis, LL; Sha, RS; Johnson, CM
MLA Citation
Shaw, RJ, Bosworth, HB, Silva, SS, Lipkus, IM, Davis, LL, Sha, RS, and Johnson, CM. "Mobile health messages help sustain recent weight loss." Am J Med 126.11 (November 2013): 1002-1009.
PMID
24050486
Source
pubmed
Published In
American Journal of Medicine
Volume
126
Issue
11
Publish Date
2013
Start Page
1002
End Page
1009
DOI
10.1016/j.amjmed.2013.07.001

Association between perceived life chaos and medication adherence in a postmyocardial infarction population.

BACKGROUND: The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence. METHODS AND RESULTS: Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence. CONCLUSIONS: Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.

Authors
Zullig, LL; Shaw, RJ; Crowley, MJ; Lindquist, J; Grambow, SC; Peterson, E; Shah, BR; Bosworth, HB
MLA Citation
Zullig, LL, Shaw, RJ, Crowley, MJ, Lindquist, J, Grambow, SC, Peterson, E, Shah, BR, and Bosworth, HB. "Association between perceived life chaos and medication adherence in a postmyocardial infarction population." Circ Cardiovasc Qual Outcomes 6.6 (November 2013): 619-625.
PMID
24221839
Source
pubmed
Published In
Circulation. Cardiovascular quality and outcomes
Volume
6
Issue
6
Publish Date
2013
Start Page
619
End Page
625
DOI
10.1161/CIRCOUTCOMES.113.000435

Challenges facing translational research organizations in China: A qualitative multiple case study

Background: Translational medicine is attracting much attention worldwide and many translational research organizations (TROs) have been established. In China, translational medicine has developed rapidly, but faces many challenges. This study was aimed at exploring these challenges faced by emerging TROs in China. Method: A qualitative, multiple case study approach was used to assess the challenges faced by TROs in China. Data were collected between May and August 2012. Results: Eight cases were identified. Overall, four themes that characterized TROs in China emerged from analyses: 1. objectives, organizer, and funding resources, 2. participating partners and research teams, 3. management, and 4. achievements. All TROs had objectives related to translating basic discovery to clinic treatment and cultivating translational researchers. In terms of organizer and funding resources, 7 out of 8 TROs were launched only by universities and/or hospitals, and funded mostly through research grants. As for participating partners and multidisciplinary research teams, all but one of the TROs only involved biomedical research institutions who were interested in translational research, and characterized as clinical research centers; 7 out of 8 TROs involved only researchers from biomedicine and clinical disciplines and none involved disciplines related to education, ethnicity, and sociology, or engaged the community. Current management of the TROs were generally nested within the traditional research management paradigms, and failed to adapt to the tenets of translational research. Half of the TROs were at developmental stages defined as infrastructure construction and recruitment of translational researchers. Conclusions: TROs in China face the challenge of attracting sustainable funding sources, widening multidisciplinary cooperation, cultivating multi-disciplinary translational researchers and adapting current research management to translational research. Greater emphasis should be placed on increasing multidisciplinary cooperation, and innovating in education programs to cultivate of translational researchers. Efforts should be made to reform research management in TROs, and establish sustainable funding resources. © 2013 Zhou et al.; licensee BioMed Central Ltd.

Authors
Zhou, L; Li, Y; Bosworth, HB; Ehiri, J; Luo, C
MLA Citation
Zhou, L, Li, Y, Bosworth, HB, Ehiri, J, and Luo, C. "Challenges facing translational research organizations in China: A qualitative multiple case study." Journal of Translational Medicine 11.1 (October 13, 2013).
PMID
24119837
Source
scopus
Published In
Journal of Translational Medicine
Volume
11
Issue
1
Publish Date
2013
DOI
10.1186/1479-5876-11-256

Patient Characteristics Associated With Insomnia and Sleep Apnea In Knee and Hip OA

Authors
Allen, KD; Bosworth, HB; Coffman, C; Jeffreys, A; Oddone, EZ; Jr, YWS; Ulmer, C
MLA Citation
Allen, KD, Bosworth, HB, Coffman, C, Jeffreys, A, Oddone, EZ, Jr, YWS, and Ulmer, C. "Patient Characteristics Associated With Insomnia and Sleep Apnea In Knee and Hip OA." October 2013.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
65
Publish Date
2013
Start Page
S458
End Page
S459

Association Of Back Pain With Functional Limitations In Patients With Knee and Hip Osteoarthritis

Authors
Goode, AP; Bosworth, HB; Coffman, C; Jeffreys, A; Oddone, EZ; Jr, YWS; Allen, KD
MLA Citation
Goode, AP, Bosworth, HB, Coffman, C, Jeffreys, A, Oddone, EZ, Jr, YWS, and Allen, KD. "Association Of Back Pain With Functional Limitations In Patients With Knee and Hip Osteoarthritis." October 2013.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
65
Publish Date
2013
Start Page
S1224
End Page
S1224

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

BACKGROUND: Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. OBJECTIVES: Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? STUDY DESIGN: Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. RESULTS: Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. CONCLUSIONS: The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.

Authors
Shaw, RJ; Kaufman, MA; Bosworth, HB; Weiner, BJ; Zullig, LL; Lee, S-YD; Kravetz, JD; Rakley, SM; Roumie, CL; Bowen, ME; Del Monte, PS; Oddone, EZ; Jackson, GL
MLA Citation
Shaw, RJ, Kaufman, MA, Bosworth, HB, Weiner, BJ, Zullig, LL, Lee, S-YD, Kravetz, JD, Rakley, SM, Roumie, CL, Bowen, ME, Del Monte, PS, Oddone, EZ, and Jackson, GL. "Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. (Published online)" Implement Sci 8 (September 8, 2013): 106-.
PMID
24010683
Source
pubmed
Published In
Implementation Science
Volume
8
Publish Date
2013
Start Page
106
DOI
10.1186/1748-5908-8-106

Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics.

BACKGROUND: Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension. METHODS: Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness. RESULTS: Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending. CONCLUSIONS: If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings.

Authors
Crowley, MJ; Bosworth, HB; Coffman, CJ; Lindquist, JH; Neary, AM; Harris, AC; Datta, SK; Granger, BB; Pereira, K; Dolor, RJ; Edelman, D
MLA Citation
Crowley, MJ, Bosworth, HB, Coffman, CJ, Lindquist, JH, Neary, AM, Harris, AC, Datta, SK, Granger, BB, Pereira, K, Dolor, RJ, and Edelman, D. "Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics." Contemp Clin Trials 36.1 (September 2013): 298-306.
PMID
23916915
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
36
Issue
1
Publish Date
2013
Start Page
298
End Page
306
DOI
10.1016/j.cct.2013.07.010

The role of home blood pressure telemonitoring in managing hypertensive populations.

Hypertension is a common chronic disease affecting nearly one-third of the United States population. Many interventions have been designed to help patients manage their hypertension. With the evolving climate of healthcare, rapidly developing technology, and emphasis on delivering patient-centered care, home-based blood pressure telemonitoring is a promising tool to help patients achieve optimal blood pressure (BP) control. Home-based blood pressure telemonitoring is associated with reductions in blood pressure values and increased patient satisfaction. However, additional research is needed to understand cost-effectiveness and long-term clinical outcomes of home-based BP monitoring. We review key interventional trials involving home based BP monitoring, with special emphasis placed on studies involving additionally behavioral modification and/or medication management. Furthermore, we discuss the role of home-based blood pressure telemonitoring within the context of the patient-centered medical home and the evolving role of technology.

Authors
Zullig, LL; Melnyk, SD; Goldstein, K; Shaw, RJ; Bosworth, HB
MLA Citation
Zullig, LL, Melnyk, SD, Goldstein, K, Shaw, RJ, and Bosworth, HB. "The role of home blood pressure telemonitoring in managing hypertensive populations." Curr Hypertens Rep 15.4 (August 2013): 346-355. (Review)
PMID
23625207
Source
pubmed
Published In
Current Hypertension Reports
Volume
15
Issue
4
Publish Date
2013
Start Page
346
End Page
355
DOI
10.1007/s11906-013-0351-6

Recruiting young adults into a weight loss trial: report of protocol development and recruitment results.

Obesity has spread to all segments of the U.S. population. Young adults, aged 18-35 years, are rarely represented in clinical weight loss trials. We conducted a qualitative study to identify factors that may facilitate recruitment of young adults into a weight loss intervention trial. Participants were 33 adults aged 18-35 years with BMI ≥25 kg/m(2). Six group discussions were conducted using the nominal group technique. Health, social image, and "self" factors such as emotions, self-esteem, and confidence were reported as reasons to pursue weight loss. Physical activity, dietary intake, social support, medical intervention, and taking control (e.g. being motivated) were perceived as the best weight loss strategies. Incentives, positive outcomes, education, convenience, and social support were endorsed as reasons young adults would consider participating in a weight loss study. Incentives, advertisement, emphasizing benefits, and convenience were endorsed as ways to recruit young adults. These results informed the Cellphone Intervention for You (CITY) marketing and advertising, including message framing and advertising avenues. Implications for recruitment methods are discussed.

Authors
Corsino, L; Lin, P-H; Batch, BC; Intille, S; Grambow, SC; Bosworth, HB; Bennett, GG; Tyson, C; Svetkey, LP; Voils, CI
MLA Citation
Corsino, L, Lin, P-H, Batch, BC, Intille, S, Grambow, SC, Bosworth, HB, Bennett, GG, Tyson, C, Svetkey, LP, and Voils, CI. "Recruiting young adults into a weight loss trial: report of protocol development and recruitment results." Contemp Clin Trials 35.2 (July 2013): 1-7.
Website
http://hdl.handle.net/10161/10735
PMID
23591327
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
35
Issue
2
Publish Date
2013
Start Page
1
End Page
7
DOI
10.1016/j.cct.2013.04.002

Progression of diabetic retinopathy in the hypertension intervention nurse telemedicine study.

Authors
Muir, KW; Grubber, J; Mruthyunjaya, P; McCant, F; Bosworth, HB
MLA Citation
Muir, KW, Grubber, J, Mruthyunjaya, P, McCant, F, and Bosworth, HB. "Progression of diabetic retinopathy in the hypertension intervention nurse telemedicine study." JAMA Ophthalmol 131.7 (July 2013): 957-958. (Letter)
PMID
23702951
Source
pubmed
Published In
JAMA Ophthalmology
Volume
131
Issue
7
Publish Date
2013
Start Page
957
End Page
958
DOI
10.1001/jamaophthalmol.2013.81

Setting the Stage: Research to Inform Interventions, Practice and Policy to Improve Women Veterans' Health and Health Care

Authors
Bastian, LA; Bosworth, HB; Washington, DL; Yano, EM
MLA Citation
Bastian, LA, Bosworth, HB, Washington, DL, and Yano, EM. "Setting the Stage: Research to Inform Interventions, Practice and Policy to Improve Women Veterans' Health and Health Care." JOURNAL OF GENERAL INTERNAL MEDICINE 28 (July 2013): S491-S494.
PMID
23807053
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
28
Publish Date
2013
Start Page
S491
End Page
S494
DOI
10.1007/s11606-013-2470-9

The meanings associated with medicines in heart failure patients.

BACKGROUND: The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear. METHODS: Using a prospective mixed methods design, the study assessed patients' (n=10) perception of chronic heart failure symptoms and medication adherence. Patients completed guided interviews related to six concepts of meaning ascribed to medication use and four standardized measures of medication-related beliefs, behaviours, symptoms, and satisfaction. RESULTS: This study suggests that patients' perception of meaning associated with medication taking was categorized as positive, negative, or absent. Symptom persistence influenced a majority of patient beliefs in the efficacy medicines, and patients with more positive meaningful associations with their medicines were more likely to remain adherent during the course of this study. CONCLUSIONS: Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.

Authors
Granger, BB; McBroom, K; Bosworth, HB; Hernandez, A; Ekman, I
MLA Citation
Granger, BB, McBroom, K, Bosworth, HB, Hernandez, A, and Ekman, I. "The meanings associated with medicines in heart failure patients." Eur J Cardiovasc Nurs 12.3 (June 2013): 276-283.
PMID
22653088
Source
pubmed
Published In
European Journal of Cardiovascular Nursing
Volume
12
Issue
3
Publish Date
2013
Start Page
276
End Page
283
DOI
10.1177/1474515112447734

Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy.

We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain (Arthritis Impact Measurement Scales-2 [AIMS2] and Visual Analogue Scale), function (AIMS2 mobility and walking/bending), affect (AIMS2) and arthritis self-efficacy by: (i) race (white/non-white), (ii) health literacy (high/low) and (iii) race by health literacy. AIMS2 mobility improved more among non-whites than whites in the intervention compared with HE and UC (P = 0.02 and 0.008). AIMS2 pain improved more among participants with low than high literacy in the intervention compared with HE (P = 0.05). However, we found a differential effect of the intervention on AIMS2 pain compared with UC according to the combination of race and health literacy (P = 0.05); non-whites with low literacy in the intervention had the greatest improvement in pain. This telephone-based OA intervention may be particularly beneficial for patients with OA who are racial/ethnic minorities and have low health literacy. These results warrant further research designed specifically to assess whether this type of intervention can reduce OA disparities.

Authors
Sperber, NR; Bosworth, HB; Coffman, CJ; Lindquist, JH; Oddone, EZ; Weinberger, M; Allen, KD
MLA Citation
Sperber, NR, Bosworth, HB, Coffman, CJ, Lindquist, JH, Oddone, EZ, Weinberger, M, and Allen, KD. "Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy." Health Educ Res 28.3 (June 2013): 502-511.
PMID
23525779
Source
pubmed
Published In
Health Education Research
Volume
28
Issue
3
Publish Date
2013
Start Page
502
End Page
511
DOI
10.1093/her/cyt043

Telemedicine cardiovascular risk reduction in veterans.

BACKGROUND: Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical pharmacy specialist-, telephone-administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk. METHODS: Randomized controlled trial including patients with hypertension (blood pressure >150/100 mm Hg) or elevated low density liporotein (>130 mg/dL). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined. CONCLUSION: Given the national prevalence of CVD and the dismal rates of risk factor control, intensive but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans.

Authors
Melnyk, SD; Zullig, LL; McCant, F; Danus, S; Oddone, E; Bastian, L; Olsen, M; Stechuchak, KM; Edelman, D; Rakley, S; Morey, M; Bosworth, HB
MLA Citation
Melnyk, SD, Zullig, LL, McCant, F, Danus, S, Oddone, E, Bastian, L, Olsen, M, Stechuchak, KM, Edelman, D, Rakley, S, Morey, M, and Bosworth, HB. "Telemedicine cardiovascular risk reduction in veterans." Am Heart J 165.4 (April 2013): 501-508.
PMID
23537965
Source
pubmed
Published In
American Heart Journal
Volume
165
Issue
4
Publish Date
2013
Start Page
501
End Page
508
DOI
10.1016/j.ahj.2012.08.005

PREDICTORS OF FATIGUE IN PATIENTS WITH HIP AND KNEE OSTEOARTHRITIS

Authors
Allen, KD; Bosworth, HB; Coffman, CJ; Jeffreys, AS; Oddone, EZ; Jr, YWS
MLA Citation
Allen, KD, Bosworth, HB, Coffman, CJ, Jeffreys, AS, Oddone, EZ, and Jr, YWS. "PREDICTORS OF FATIGUE IN PATIENTS WITH HIP AND KNEE OSTEOARTHRITIS." April 2013.
Source
wos-lite
Published In
Osteoarthritis and Cartilage
Volume
21
Publish Date
2013
Start Page
S250
End Page
S250

ASSOCIATIONS OF FREQUENT PREDICTABLE AND UNPREDICTABLE PAIN WITH FUNCTIONAL AND PSYCHOLOGICAL OUTCOMES

Authors
Allen, KD; Bosworth, HB; Coffman, CJ; Jeffreys, AS; Oddone, EZ; Jr, YWS
MLA Citation
Allen, KD, Bosworth, HB, Coffman, CJ, Jeffreys, AS, Oddone, EZ, and Jr, YWS. "ASSOCIATIONS OF FREQUENT PREDICTABLE AND UNPREDICTABLE PAIN WITH FUNCTIONAL AND PSYCHOLOGICAL OUTCOMES." April 2013.
Source
wos-lite
Published In
Osteoarthritis and Cartilage
Volume
21
Publish Date
2013
Start Page
S263
End Page
S264

Health literacy and glaucoma.

PURPOSE OF REVIEW: This review discusses the concept and measurement of health literacy, with a focus on the care of patients with glaucoma. RECENT FINDINGS: Nearly one-fourth of adults in the USA lack the skills needed to fully comprehend and act on verbal or written information in the healthcare environment. This problem, referred to as poor health literacy, is associated with worse health-related outcomes in many chronic diseases, including glaucoma. Patients with glaucoma and poor literacy skills are less likely to refill their prescribed medications and miss more scheduled appointments than their more literate peers. Moreover, ophthalmic educational materials are often written at a level of readability that surpasses the skills of many patients with glaucoma. SUMMARY: Patients with chronic eye diseases such as glaucoma and limited health literacy skills are vulnerable to poor visual outcomes. Attention to health literacy may improve the care and outcomes of these patients.

Authors
Muir, KW; Christensen, L; Bosworth, HB
MLA Citation
Muir, KW, Christensen, L, and Bosworth, HB. "Health literacy and glaucoma." Curr Opin Ophthalmol 24.2 (March 2013): 119-124. (Review)
PMID
23241740
Source
pubmed
Published In
Current Opinion in Ophthalmology
Volume
24
Issue
2
Publish Date
2013
Start Page
119
End Page
124
DOI
10.1097/ICU.0b013e32835c8b0e

Group physical therapy for veterans with knee osteoarthritis: study design and methodology.

Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that cost-effectively extend PT services for patients with this condition. This manuscript describes a randomized clinical trial of a group-based physical therapy program that can potentially extend services to more patients with knee OA, providing a greater number of sessions per patient, at lower staffing costs compared to traditional individual PT. Participants with symptomatic knee OA (n = 376) are randomized to either a 12-week group-based PT program (six 1 h sessions, eight patients per group, led by a physical therapist and physical therapist assistant) or usual PT care (two individual visits with a physical therapist). Participants in both PT arms receive instruction in an exercise program, information on joint care and protection, and individual consultations with a physical therapist to address specific functional and therapeutic needs. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and the secondary outcome is the Short Physical Performance Test Protocol (objective physical function). Outcomes are assessed at baseline and 12-week follow-up, and the primary outcome is also assessed via telephone at 24-week follow-up to examine sustainability of effects. Linear mixed models will be used to compare outcomes for the two study arms. An economic cost analysis of the PT interventions will also be conducted.

Authors
Allen, KD; Bongiorni, D; Walker, TA; Bartle, J; Bosworth, HB; Coffman, CJ; Datta, SK; Edelman, D; Hall, KS; Hansen, G; Jennings, C; Lindquist, JH; Oddone, EZ; Senick, MJ; Sizemore, JC; St John, J; Hoenig, H
MLA Citation
Allen, KD, Bongiorni, D, Walker, TA, Bartle, J, Bosworth, HB, Coffman, CJ, Datta, SK, Edelman, D, Hall, KS, Hansen, G, Jennings, C, Lindquist, JH, Oddone, EZ, Senick, MJ, Sizemore, JC, St John, J, and Hoenig, H. "Group physical therapy for veterans with knee osteoarthritis: study design and methodology." Contemp Clin Trials 34.2 (March 2013): 296-304.
PMID
23279750
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
34
Issue
2
Publish Date
2013
Start Page
296
End Page
304
DOI
10.1016/j.cct.2012.12.007

Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument.

BACKGROUND: Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs. OBJECTIVES: 1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure. DESIGN: Cross-sectional analysis of randomized trial data. PATIENTS: Six hundred and thirty-six primary care patients with hypertension. MEASUREMENTS: 1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP. CONCLUSIONS: We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with non-adherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of non-adherent patients with hypertension.

Authors
Crowley, MJ; Grubber, JM; Olsen, MK; Bosworth, HB
MLA Citation
Crowley, MJ, Grubber, JM, Olsen, MK, and Bosworth, HB. "Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument." J Gen Intern Med 28.1 (January 2013): 99-106.
PMID
22926634
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
28
Issue
1
Publish Date
2013
Start Page
99
End Page
106
DOI
10.1007/s11606-012-2195-1

A randomized controlled trial to evaluate the effectiveness of CouPLES: a spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol.

OBJECTIVE: This randomized controlled trial evaluated the effectiveness of a telephone-delivered, spouse-assisted lifestyle intervention to reduce patient LDL-C. METHOD: From 2007 to 2010, 255 outpatients with LDL-C>76 mg/dL and their spouses from the Durham Veterans Affairs Medical Center were randomized to intervention or usual care. The intervention comprised nine monthly goal-setting telephone calls to patients and support planning calls to spouses. Outcomes were assessed at 11 months. RESULTS: Patients were 95% male and 65% White. LDL-C did not differ between groups (mean difference = 2.3 mg/dL, 95% CI = -3.6, 8.3, p = 0.44), nor did the odds of meeting goal LDL-C (OR = 0.95, 95% CI = 0.6, 1.7; p = 0.87). Intakes of calories (p = 0.03), total fat (p = 0.02), and saturated fat (p = 0.02) were lower for the intervention group. Cholesterol and fiber intake did not differ between groups (p = 0.11 and 0.26, respectively). The estimated rate of moderate intensity physical activity per week was 20% higher in the intervention group (IRR = 1.2, 95% CI = 1.0, 1.5, p = 0.06). Most participants did not experience a change in cholesterol medication usage during the study period in the intervention (71.7%) and usual care (78.9%) groups. CONCLUSION: This intervention might be an adjunct to usual primary care to improve adherence to lifestyle behaviors.

Authors
Voils, CI; Coffman, CJ; Yancy, WS; Weinberger, M; Jeffreys, AS; Datta, S; Kovac, S; McKenzie, J; Smith, R; Bosworth, HB
MLA Citation
Voils, CI, Coffman, CJ, Yancy, WS, Weinberger, M, Jeffreys, AS, Datta, S, Kovac, S, McKenzie, J, Smith, R, and Bosworth, HB. "A randomized controlled trial to evaluate the effectiveness of CouPLES: a spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol." Prev Med 56.1 (January 2013): 46-52.
PMID
23146744
Source
pubmed
Published In
Preventive Medicine
Volume
56
Issue
1
Publish Date
2013
Start Page
46
End Page
52
DOI
10.1016/j.ypmed.2012.11.001

Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women.

Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d = .15). However, non-dippers endorsed more traumatic event categories (d = .53), more PTSD hyperarousal symptoms (d = .53), poorer overall sleep quality (d = .59), more frequent use of sleep medication (d = .62), greater sleep-related daytime dysfunction (d = .58), and longer sleep onset latencies (d = .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.

Authors
Ulmer, CS; Calhoun, PS; Bosworth, HB; Dennis, MF; Beckham, JC
MLA Citation
Ulmer, CS, Calhoun, PS, Bosworth, HB, Dennis, MF, and Beckham, JC. "Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women." Behav Med 39.4 (2013): 111-121.
PMID
24236808
Source
pubmed
Published In
Behavioral medicine (Washington, D.C.)
Volume
39
Issue
4
Publish Date
2013
Start Page
111
End Page
121
DOI
10.1080/08964289.2013.813434

Patient self-efficacy and spouse perception of spousal support are associated with lower patient weight: baseline results from a spousal support behavioral intervention.

Obesity and related chronic illnesses are leading causes of death and excessive health care costs, necessitating identification of factors that can help patients achieve and maintain healthy weight. Greater self-efficacy and perceived spousal support in patients have been associated with successful weight management. The current study also assesses self-efficacy and perceived support in spouses and whether these factors are related to patient weight. At baseline of a spousal support trial, patients and spouses (N = 255 couples) each completed measures of self-efficacy and spousal support for their own exercise and healthy eating behaviors. We fit a multivariable regression model to examine the relationship between these factors and patient weight. Patients were 95% males and 65% Whites, with average age of 61 years (SD = 12) and weight of 212 lbs (SD = 42). Spouses were 64% Whites, with average age of 59 years (SD = 12). Factors associated with lower patient weight were older patient age (estimate = -0.8 lbs, p < .01), normal blood pressure (estimate = -17.6 lbs, p < .01), higher patient self-efficacy for eating healthy (estimate = -3.8 lbs, p = .02), and spouse greater perceived support for eating healthy (estimate = -10.0 lbs, p = .03). Future research should explore the causal pathways between perceived support and health outcomes to establish whether patient support behaviors could be a point of intervention for weight management.

Authors
Gallagher, P; Yancy, WS; Jeffreys, AS; Coffman, CJ; Weinberger, M; Bosworth, HB; Voils, CI
MLA Citation
Gallagher, P, Yancy, WS, Jeffreys, AS, Coffman, CJ, Weinberger, M, Bosworth, HB, and Voils, CI. "Patient self-efficacy and spouse perception of spousal support are associated with lower patient weight: baseline results from a spousal support behavioral intervention." Psychol Health Med 18.2 (2013): 175-181.
PMID
22963235
Source
pubmed
Published In
Psychology, Health & Medicine
Volume
18
Issue
2
Publish Date
2013
Start Page
175
End Page
181
DOI
10.1080/13548506.2012.715176

A randomized controlled trial to evaluate the effectiveness of CouPLES: A spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol

Objective: This randomized controlled trial evaluated the effectiveness of a telephone-delivered, spouse-assisted lifestyle intervention to reduce patient LDL-C. Method: From 2007 to 2010, 255 outpatients with LDL-C>76. mg/dL and their spouses from the Durham Veterans Affairs Medical Center were randomized to intervention or usual care. The intervention comprised nine monthly goal-setting telephone calls to patients and support planning calls to spouses. Outcomes were assessed at 11. months. Results: Patients were 95% male and 65% White. LDL-C did not differ between groups (mean difference=2.3 mg/dL, 95% CI=-3.6, 8.3, p=0.44), nor did the odds of meeting goal LDL-C (OR=0.95, 95% CI=0.6, 1.7; p=0.87). Intakes of calories (p=0.03), total fat (p=0.02), and saturated fat (p=0.02) were lower for the intervention group. Cholesterol and fiber intake did not differ between groups (p=0.11 and 0.26, respectively). The estimated rate of moderate intensity physical activity per week was 20% higher in the intervention group (IRR=1.2, 95% CI=1.0, 1.5, p=0.06). Most participants did not experience a change in cholesterol medication usage during the study period in the intervention (71.7%) and usual care (78.9%) groups. Conclusion: This intervention might be an adjunct to usual primary care to improve adherence to lifestyle behaviors. © 2012.

Authors
Voils, CI; Coffman, CJ; Yancy, WS; Weinberger, M; Jeffreys, AS; Datta, S; Kovac, S; McKenzie, J; Smith, R; Bosworth, HB
MLA Citation
Voils, CI, Coffman, CJ, Yancy, WS, Weinberger, M, Jeffreys, AS, Datta, S, Kovac, S, McKenzie, J, Smith, R, and Bosworth, HB. "A randomized controlled trial to evaluate the effectiveness of CouPLES: A spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol." Preventive Medicine 56.1 (2013): 46-52.
Source
scival
Published In
Preventive Medicine
Volume
56
Issue
1
Publish Date
2013
Start Page
46
End Page
52
DOI
10.1016/j.ypmed.2012.11.001

Factors associated with non-adherence to three hypertension self-management behaviors: Preliminary data for a new instrument

Background: Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs. OBJECTIVES: 1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure. DESIGN: Cross-sectional analysis of randomized trial data. PATIENTS: Six hundred and thirty-six primary care patients with hypertension. MEASUREMENTS: 1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP. CONCLUSIONS: We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with non-adherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of non-adherent patients with hypertension. © 2012 Society of General Internal Medicine.

Authors
Crowley, MJ; Grubber, JM; Olsen, MK; Bosworth, HB
MLA Citation
Crowley, MJ, Grubber, JM, Olsen, MK, and Bosworth, HB. "Factors associated with non-adherence to three hypertension self-management behaviors: Preliminary data for a new instrument." Journal of General Internal Medicine 28.1 (2013): 99-106.
Source
scival
Published In
Journal of General Internal Medicine
Volume
28
Issue
1
Publish Date
2013
Start Page
99
End Page
106
DOI
10.1007/s11606-012-2195-1

Health literacy and glaucoma

Patients with chronic eye diseases such as glaucoma and limited health literacy skills are vulnerable to poor visual outcomes. Attention to health literacy may improve the care and outcomes of these patients. © 2013 Wolters Kluwer Health.

Authors
Muira, KW; Christensenc, L; Bosworth, HB
MLA Citation
Muira, KW, Christensenc, L, and Bosworth, HB. "Health literacy and glaucoma." Current Opinion in Ophthalmology 24.2 (2013): 119-124.
Source
scival
Published In
Current Opinion in Ophthalmology
Volume
24
Issue
2
Publish Date
2013
Start Page
119
End Page
124
DOI
10.1097/ICU.0b013e32835c8b0e

The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: Results from a randomized controlled trial in African Americans with diabetes

Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. Methods: We randomized 359 African Americans with type 2 diabetes to receive usual care or a nurse telephone intervention. The 12-month intervention provided monthly self-management support and quarterly medication management facilitation. Coprimary outcomes were changes in systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) over 12 months. We estimated between-intervention group differences over time using linear mixed-effects models. The secondary outcome was self-reported medication adherence. Results: The sample was 72% female; 49% had low health literacy, and 37% had annual income <$10,000. Model-based estimates for mean baseline SBP, HbA1c, and LDL-C were 136.8 mm Hg (95% CI 135.0-138.6), 8.0% (95% CI 7.8-8.2), and 99.1 mg/dL (95% CI 94.7-103.5), respectively. Intervention patients received 9.9 (SD 3.0) intervention calls on average. Primary providers replied to 76% of nurse medication management facilitation contacts, 18% of these resulted in medication changes. There were no between-group differences over time for SBP (P = .11), HbA1c (P = .66), or LDL-C (P = .79). Intervention patients were more likely than those receiving usual care to report improved medication adherence (odds ratio 4.4, 95% CI 1.8-10.6, P = .0008), but adherent patients did not exhibit relative improvement in primary outcomes. Conclusions: This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes. Further research is needed to determine how to maximally impact CVD risk factors in African American patients.

Authors
Crowley, MJ; Powers, BJ; Olsen, MK; Grubber, JM; Koropchak, C; Rose, CM; Gentry, P; Bowlby, L; Trujillo, G; Maciejewski, ML; al, E
MLA Citation
Crowley, MJ, Powers, BJ, Olsen, MK, Grubber, JM, Koropchak, C, Rose, CM, Gentry, P, Bowlby, L, Trujillo, G, Maciejewski, ML, and al, E. "The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: Results from a randomized controlled trial in African Americans with diabetes." American Heart Journal (2013).
PMID
23816038
Source
scival
Published In
American Heart Journal
Publish Date
2013
DOI
10.1016/j.ahj.2013.04.004

Development of a theoretically driven mHealth text messaging application for sustaining recent weight loss

Background: Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective: To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods: We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results: All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions: Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content.

Authors
Shaw, RJ; Bosworth, HB; Hess, JC; Silva, SG; Lipkus, IM; Davis, LL; Johnson, CM
MLA Citation
Shaw, RJ, Bosworth, HB, Hess, JC, Silva, SG, Lipkus, IM, Davis, LL, and Johnson, CM. "Development of a theoretically driven mHealth text messaging application for sustaining recent weight loss." Journal of Medical Internet Research 15.5 (2013).
PMID
25100678
Source
scival
Published In
Journal of medical Internet research
Volume
15
Issue
5
Publish Date
2013
DOI
10.2196/mhealth.2343

The cholesterol, hypertension, and glucose education (CHANGE) study: Results from a randomized controlled trial in African Americans with diabetes

Background Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. Methods We randomized 359 African Americans with type 2 diabetes to receive usual care or a nurse telephone intervention. The 12-month intervention provided monthly self-management support and quarterly medication management facilitation. Coprimary outcomes were changes in systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) over 12 months. We estimated between-intervention group differences over time using linear mixed-effects models. The secondary outcome was self-reported medication adherence. Results The sample was 72% female; 49% had low health literacy, and 37% had annual income <$10,000. Model-based estimates for mean baseline SBP, HbA1c, and LDL-C were 136.8 mm Hg (95% CI 135.0-138.6), 8.0% (95% CI 7.8-8.2), and 99.1 mg/dL (95% CI 94.7-103.5), respectively. Intervention patients received 9.9 (SD 3.0) intervention calls on average. Primary providers replied to 76% of nurse medication management facilitation contacts, 18% of these resulted in medication changes. There were no between-group differences over time for SBP (P =.11), HbA1c (P =.66), or LDL-C (P =.79). Intervention patients were more likely than those receiving usual care to report improved medication adherence (odds ratio 4.4, 95% CI 1.8-10.6, P =.0008), but adherent patients did not exhibit relative improvement in primary outcomes. Conclusions This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes. Further research is needed to determine how to maximally impact CVD risk factors in African American patients. © 2013 Mosby, Inc.

Authors
Crowley, MJ; Powers, BJ; Olsen, MK; Grubber, JM; Koropchak, C; Rose, CM; Gentry, P; Bowlby, L; Trujillo, G; Maciejewski, ML; Bosworth, HB
MLA Citation
Crowley, MJ, Powers, BJ, Olsen, MK, Grubber, JM, Koropchak, C, Rose, CM, Gentry, P, Bowlby, L, Trujillo, G, Maciejewski, ML, and Bosworth, HB. "The cholesterol, hypertension, and glucose education (CHANGE) study: Results from a randomized controlled trial in African Americans with diabetes." American Heart Journal 166.1 (2013): 179-186.e2.
Source
scival
Published In
American Heart Journal
Volume
166
Issue
1
Publish Date
2013
Start Page
179
End Page
186.e2
DOI
10.1016/j.ahj.2013.04.004

The role of home blood pressure telemonitoring in managing hypertensive populations

Hypertension is a common chronic disease affecting nearly one-third of the United States population. Many interventions have been designed to help patients manage their hypertension. With the evolving climate of healthcare, rapidly developing technology, and emphasis on delivering patient-centered care, home-based blood pressure telemonitoring is a promising tool to help patients achieve optimal blood pressure (BP) control. Home-based blood pressure telemonitoring is associated with reductions in blood pressure values and increased patient satisfaction. However, additional research is needed to understand cost-effectiveness and long-term clinical outcomes of home-based BP monitoring. We review key interventional trials involving home based BP monitoring, with special emphasis placed on studies involving additionally behavioral modification and/or medication management. Furthermore, we discuss the role of home-based blood pressure telemonitoring within the context of the patient-centered medical home and the evolving role of technology. © 2013 Springer Science+Business Media New York.

Authors
Zullig, LL; Melnyk, SD; Goldstein, K; Shaw, RJ; Bosworth, HB
MLA Citation
Zullig, LL, Melnyk, SD, Goldstein, K, Shaw, RJ, and Bosworth, HB. "The role of home blood pressure telemonitoring in managing hypertensive populations." Current Hypertension Reports 15.4 (2013): 346-355.
Source
scival
Published In
Current Hypertension Reports
Volume
15
Issue
4
Publish Date
2013
Start Page
346
End Page
355
DOI
10.1007/s11906-013-0351-6

Blood Pressure Control in a Hypertension Telemedicine Intervention: Does Distance to Primary Care Matter?

Although telemedicine may help overcome geographic access barriers, it is unknown whether rural patients receive greater benefits. In a secondary analysis of 503 veterans participating in a hypertension telemedicine study, the authors hypothesized that patients with greater travel distances would have greater improvements in 18-month systolic blood pressure (SBP). Patients were categorized by telemedicine exposure and travel distance to primary care, derived from zip codes. Comparisons were (1) usual care (UC), distance <30 miles (reference); (2) UC, distance ≥30 miles; (3) telemedicine, distance <30 miles; (4) telemedicine, distance ≥30 miles. Compared with patients receiving UC, distance <30 miles (intercept=127.7), no difference in 18-month SBP was observed in patients receiving UC, distance ≥30 miles (0.13 mm Hg, 95% confidence interval [-6.6 to 6.8]); telemedicine, distance <30 miles (-1.1 mm Hg [-7.3 to 5.2]); telemedicine, distance ≥30 miles (-0.80 mm Hg [-6.6 to 5.1]). Although telemedicine may help overcome geographic access barriers, additional studies are needed to identify patients most likely to benefit. © 2013 Wiley Periodicals, Inc.

Authors
Bowen, ME; Bosworth, HB; Roumie, CL
MLA Citation
Bowen, ME, Bosworth, HB, and Roumie, CL. "Blood Pressure Control in a Hypertension Telemedicine Intervention: Does Distance to Primary Care Matter?." Journal of Clinical Hypertension (2013).
PMID
24088280
Source
scival
Published In
Journal of Clinical Hypertension
Publish Date
2013
DOI
10.1111/jch.12172

Blood pressure control in a hypertension telemedicine intervention: Does distance to primary care matter?

Although telemedicine may help overcome geographic access barriers, it is unknown whether rural patients receive greater benefits. In a secondary analysis of 503 veterans participating in a hypertension telemedicine study, the authors hypothesized that patients with greater travel distances would have greater improvements in 18-month systolic blood pressure (SBP). Patients were categorized by telemedicine exposure and travel distance to primary care, derived from zip codes. Comparisons were (1) usual care (UC), distance <30 miles (reference); (2) UC, distance ≥30 miles; (3) telemedicine, distance <30 miles; (4) telemedicine, distance ≥30 miles. Compared with patients receiving UC, distance <30 miles (intercept=127.7), no difference in 18-month SBP was observed in patients receiving UC, distance ≥30 miles (0.13 mm Hg, 95% confidence interval [-6.6 to 6.8]); telemedicine, distance <30 miles (-1.1 mm Hg [-7.3 to 5.2]); telemedicine, distance ≥30 miles (-0.80 mm Hg [-6.6 to 5.1]). Although telemedicine may help overcome geographic access barriers, additional studies are needed to identify patients most likely to benefit. © 2013 Wiley Periodicals, Inc.

Authors
Bowen, ME; Bosworth, HB; Roumie, CL
MLA Citation
Bowen, ME, Bosworth, HB, and Roumie, CL. "Blood pressure control in a hypertension telemedicine intervention: Does distance to primary care matter?." Journal of Clinical Hypertension 15.10 (2013): 723-730.
Source
scival
Published In
Journal of Clinical Hypertension
Volume
15
Issue
10
Publish Date
2013
Start Page
723
End Page
730
DOI
10.1111/jch.12172

Racial differences in the effect of a telephone-delivered hypertension disease management program.

BACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. OBJECTIVE: The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. PARTICIPANTS: Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. INTERVENTIONS: Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. MAIN MEASURES: Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p=0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p=0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p=0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients. CONCLUSIONS: The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.

Authors
Jackson, GL; Oddone, EZ; Olsen, MK; Powers, BJ; Grubber, JM; McCant, F; Bosworth, HB
MLA Citation
Jackson, GL, Oddone, EZ, Olsen, MK, Powers, BJ, Grubber, JM, McCant, F, and Bosworth, HB. "Racial differences in the effect of a telephone-delivered hypertension disease management program." J Gen Intern Med 27.12 (December 2012): 1682-1689.
PMID
22865016
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
27
Issue
12
Publish Date
2012
Start Page
1682
End Page
1689
DOI
10.1007/s11606-012-2138-x

Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer.

CONTEXT: Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer. OBJECTIVES: We evaluated the validity and reliability of the English version of the CDS (CDS-E) that has 12 items and takes, on average, 140 seconds for individuals to complete. METHODS: Eligible patients had advanced lung cancer, consented, and were fluent in English. Participants completed a 100 mm visual analogue scale (VAS), the modified Borg scale, the CDS-E, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy--Lung quality-of-life scale. Demographic, radiographic, and treatment information were obtained from patients' medical records. RESULTS: One hundred twelve participants were enrolled at three sites in the U.S., Australia, and the U.K. Mean age was 64.5 years (SD 11.5); 90% were Caucasian, 68% had Eastern Cooperative Oncology Group performance status 0-1, and 50% had non-small cell carcinoma. All completed the CDS-E independently, without difficulty. The CDS-E had reasonable internal consistency overall (Cronbach's α = 0.71) and for each of the three factors (effort, anxiety, discomfort Cronbach's α = 0.80-0.84). CDS-E scores were significantly correlated with the 100mm VAS (r = 0.82; P < 0.001) and the modified Borg (r = 0.87; P < 0.001). After factor analysis, the CDS-E was revised by removing three items (r-CDS-E). CONCLUSION: The CDS-E and r-CDS-E are reliable and valid measures of the sensation and the psychological components of dyspnea, with the shorter version having similar psychometric properties.

Authors
Uronis, HE; Shelby, RA; Currow, DC; Ahmedzai, SH; Bosworth, HB; Coan, A; Abernethy, AP
MLA Citation
Uronis, HE, Shelby, RA, Currow, DC, Ahmedzai, SH, Bosworth, HB, Coan, A, and Abernethy, AP. "Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer." J Pain Symptom Manage 44.5 (November 2012): 741-749.
PMID
22765966
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
44
Issue
5
Publish Date
2012
Start Page
741
End Page
749
DOI
10.1016/j.jpainsymman.2011.10.027

Racial Differences in Pain Coping Efficacy in Patients with Hip and Knee Osteoarthritis

Authors
Allen, KD; Bosworth, HB; Coffman, C; Lindquist, JH; Sperber, NR; Weinberger, M; Oddone, EZ
MLA Citation
Allen, KD, Bosworth, HB, Coffman, C, Lindquist, JH, Sperber, NR, Weinberger, M, and Oddone, EZ. "Racial Differences in Pain Coping Efficacy in Patients with Hip and Knee Osteoarthritis." October 2012.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
64
Issue
10
Publish Date
2012
Start Page
S345
End Page
S345

Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus.

OBJECTIVES: To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus. DESIGN: Controlled clinical trial. SETTING: Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010. PARTICIPANTS: Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122). INTERVENTION: A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program. MEASUREMENTS: The primary outcome was a homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function. RESULTS: There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose (P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group (P < .001) and not in the usual care group. CONCLUSION: Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus.

Authors
Morey, MC; Pieper, CF; Edelman, DE; Yancy, WS; Green, JB; Lum, H; Peterson, MJ; Sloane, R; Cowper, PA; Bosworth, HB; Huffman, KM; Cavanaugh, JT; Hall, KS; Pearson, MP; Taylor, GA
MLA Citation
Morey, MC, Pieper, CF, Edelman, DE, Yancy, WS, Green, JB, Lum, H, Peterson, MJ, Sloane, R, Cowper, PA, Bosworth, HB, Huffman, KM, Cavanaugh, JT, Hall, KS, Pearson, MP, and Taylor, GA. "Enhanced fitness: a randomized controlled trial of the effects of home-based physical activity counseling on glycemic control in older adults with prediabetes mellitus." J Am Geriatr Soc 60.9 (September 2012): 1655-1662.
PMID
22985140
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
9
Publish Date
2012
Start Page
1655
End Page
1662
DOI
10.1111/j.1532-5415.2012.04119.x

Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program

BACKGROUND: African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. OBJECTIVE: The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. PARTICIPANTS: Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. INTERVENTIONS: Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. MAIN MEASURES: Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). KEY RESULTS: Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p = 0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p = 0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p = 0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients. CONCLUSIONS: The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients. © 2012 Society of General Internal Medicine.

Authors
Jackson, GL; Oddone, EZ; Olsen, MK; Powers, BJ; Grubber, JM; McCant, F; Bosworth, HB
MLA Citation
Jackson, GL, Oddone, EZ, Olsen, MK, Powers, BJ, Grubber, JM, McCant, F, and Bosworth, HB. "Racial Differences in the Effect of a Telephone-Delivered Hypertension Disease Management Program (Accepted)." Journal of General Internal Medicine (August 6, 2012): 1-8.
Source
scopus
Published In
Journal of General Internal Medicine
Publish Date
2012
Start Page
1
End Page
8
DOI
10.1007/s11606-012-2138-x

Economic evaluation of telephone self-management interventions for blood pressure control.

BACKGROUND: Half of patients with hypertension have poor blood pressure (BP) control. Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients' homes. This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study (HINTS), aimed to improve BP control in veterans. METHODS: Eligible veterans were randomized to either usual care or 1 of 3 telephone-based intervention groups using home BP telemonitoring: (1) behavioral management, (2) medication management, or (3) combined. Intervention costs were derived from information collected during the trial. Direct medical costs (inpatient, outpatient, and outpatient pharmacy, including hypertension-specific pharmacy) at 18 months by group were calculated using Veterans Affairs (VA) Decision Support System data. Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care. RESULTS: Patients receiving behavior or medication management showed significant gains in BP control at 12 months; there were no differences in BP control at 18 months. In subgroup analysis, patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months. In overall and subgroup samples, average intervention costs were similar in the 3 study arms, and at 18 months, there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care. CONCLUSIONS: To optimize investment in telephone-based home interventions such as the HINTS, it is important to identify groups of patients who are most likely to benefit from more intensive home BP management.

Authors
Wang, V; Smith, VA; Bosworth, HB; Oddone, EZ; Olsen, MK; McCant, F; Powers, BJ; Van Houtven, CH
MLA Citation
Wang, V, Smith, VA, Bosworth, HB, Oddone, EZ, Olsen, MK, McCant, F, Powers, BJ, and Van Houtven, CH. "Economic evaluation of telephone self-management interventions for blood pressure control." Am Heart J 163.6 (June 2012): 980-986.
PMID
22709750
Source
pubmed
Published In
American Heart Journal
Volume
163
Issue
6
Publish Date
2012
Start Page
980
End Page
986
DOI
10.1016/j.ahj.2012.03.016

Factors contributing to improved adherence rates following a clinical pharmacist intervention

Authors
Riendeau, AB; Ivey, JL; Roth, MT; Weinberger, M; Esserman, DA; Bosworth, HB
MLA Citation
Riendeau, AB, Ivey, JL, Roth, MT, Weinberger, M, Esserman, DA, and Bosworth, HB. "Factors contributing to improved adherence rates following a clinical pharmacist intervention." PHARMACOTHERAPY 32.5 (May 2012): E128-E128.
Source
wos-lite
Published In
Pharmacotherapy
Volume
32
Issue
5
Publish Date
2012
Start Page
E128
End Page
E128

Baseline medication adherence and blood pressure in a 24-month longitudinal hypertension study.

AIM AND OBJECTIVES: We sought to identify the feasibility and predictive validity of an easy and quick self-reported measure of medication adherence and to identify characteristics of people with hypertension that may warrant increase attentiveness by nurses to address hypertensive self-management needs. BACKGROUND: Current control rates of hypertension are approximately 50%. Effective blood pressure control can be achieved in most people with hypertension through antihypertensive medication. However, hypertension control can only be achieved if the patient is adherent with their medication regimen. Patients who are non-adherent may be in need of additional intervention. DESIGN: This secondary analysis evaluated the systolic blood pressure of patients who received usual hypertension management across 24 months at six-month intervals. METHODS: A longitudinal study of 159 hypertensive patients in two primary care clinics. RESULTS: In a sample of 159 patients receiving care in a primary care facility, baseline medication non-adherence was associated with a 6·3 mmHg increase in systolic blood pressure (p < 0·05) at baseline, a 8·4 mmHg increase in systolic blood pressure (p < 0·05) at 12 months and a 7·5 increase in systolic blood pressure at 24 months (p < 0·05) compared with adherent patients, respectively. Results also indicate a significant increase in systolic blood pressure across 24 months among people who identified as minority and of low financial status. CONCLUSIONS: Non-adherence with antihypertensive medication at baseline was predictive of increased systolic blood pressure up to 24 months postbaseline. RELEVANCE TO CLINICAL PRACTICE: This study demonstrates the use of an easy-to-use questionnaire to identify patients who are non-adherent. We recommend assessing medication adherence to identify patients who are non-adherent with their anti-hypertensive medication and to be especially vigilant with patients who are minority or are considered low income.

Authors
Shaw, R; Bosworth, HB
MLA Citation
Shaw, R, and Bosworth, HB. "Baseline medication adherence and blood pressure in a 24-month longitudinal hypertension study." J Clin Nurs 21.9-10 (May 2012): 1401-1406.
PMID
22107599
Source
pubmed
Published In
Journal of Clinical Nursing
Volume
21
Issue
9-10
Publish Date
2012
Start Page
1401
End Page
1406
DOI
10.1111/j.1365-2702.2011.03859.x

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.

BACKGROUND: Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. METHODS / DESIGN: One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. DISCUSSION: Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. TRIAL REGISTRATION: NCT01130740 (VA); NCT 01435109 (NIH).

Authors
Allen, KD; Bosworth, HB; Brock, DS; Chapman, JG; Chatterjee, R; Coffman, CJ; Datta, SK; Dolor, RJ; Jeffreys, AS; Juntilla, KA; Kruszewski, J; Marbrey, LE; McDuffie, J; Oddone, EZ; Sperber, N; Sochacki, MP; Stanwyck, C; Strauss, JL; Yancy, WS
MLA Citation
Allen, KD, Bosworth, HB, Brock, DS, Chapman, JG, Chatterjee, R, Coffman, CJ, Datta, SK, Dolor, RJ, Jeffreys, AS, Juntilla, KA, Kruszewski, J, Marbrey, LE, McDuffie, J, Oddone, EZ, Sperber, N, Sochacki, MP, Stanwyck, C, Strauss, JL, and Yancy, WS. "Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials. (Published online)" BMC Musculoskelet Disord 13 (April 24, 2012): 60-.
PMID
22530979
Source
pubmed
Published In
BMC Musculoskeletal Disorders
Volume
13
Publish Date
2012
Start Page
60
DOI
10.1186/1471-2474-13-60

Enhancing medication adherence: The public health dilemma

© 2012 Springer Healthcare, a part of Springer Science+Business Media. All rights reserved.Enhancing Medication Adherence: The Public Health Dilemma is a comprehensive guide to medication adherence for the healthcare professional. Clinicians and pharmacists alike can benefit from key opinion leader and author Hayden Bosworth’s text as he explains the details and causes behind medication nonadherence as well as methods on how healthcare providers can determine if a patient is nonadherent. Additionally, Bosworth discusses various studies, which assess adherence, adherence-related technology, best practices for clinicians and pharmacists, and future directions and recommendations in the field.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. Enhancing medication adherence: The public health dilemma. January 1, 2012.
Source
scopus
Publish Date
2012
Start Page
1
End Page
60
DOI
10.1007/978-1-908517-66-1

Participant evaluation of a telephone-based osteoarthritis self-management program, 2006-2009.

INTRODUCTION: Self-management support interventions can help improve osteoarthritis outcomes but are underused. Little is known about how participants evaluate the helpfulness of these programs. We describe participants' evaluations of a telephone-based, osteoarthritis self-management support intervention that yielded improved outcomes in a clinical trial. METHODS: Participants were 140 people in the intervention arm of the trial who completed an end-of-trial survey. We used mixed methods to describe participants' perceived helpfulness of the program and its components. We compared ratings of helpfulness according to participant characteristics and analyzed themes from open-ended responses with a constant comparison approach. We calculated Pearson correlation coefficients between perceived helpfulness and changes in pain, function, affect, and self-efficacy. RESULTS: The average rating of overall helpfulness on a scale from 1 to 10 was 7.6 (standard deviation, 2.3), and more than 80% of participants agreed that each component (phone calls, educational material, setting goals and action plans) was helpful. Participants had better perceived helpfulness ratings than their counterparts if they were nonwhite, had limited health literacy, had no college education, had perceived inadequate income, were older, had a spouse or were living together in a committed relationship, and had greater symptom duration and less pain. Ratings of helpfulness increased with greater improvement in outcomes. Participants frequently mentioned the health educator's calls as being helpful for staying on task with self-management behaviors. CONCLUSION: Participants viewed this intervention and each of its components as helpful for improving osteoarthritis symptoms. In addition to the improvements in objective outcomes seen in the clinical trial, these results provide further support for the dissemination of self-management support interventions.

Authors
Sperber, NR; Bosworth, HB; Coffman, CJ; Juntilla, KA; Lindquist, JH; Oddone, EZ; Walker, TA; Weinberger, M; Allen, KD
MLA Citation
Sperber, NR, Bosworth, HB, Coffman, CJ, Juntilla, KA, Lindquist, JH, Oddone, EZ, Walker, TA, Weinberger, M, and Allen, KD. "Participant evaluation of a telephone-based osteoarthritis self-management program, 2006-2009." Prev Chronic Dis 9 (2012): E73-.
PMID
22440547
Source
pubmed
Published In
Preventing Chronic Diseases: Public health research, practice, and policy
Volume
9
Publish Date
2012
Start Page
E73

The Latino Health Project: pilot testing a culturally adapted behavioral weight loss intervention in obese and overweight Latino adults.

OBJECTIVE: To pilot test a culturally adapted behavioral weight loss intervention in obese and overweight Latino adults. DESIGN: Pilot study. SETTING: Latino community organization in Durham, North Carolina. PARTICIPANTS: Overweight and obese, self-identified Latinos > or =18 years old. INTERVENTION: Intervention consisted of 20 weekly group sessions (90-120 minutes each) incorporating motivational interviewing techniques. The intervention goal was weight loss by adopting the Dietary Approach to Stop Hypertension (DASH) dietary pattern, increasing physical activity, and reducing caloric intake. The cultural adaptation included foods and physical activities commonly used in the Latino culture, using a Spanish-speaking interventionist, and conducting the intervention at a local Latino community organization. MAIN OUTCOME MEASURES: Weight, body mass index (BMI), blood pressure, dietary pattern, and physical activity were measured at baseline and at 20 weeks. RESULTS: A total of 56 participants are included in the final analysis. The average weight loss was 5.1 lbs (95% CI -8.7 to -1.5; P = .006); and there was a reduction in BMI of 1.3 kg/m2 (95% CI -2.2 to -0.5; P =.002) at 20 weeks. Systolic blood pressure decreased by 2.6 mm Hg (95% CI -4.7 to -0.6; P = .013). CONCLUSION: A culturally adapted behavioral intervention for the treatment of overweight and obesity is potentially effective in a diverse group of Latino adults.

Authors
Corsino, L; Rocha-Goldberg, MP; Batch, BC; Ortiz-Melo, DI; Bosworth, HB; Svetkey, LP
MLA Citation
Corsino, L, Rocha-Goldberg, MP, Batch, BC, Ortiz-Melo, DI, Bosworth, HB, and Svetkey, LP. "The Latino Health Project: pilot testing a culturally adapted behavioral weight loss intervention in obese and overweight Latino adults." Ethn Dis 22.1 (2012): 51-57.
PMID
22774309
Source
pubmed
Published In
Ethnicity & disease
Volume
22
Issue
1
Publish Date
2012
Start Page
51
End Page
57

Short message service (SMS) text messaging as an intervention medium for weight loss: A literature review

Nearly 68% of American adults are obese or overweight. Mobile devices such as mobile phones have emerged as a mode of intervention delivery to help people improve their health, particularly in relation to weight loss. This literature review examines the relationship between the use of short message service (SMS) text messaging as an intervention medium and weight loss. Results from this literature review (n = 14) suggest that SMS as an intervention tool for weight loss is still in its infancy. Initial results are promising but continued investigation is needed. We offer several recommendations for future research. © The Author(s) 2012.

Authors
Shaw, R; Bosworth, H
MLA Citation
Shaw, R, and Bosworth, H. "Short message service (SMS) text messaging as an intervention medium for weight loss: A literature review." Health Informatics Journal 18.4 (2012): 235-250.
PMID
23257055
Source
scival
Published In
Health Informatics Journal
Volume
18
Issue
4
Publish Date
2012
Start Page
235
End Page
250
DOI
10.1177/1460458212442422

Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: The adherence and intensification of medications cluster randomized, controlled pragmatic trial

Background-Even in high-performing health systems, some patients with diabetes mellitus have poor blood pressure (BP) control because of poor medication adherence and lack of medication intensification. We examined whether the Adherence and Intensification of Medications intervention, a pharmacist-led intervention combining elements found in efficacy studies to lower BP, improved BP among patients with diabetes mellitus with persistent hypertension and poor refill adherence or insufficient medication intensification in 2 high-performing health systems. Methods and Results-We conducted a prospective, multisite cluster randomized pragmatic trial with randomization of 16 primary care teams at 5 medical centers (3 Veterans Affairs and 2 Kaiser Permanente) to the Adherence and Intensification of Medications intervention or usual care. The primary outcome was relative change in systolic BP (SBP), comparing 1797 intervention with 2303 control team patients, from 6 months preceding to 6 months after the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. The mean SBP decrease from 6 months before to 6 months after the intervention period was ≈9 mm Hg in both arms. Mean SBPs of eligible intervention patients were 2.4 mm Hg lower (95% CI:-3.4 to-1.5; P<0.001) immediately after the intervention than those achieved by control patients. Conclusions-The Adherence and Intensification of Medications program more rapidly lowered SBPs among intervention patients, but usual-care patients achieved equally low SBP levels by 6 months after the intervention period. These findings show the importance of evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique identifier: NCT00495794. © 2012 American Heart Association, Inc.

Authors
Heisler, M; Hofer, TP; Schmittdiel, JA; Selby, JV; Klamerus, ML; Bosworth, HB; Bermann, M; Kerr, EA
MLA Citation
Heisler, M, Hofer, TP, Schmittdiel, JA, Selby, JV, Klamerus, ML, Bosworth, HB, Bermann, M, and Kerr, EA. "Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: The adherence and intensification of medications cluster randomized, controlled pragmatic trial." Circulation 125.23 (2012): 2863-2872.
PMID
22570370
Source
scival
Published In
Circulation
Volume
125
Issue
23
Publish Date
2012
Start Page
2863
End Page
2872
DOI
10.1161/CIRCULATIONAHA.111.089169

Patient-centered adherence intervention after acute coronary syndrome hospitalization

Background-Adherence to cardioprotective medications in the year after acute coronary syndrome hospitalization is generally poor and is associated with increased risk of rehospitalization and mortality. Few interventions have specifically targeted this high-risk patient population to improve medication adherence. We hypothesize that a multifaceted patientcentered intervention could improve adherence to cardioprotective medications. Methods and Results-To evaluate this intervention, we propose enrolling 280 patients with a recent acute coronary syndrome event into a multicenter randomized, controlled trial. The intervention comprises4 main components: (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and primary care provider/cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls). Patients in the intervention arm will visit with the study pharmacist ̃1 week post-hospital discharge. The pharmacist will work with the patient and collaborate with providers to reconcile medication issues. Voice messages will augment the educational process and remind patients to refill their cardioprotective medications. The study will compare the intervention versus usual care for 12 months. The primary outcome of interest is adherence using the ReComp method. Secondary and tertiary outcomes include achievement of targets for blood pressure and low-density lipoprotein, and reduction in the combined cardiovascular end points of myocardial infarction hospitalization, coronary revascularization, and all-cause mortality. Finally, we will also evaluate the cost-effectiveness of the intervention compared with usual care. Conclusions-If the intervention is effective in improving medication adherence and demonstrating a lower cost, the intervention has the potential to improve cardiovascular outcomes in this high-risk patient population. © 2012 American Heart Association, Inc.

Authors
Lambert-Kerzner, A; Giacco, EJD; Fahdi, IE; Bryson, CL; Melnyk, SD; Bosworth, HB; Davis, R; Mun, H; Weaver, J; Barnett, C; Radcliff, T; Hubbard, A; Bosket, KD; Carey, E; Virchow, A; Mihalko-Corbitt, R; Kaufman, A; Marchant-Miros, K; Ho, PM
MLA Citation
Lambert-Kerzner, A, Giacco, EJD, Fahdi, IE, Bryson, CL, Melnyk, SD, Bosworth, HB, Davis, R, Mun, H, Weaver, J, Barnett, C, Radcliff, T, Hubbard, A, Bosket, KD, Carey, E, Virchow, A, Mihalko-Corbitt, R, Kaufman, A, Marchant-Miros, K, and Ho, PM. "Patient-centered adherence intervention after acute coronary syndrome hospitalization." Circulation: Cardiovascular Quality and Outcomes 5.4 (2012): 571-576.
PMID
22811499
Source
scival
Published In
Circulation. Cardiovascular quality and outcomes
Volume
5
Issue
4
Publish Date
2012
Start Page
571
End Page
576
DOI
10.1161/CIRCOUTCOMES.111.962290

How can innovative uses of technology be harnessed to improve medication adherence?

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "How can innovative uses of technology be harnessed to improve medication adherence?." Expert Review of Pharmacoeconomics and Outcomes Research 12.2 (2012): 133-135.
PMID
22458612
Source
scival
Published In
Expert review of pharmacoeconomics & outcomes research
Volume
12
Issue
2
Publish Date
2012
Start Page
133
End Page
135
DOI
10.1586/erp.12.6

The hypertension team: The role of the pharmacist, nurse, and teamwork in hypertension therapy

Team-based care is one of the key components of the patient-centered medical home. Studies have consistently demonstrated that teams involving pharmacists or nurses in patient management can significantly improve blood pressure control. These findings have been demonstrated in several meta-analyses and systematic reviews. These reviews have generally found that team-based care can reduce systolic blood pressure by 4-10 mm Hg over usual care. However, these reviews have also concluded that many of the studies had various limitations and that additional research should be conducted. The present state of the art review paper will highlight newer studies, many of which were funded by the National Institutes of Health. Newer strategies involve telephone and/or web-based management which is an evolving area to improve blood pressure control in large populations. Social media and other technology is currently being investigated to assist pharmacists or nurses in communicating with patients to improve hypertension management. Few cost-effectiveness analyses have been performed but generally have found favorable costs for team-based care when considering the potential to reduce morbidity and mortality. The authors will suggest additional research that needs to be conducted to help evaluate strategies to best implement team-based care to improve blood pressure management. © 2011 Wiley Periodicals, Inc.

Authors
Carter, BL; Bosworth, HB; Green, BB
MLA Citation
Carter, BL, Bosworth, HB, and Green, BB. "The hypertension team: The role of the pharmacist, nurse, and teamwork in hypertension therapy." Journal of Clinical Hypertension 14.1 (2012): 51-65.
PMID
22235824
Source
scival
Published In
Journal of Clinical Hypertension
Volume
14
Issue
1
Publish Date
2012
Start Page
51
End Page
65
DOI
10.1111/j.1751-7176.2011.00542.x

Racial differences in the effect of a telephone-delivered hypertension disease management program.

African Americans are significantly more likely than whites to have uncontrolled hypertension, contributing to significant disparities in cardiovascular disease and events. The goal of this study was to examine whether there were differences in change in blood pressure (BP) for African American and non-Hispanic white patients in response to a medication management and tailored nurse-delivered telephone behavioral program. Five hundred and seventy-three patients (284 African American and 289 non-Hispanic white) primary care patients who participated in the Hypertension Intervention Nurse Telemedicine Study (HINTS) clinical trial. Study arms included: 1) nurse-administered, physician-directed medication management intervention, utilizing a validated clinical decision support system; 2) nurse-administered, behavioral management intervention; 3) combined behavioral management and medication management intervention; and 4) usual care. All interventions were activated based on poorly controlled home BP values. Post-hoc analysis of change in systolic and diastolic blood pressure. General linear models (PROC MIXED in SAS, version 9.2) were used to estimate predicted means at 6-month, 12-month, and 18-month time points, by intervention arm and race subgroups (separate models for systolic and diastolic blood pressure). Improvement in mean systolic blood pressure post-baseline was greater for African American patients in the combined intervention, compared to African American patients in usual care, at 12 months (6.6 mmHg; 95 % CI: -12.5, -0.7; p=0.03) and at 18 months (9.7 mmHg; -16.0, -3.4; p=0.003). At 18 months, mean diastolic BP was 4.8 mmHg lower (95 % CI: -8.5, -1.0; p=0.01) among African American patients in the combined intervention arm, compared to African American patients in usual care. There were no analogous differences for non-Hispanic white patients. The combination of home BP monitoring, remote medication management, and telephone tailored behavioral self-management appears to be particularly effective for improving BP among African Americans. The effect was not seen among non-Hispanic white patients.

Authors
Jackson, GL; Oddone, EZ; Olsen, MK; Powers, BJ; Grubber, JM; McCant, F; Bosworth, HB
MLA Citation
Jackson, GL, Oddone, EZ, Olsen, MK, Powers, BJ, Grubber, JM, McCant, F, and Bosworth, HB. "Racial differences in the effect of a telephone-delivered hypertension disease management program." Journal of general internal medicine 27.12 (2012): 1682-1689.
Source
scival
Published In
Journal of General Internal Medicine
Volume
27
Issue
12
Publish Date
2012
Start Page
1682
End Page
1689
DOI
10.1007/s11606-012-2138-x

Resilience in chronic illness

Resilience has been written about and valued since time immemorial. Its value is transmitted down generations through adages, mythology, anecdotes, and even children's books. In essence, resilience can be thought of as a process of successfully adapting to maintain or regain emotional well-being in the face of adversity. It does not mean that distress is not experienced; rather, it is a process through which an individual's thoughts and behaviors overcome distress and optimize positive outcomes. © 2011 Springer Science+Business Media, LLC.

Authors
Trivedi, RB; Bosworth, HB; Jackson, GL
MLA Citation
Trivedi, RB, Bosworth, HB, and Jackson, GL. "Resilience in chronic illness." (December 1, 2011): 181-197. (Chapter)
Source
scopus
Publish Date
2011
Start Page
181
End Page
197
DOI
10.1007/978-1-4419-0232-0_12

A re-conceptualization of access for 21st century healthcare.

Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.

Authors
Fortney, JC; Burgess, JF; Bosworth, HB; Booth, BM; Kaboli, PJ
MLA Citation
Fortney, JC, Burgess, JF, Bosworth, HB, Booth, BM, and Kaboli, PJ. "A re-conceptualization of access for 21st century healthcare." J Gen Intern Med 26 Suppl 2 (November 2011): 639-647. (Review)
PMID
21989616
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
26 Suppl 2
Publish Date
2011
Start Page
639
End Page
647
DOI
10.1007/s11606-011-1806-6

Defining core issues in utilizing information technology to improve access: evaluation and research agenda.

The Department of Veterans Affairs (VA) has been at the vanguard of information technology (IT) and use of comprehensive electronic health records. Despite the widespread use of health IT in the VA, there are still a variety of key questions that need to be answered in order to maximize the utility of IT to improve patient access to quality services. This paper summarizes the potential of IT to enhance healthcare access, key gaps in current evidence linking IT and access, and methodologic challenges for related research. We also highlight four key issues to be addressed when implementing and evaluating the impact of IT interventions on improving access to quality care: 1) Understanding broader needs/perceptions of the Veteran population and their caregivers regarding use of IT to access healthcare services and related information. 2) Understanding individual provider/clinician needs/perceptions regarding use of IT for patient access to healthcare. 3) System/Organizational issues within the VA and other organizations related to the use of IT to improve access. 4) IT integration and information flow with non-VA entities. While the VA is used as an example, the issues are salient for healthcare systems that are beginning to take advantage of IT solutions.

Authors
Jackson, GL; Krein, SL; Alverson, DC; Darkins, AW; Gunnar, W; Harada, ND; Helfrich, CD; Houston, TK; Klobucar, TF; Nazi, KM; Poropatich, RK; Ralston, JD; Bosworth, HB
MLA Citation
Jackson, GL, Krein, SL, Alverson, DC, Darkins, AW, Gunnar, W, Harada, ND, Helfrich, CD, Houston, TK, Klobucar, TF, Nazi, KM, Poropatich, RK, Ralston, JD, and Bosworth, HB. "Defining core issues in utilizing information technology to improve access: evaluation and research agenda." J Gen Intern Med 26 Suppl 2 (November 2011): 623-627.
PMID
21989613
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
26 Suppl 2
Publish Date
2011
Start Page
623
End Page
627
DOI
10.1007/s11606-011-1789-3

Lessons learned when innovations go awry: a baseline description of a behavioral trial-the Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose study.

Individuals diagnosed with impaired glucose tolerance (i.e., prediabetes) are at increased risk for developing diabetes. We proposed a clinical trial with a novel adaptive randomization designed to examine the impact of a home-based physical activity (PA) counseling intervention on metabolic risk in prediabetic elders. This manuscript details the lessons learned relative to recruitment, study design, and implementation of a 12-month randomized controlled PA counseling trial. A detailed discussion on how we responded to unforeseen challenges is provided. A total of 302 older patients with prediabetes were randomly assigned to either PA counseling or usual care. A novel adaptive design that reallocated counseling intensity based on self-report of adherence to PA was initiated but revised when rates of non-response were lower than projected. This study presents baseline participant characteristics and discusses unwelcome adaptations to a highly innovative study design to increase PA and enhance glucose metabolism when the best-laid plans went awry.

Authors
Hall, KS; Pieper, CF; Edelman, DE; Yancy, WS; Green, JB; Lum, H; Peterson, MJ; Sloane, R; Cowper, PA; Bosworth, HB; Huffman, KM; Cavanaugh, JT; Chapman, JG; Pearson, MP; Howard, TA; Ekelund, CC; McCraw, BL; Burrell, JB; Taylor, GA; Morey, MC
MLA Citation
Hall, KS, Pieper, CF, Edelman, DE, Yancy, WS, Green, JB, Lum, H, Peterson, MJ, Sloane, R, Cowper, PA, Bosworth, HB, Huffman, KM, Cavanaugh, JT, Chapman, JG, Pearson, MP, Howard, TA, Ekelund, CC, McCraw, BL, Burrell, JB, Taylor, GA, and Morey, MC. "Lessons learned when innovations go awry: a baseline description of a behavioral trial-the Enhancing Fitness in Older Overweight Veterans with Impaired Fasting Glucose study." Transl Behav Med 1.4 (November 2011): 573-587.
PMID
22866170
Source
pubmed
Published In
Translational Behavioral Medicine
Volume
1
Issue
4
Publish Date
2011
Start Page
573
End Page
587
DOI
10.1007/s13142-011-0075-6

Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment?

Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%). When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135.3/76.7 versus 143.2/80.6 mm Hg; P<0.0001). Blood pressure acceptable intervention alerts were associated with the lowest incidence of repeat alerts (hazard ratio: 0.69 [95% CI: 0.58 to 0.83]), meaning that the patient home blood pressure was less likely to subsequently rise above goal, despite apparent clinical inertia. This telemedicine intervention targeting clinical inertia did not guarantee treatment intensification in response to elevated home blood pressures. However, when physicians did not intensify treatment, it was because blood pressure was closer to an acceptable threshold, and repeat blood pressure elevations occurred less frequently. Failure to intensify treatment when home blood pressure is elevated may, at times, represent good clinical judgment, not clinical inertia.

Authors
Crowley, MJ; Smith, VA; Olsen, MK; Danus, S; Oddone, EZ; Bosworth, HB; Powers, BJ
MLA Citation
Crowley, MJ, Smith, VA, Olsen, MK, Danus, S, Oddone, EZ, Bosworth, HB, and Powers, BJ. "Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment?." Hypertension 58.4 (October 2011): 552-558.
PMID
21844490
Source
pubmed
Published In
Hypertension
Volume
58
Issue
4
Publish Date
2011
Start Page
552
End Page
558
DOI
10.1161/HYPERTENSIONAHA.111.174367

Effects of a Telephone Based Osteoarthritis Self-Management Program on Communication with Health Care Providers

Authors
Allen, KD; Bosworth, HB; Coffman, C; Lindquist, JH; Sperber, NR; Weinberger, M; Oddone, EZ
MLA Citation
Allen, KD, Bosworth, HB, Coffman, C, Lindquist, JH, Sperber, NR, Weinberger, M, and Oddone, EZ. "Effects of a Telephone Based Osteoarthritis Self-Management Program on Communication with Health Care Providers." October 2011.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
63
Issue
10
Publish Date
2011
Start Page
S617
End Page
S617

Medication adherence: a call for action.

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.

Authors
Bosworth, HB; Granger, BB; Mendys, P; Brindis, R; Burkholder, R; Czajkowski, SM; Daniel, JG; Ekman, I; Ho, M; Johnson, M; Kimmel, SE; Liu, LZ; Musaus, J; Shrank, WH; Whalley Buono, E; Weiss, K; Granger, CB
MLA Citation
Bosworth, HB, Granger, BB, Mendys, P, Brindis, R, Burkholder, R, Czajkowski, SM, Daniel, JG, Ekman, I, Ho, M, Johnson, M, Kimmel, SE, Liu, LZ, Musaus, J, Shrank, WH, Whalley Buono, E, Weiss, K, and Granger, CB. "Medication adherence: a call for action." Am Heart J 162.3 (September 2011): 412-424. (Review)
PMID
21884856
Source
pubmed
Published In
American Heart Journal
Volume
162
Issue
3
Publish Date
2011
Start Page
412
End Page
424
DOI
10.1016/j.ahj.2011.06.007

Home blood pressure management and improved blood pressure control: results from a randomized controlled trial.

BACKGROUND: To determine which of 3 interventions was most effective in improving blood pressure (BP) control, we performed a 4-arm randomized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center. METHODS: Eligible patients were randomized to either usual care or 1 of 3 telephone-based intervention groups: (1) nurse-administered behavioral management, (2) nurse- and physician-administered medication management, or (3) a combination of both. Of the 1551 eligible patients, 593 individuals were randomized; 48% were African American. The intervention telephone calls were triggered based on home BP values transmitted via telemonitoring devices. Behavioral management involved promotion of health behaviors. Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines. RESULTS: The primary outcome was change in BP control measured at 6-month intervals over 18 months. Both the behavioral management and medication management alone showed significant improvements at 12 months-12.8% (95% confidence interval [CI], 1.6%-24.1%) and 12.5% (95% CI, 1.3%-23.6%), respectively-but not at 18 months. In subgroup analyses, among those with poor baseline BP control, systolic BP decreased in the combined intervention group by 14.8 mm Hg (95% CI, -21.8 to -7.8 mm Hg) at 12 months and 8.0 mm Hg (95% CI, -15.5 to -0.5 mm Hg) at 18 months, relative to usual care. CONCLUSIONS: Overall intervention effects were moderate, but among individuals with poor BP control at baseline, the effects were larger. This study indicates the importance of identifying individuals most likely to benefit from potentially resource intensive programs. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00237692.

Authors
Bosworth, HB; Powers, BJ; Olsen, MK; McCant, F; Grubber, J; Smith, V; Gentry, PW; Rose, C; Van Houtven, C; Wang, V; Goldstein, MK; Oddone, EZ
MLA Citation
Bosworth, HB, Powers, BJ, Olsen, MK, McCant, F, Grubber, J, Smith, V, Gentry, PW, Rose, C, Van Houtven, C, Wang, V, Goldstein, MK, and Oddone, EZ. "Home blood pressure management and improved blood pressure control: results from a randomized controlled trial." Arch Intern Med 171.13 (July 11, 2011): 1173-1180.
PMID
21747013
Source
pubmed
Published In
Archives of internal medicine
Volume
171
Issue
13
Publish Date
2011
Start Page
1173
End Page
1180
DOI
10.1001/archinternmed.2011.276

Medication adherence: emerging use of technology.

PURPOSE OF REVIEW: Adherence to proven, effective medications remains low, resulting in high rates of clinical complications, hospital readmissions, and death. The use of technology to identify patients at risk and to target interventions for poor adherence has increased. This review focuses on research that tests these emerging technologies and evaluates the effect of technology-based adherence interventions on cardiovascular outcomes. RECENT FINDINGS: Recent studies have evaluated technology-based interventions to improve medication adherence by using pharmaceutical databases, tailoring educational information to individual patient needs, delivering technology-driven reminders to patients and providers, and integrating in-person interventions with electronic alerts. Cellular phone reminders and in-home electronic technology used to communicate reminder messages have shown mixed results. Only one study has shown improvement in both adherence and clinical outcome. Current trials suggest that increasing automated reminders will complement but not replace the benefits seen with in-person communication for medication taking. SUMMARY: Integration of in-person contacts with technology-driven medication adherence reminders, electronic medication reconciliation, and pharmaceutical databases may improve medication adherence and have a positive effect on cardiovascular clinical outcomes. Opportunities for providers to monitor the quality of care based on new adherence research are evolving and may be useful as standards for quality improvement emerge.

Authors
Granger, BB; Bosworth, HB
MLA Citation
Granger, BB, and Bosworth, HB. "Medication adherence: emerging use of technology." Curr Opin Cardiol 26.4 (July 2011): 279-287. (Review)
PMID
21597368
Source
pubmed
Published In
Current Opinion in Cardiology
Volume
26
Issue
4
Publish Date
2011
Start Page
279
End Page
287
DOI
10.1097/HCO.0b013e328347c150

The trials and tribulations of enrolling couples in a randomized, controlled trial: a self-management program for hyperlipidemia as a model.

OBJECTIVE: Capitalizing on spousal support may enhance the effectiveness of interventions for chronic disease management. However, couples-based interventions present logistical challenges. We describe our experience and lessons learned while recruiting couples into the Couples Partnering for Lipid-Enhancing Strategies (CouPLES) trial. METHODS: This trial seeks to reduce serum low-density lipoprotein cholesterol levels using a couples-based intervention designed to help patients engage in self-management behaviors. We proposed enrolling 250 couples over 13 months. RESULTS: Due to practical challenges that we encountered, recruitment and enrollment lasted 21 months. Those challenges included: travel to study site; effectively marketing the study; participant burden; and establishing eligibility criteria. By modifying our protocol to address these challenges, the recruitment rate increased from 12 to 33%. CONCLUSION: In the absence of trials identifying the most effective recruitment strategies, investigators may need to experiment, amending their protocol intermittently until target enrollment numbers are reached. The lessons we present may help researchers conducting couples-based interventions develop more effective protocols. PRACTICE IMPLICATIONS: To achieve target enrollment numbers, researchers conducting couples-based interventions should consider minimizing travel to the study site; carefully crafting recruitment materials; budgeting more for participant incentives and staff effort; and limiting exclusion criteria. These practices may also enhance retention.

Authors
Voils, CI; Yancy, WS; Weinberger, M; Bolton, J; Coffman, CJ; Jeffreys, A; Oddone, EZ; Bosworth, HB
MLA Citation
Voils, CI, Yancy, WS, Weinberger, M, Bolton, J, Coffman, CJ, Jeffreys, A, Oddone, EZ, and Bosworth, HB. "The trials and tribulations of enrolling couples in a randomized, controlled trial: a self-management program for hyperlipidemia as a model." Patient Educ Couns 84.1 (July 2011): 33-40.
PMID
20599337
Source
pubmed
Published In
Patient Education and Counseling
Volume
84
Issue
1
Publish Date
2011
Start Page
33
End Page
40
DOI
10.1016/j.pec.2010.06.005

Measuring blood pressure for decision making and quality reporting: where and how many measures?

BACKGROUND: The optimal setting and number of blood pressure (BP) measurements that should be used for clinical decision making and quality reporting are uncertain. OBJECTIVE: To compare strategies for home or clinic BP measurement and their effect on classifying patients as having BP that was in or out of control. DESIGN: Secondary analysis of a randomized, controlled trial of strategies to improve hypertension management. (ClinicalTrials.gov registration number: NCT00237692) SETTING: Primary care clinics affiliated with the Durham Veterans Affairs Medical Center. PATIENTS: 444 veterans with hypertension followed for 18 months. MEASUREMENTS: Blood pressure was measured repeatedly by using 3 methods: standardized research BP measurements at 6-month intervals; clinic BP measurements obtained during outpatient visits; and home BP measurements using a monitor that transmitted measurements electronically. RESULTS: Patients provided 111,181 systolic BP (SBP) measurements (3218 research, 7121 clinic, and 100,842 home measurements) over 18 months. Systolic BP control rates at baseline (mean SBP<140 mm Hg for clinic or research measurement; <135 mm Hg for home measurement) varied substantially, with 28% classified as in control by clinic measurement, 47% by home measurement, and 68% by research measurement. Short-term variability was large and similar across all 3 methods of measurement, with a mean within-patient coefficient of variation of 10% (range, 1% to 24%). Patients could not be classified as having BP that was in or out of control with 80% certainty on the basis of a single clinic SBP measurement from 120 mm Hg to 157 mm Hg. The effect of within-patient variability could be greatly reduced by averaging several measurements, with most benefit accrued at 5 to 6 measurements. LIMITATION: The sample was mostly men with a long-standing history of hypertension and was selected on the basis of previous poor BP control. CONCLUSION: Physicians who want to have 80% or more certainty that they are correctly classifying patients' BP control should use the average of several measurements. Hypertension quality metrics based on a single clinic measurement potentially misclassify a large proportion of patients. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs Health Services Research and Development Service.

Authors
Powers, BJ; Olsen, MK; Smith, VA; Woolson, RF; Bosworth, HB; Oddone, EZ
MLA Citation
Powers, BJ, Olsen, MK, Smith, VA, Woolson, RF, Bosworth, HB, and Oddone, EZ. "Measuring blood pressure for decision making and quality reporting: where and how many measures?." Ann Intern Med 154.12 (June 21, 2011): 781-788.
PMID
21690592
Source
pubmed
Published In
Annals of internal medicine
Volume
154
Issue
12
Publish Date
2011
Start Page
781
End Page
788
DOI
10.7326/0003-4819-154-12-201106210-00005

Racial differences in two self-management hypertension interventions.

BACKGROUND: Only one half of Americans have their blood pressure controlled, and there are significant racial differences in blood pressure control. The goal of this study was to examine the effectiveness of 2 patient-directed interventions designed to improve blood pressure control within white and non-white subgroups (African Americans, 49%). METHODS: Post hoc analysis of a 2 by 2 randomized trial with 2-year follow-up in 2 university-affiliated primary care clinics was performed. Within white and non-white patients (n=634), 4 groups were examined: 1) usual care; 2) home blood pressure monitoring (3 times per week); 3) tailored behavioral self-management intervention administered via telephone by a nurse every other month; and 4) a combination of the 2 interventions. RESULTS: The overall race by time by treatment group effect suggested differential intervention effects on blood pressure over time for whites and non-whites (systolic blood pressure, P=. 08; diastolic blood pressure, P=.01). Estimated trajectories indicated that among the 308 whites, there was no significant effect on blood pressure at 12 or 24 months for any intervention compared with the control group. At 12 months, the non-whites (n=328) in all 3 intervention groups had systolic blood pressure decreases of 5.3 to 5.7 mm Hg compared with usual care (P <.05). At 24 months, in the combined intervention, non-whites had sustained lower systolic blood pressure compared with usual care (7.5 mm Hg; P <.02). A similar pattern was observed for diastolic blood pressure. CONCLUSION: Combined home blood pressure monitoring and a tailored behavioral phone intervention seem to be particularly effective for improving blood pressure in non-white patients.

Authors
Bosworth, HB; Olsen, MK; Grubber, JM; Powers, BJ; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Grubber, JM, Powers, BJ, and Oddone, EZ. "Racial differences in two self-management hypertension interventions." Am J Med 124.5 (May 2011): 468.e1-468.e8.
PMID
21531237
Source
pubmed
Published In
American Journal of Medicine
Volume
124
Issue
5
Publish Date
2011
Start Page
468.e1
End Page
468.e8
DOI
10.1016/j.amjmed.2010.11.024

The effectiveness of personalized coronary heart disease and stroke risk communication.

BACKGROUND: Current guidelines recommend global risk assessment to guide vascular risk factor management; however, most provider-patient communication focuses on individual risk factors in isolation. We sought to evaluate the impact of personalized coronary heart disease and stroke risk communication on patients' knowledge, beliefs, and health behavior. METHODS: We conducted a randomized controlled trial testing personalized risk communication based on Framingham stroke and coronary heart disease risk scores compared with a standard risk factor education. A total of 89 patients were recruited from primary care clinics and followed up for 3 months. Outcomes included the following: risk perception and worry, risk factor knowledge, risk reduction preferences and decision conflict, medication adherence, health behaviors, and blood pressure. RESULTS: Participants had a very low understanding of numeric information, high perceived risk for stroke or myocardial infarction, and high proportion of medication nonadherence. Patients' ability to identify vascular risk factors increased with personalized risk communication (mean 1.8 additional risk factors, 95% CI 1.3-2.2) and standard risk factor education (mean 1.6 additional risk factors, 95% CI 1.1-2.1) immediately after the intervention but was not sustained at 3 months. Patients in the personalized group had less decision conflict than the standard risk factor education group over intended risk reduction strategies (5.9 vs 10.1, P = .003). There was no appreciable impact of either communication strategy on medication adherence, exercise, smoking cessation, or blood pressure. CONCLUSIONS: Personalized risk communication was preferred by patients and had a small impact on risk reduction preferences and decision conflict but had no impact on patient beliefs or behavior compared with standard risk factor education.

Authors
Powers, BJ; Danus, S; Grubber, JM; Olsen, MK; Oddone, EZ; Bosworth, HB
MLA Citation
Powers, BJ, Danus, S, Grubber, JM, Olsen, MK, Oddone, EZ, and Bosworth, HB. "The effectiveness of personalized coronary heart disease and stroke risk communication." Am Heart J 161.4 (April 2011): 673-680.
PMID
21473965
Source
pubmed
Published In
American Heart Journal
Volume
161
Issue
4
Publish Date
2011
Start Page
673
End Page
680
DOI
10.1016/j.ahj.2010.12.021

THE RELATIONSHIP BETWEEN PATIENT AND SPOUSE PSYCHOSOCIAL FACTORS AND PATIENT WEIGHT: BASELINE RESULTS FROM THE COUPLES PARTNERING FOR LIPID ENHANCING STRATEGIES (COUPLES) TRIAL

Authors
Gallagher, P; Yancy, WS; Weinberger, M; Coffman, CJ; Jeffreys, A; Bosworth, HB; Bolton, J; Slade, A; Smith, R; Steward, N; Voils, CI
MLA Citation
Gallagher, P, Yancy, WS, Weinberger, M, Coffman, CJ, Jeffreys, A, Bosworth, HB, Bolton, J, Slade, A, Smith, R, Steward, N, and Voils, CI. "THE RELATIONSHIP BETWEEN PATIENT AND SPOUSE PSYCHOSOCIAL FACTORS AND PATIENT WEIGHT: BASELINE RESULTS FROM THE COUPLES PARTNERING FOR LIPID ENHANCING STRATEGIES (COUPLES) TRIAL." April 2011.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
41
Publish Date
2011
Start Page
S205
End Page
S205

Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management.

BACKGROUND: Secondary prevention by risk factor modification improves patient outcomes, yet it is often not achieved in clinical practice. Reasons for failure stem from challenges of prioritizing risk factor reduction and engaging patients in changing their behaviors. We hypothesize that a novel telemedicine intervention with tailored patient education could improve cardiovascular risk factors. METHODS: To evaluate this intervention, we propose enrolling 450 patients with a recent myocardial infarction and hypertension into a 3-arm randomized, controlled trial. The first arm (n=150) will receive home blood pressure (BP) monitors plus a nurse-delivered, telephone-based tailored patient education intervention and will be enrolled into HealthVault, a Microsoft electronic health record platform. The second arm (n=150) will also receive BP monitors plus a tailored patient education intervention and be enrolled in HeartVault. However, the patient education intervention will be delivered by a Web-based program and will cover topics identical to those in the nurse-delivered intervention. Both arms will be compared with a control group receiving standard care (n=150). All participants will have an in-person assessment at baseline and at completion of the study, including standardized measurements of BP, LDL cholesterol, and glycosylated hemoglobin (in diabetic subjects). The study design will allow assessment of a telephone-based, nurse-administered disease management program versus standard care. The main outcome of interest is the reduction in systolic BP in each intervention group compared with the control group at 12 months. Secondary outcomes assessed will include reductions in LDL cholesterol, body weight, and glycosylated hemoglobin, as well as adherence to evidence-based therapies and improvement in health behaviors. CONCLUSION: If successful in optimizing BP control, managing other coronary heart disease risk factors, and demonstrating a lower cost, the Web-based disease management tool has the potential to enhance coronary artery disease management, quality of care, and ultimately, patient outcomes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901277.

Authors
Shah, BR; Adams, M; Peterson, ED; Powers, B; Oddone, EZ; Royal, K; McCant, F; Grambow, SC; Lindquist, J; Bosworth, HB
MLA Citation
Shah, BR, Adams, M, Peterson, ED, Powers, B, Oddone, EZ, Royal, K, McCant, F, Grambow, SC, Lindquist, J, and Bosworth, HB. "Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management." Circ Cardiovasc Qual Outcomes 4.2 (March 2011): 235-242.
PMID
21406672
Source
pubmed
Published In
Circulation. Cardiovascular quality and outcomes
Volume
4
Issue
2
Publish Date
2011
Start Page
235
End Page
242
DOI
10.1161/CIRCOUTCOMES.110.951160

Measuring blood pressure for decision making and quality reporting

Authors
Powers, BJ; Oddone, EZ; Bosworth, HB
MLA Citation
Powers, BJ, Oddone, EZ, and Bosworth, HB. "Measuring blood pressure for decision making and quality reporting." Annals of Internal Medicine 155.8 (2011): 565-566.
PMID
22007055
Source
scival
Published In
Annals of internal medicine
Volume
155
Issue
8
Publish Date
2011
Start Page
565
End Page
566
DOI
10.7326/0003-4819-155-8-201110180-00025

Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid

Elevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients. Patients had at least one phone call by care managers. The individually tailored program focused on improving lifestyle and medication adherence. The primary outcome was the medication possession ratio (MPR), calculated using fill history from pharmacy claims. We observed an improvement of medication possession from 55% 9-12 months prior to program enrollment to 77% 9-12 months post initiation of the program. We demonstrated 12 month sustainability and increased MPR. Personal interaction by phone allows the intervention to be tailored to participants' current concerns, health goals, and specific barriers to achieving these goals. © 2010 Society of Behavioral Medicine.

Authors
Bosworth, HB; DuBard, CA; Ruppenkamp, J; Trygstad, T; Hewson, DL; Jackson, GL
MLA Citation
Bosworth, HB, DuBard, CA, Ruppenkamp, J, Trygstad, T, Hewson, DL, and Jackson, GL. "Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid." Translational Behavioral Medicine 1.1 (2011): 191-199.
PMID
24073040
Source
scival
Published In
Translational Behavioral Medicine
Volume
1
Issue
1
Publish Date
2011
Start Page
191
End Page
199
DOI
10.1007/s13142-010-0007-x

Long-term changes in physical activity following a one-year home-based physical activity counseling program in older adults with multiple morbidities.

This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more comorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed.

Authors
Hall, KS; Sloane, R; Pieper, CF; Peterson, MJ; Crowley, GM; Cowper, PA; McConnell, ES; Bosworth, HB; Ekelund, CC; Morey, MC
MLA Citation
Hall, KS, Sloane, R, Pieper, CF, Peterson, MJ, Crowley, GM, Cowper, PA, McConnell, ES, Bosworth, HB, Ekelund, CC, and Morey, MC. "Long-term changes in physical activity following a one-year home-based physical activity counseling program in older adults with multiple morbidities. (Published online)" J Aging Res 2011 (December 26, 2010): 308407-.
Website
http://hdl.handle.net/10161/8479
PMID
21234104
Source
pubmed
Published In
Journal of Aging Research
Volume
2011
Publish Date
2010
Start Page
308407
DOI
10.4061/2011/308407

Medication adherence

A key component in the management of health-care conditions is the use of prescribed medications. The effectiveness of medications and their long-term benefits depends on adherence to the prescriber's instructions [1]. Adherence is defined as the extent to which people follow the instructions they are given for prescribed treatments [2]; it involves consumer choice and is intended to be non-judgmental, unlike compliance, which reinforces patient passivity and blame. On the other hand, concordance refers to an emerging consultative and consensual partnership between the consumer and their doctor [2]. Medication adherence behavior has been divided into two main concepts, namely adherence and persistence. Although conceptually similar, adherence refers to the intensity of drug use during the duration of therapy, whereas persistence refers to overall duration [3]. Medication non-adherence includes delaying prescription fills, failing to fill prescriptions, cutting dosages, and reducing the frequency of administration. © 2010 Springer Science+Business Media, LLC.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "Medication adherence." (December 1, 2010): 68-94. (Chapter)
Source
scopus
Publish Date
2010
Start Page
68
End Page
94
DOI
10.1007/978-1-4419-5866-2_4

Improving patient treatment adherence: A clinician's guide

Virtually all medical and behavioral health treatments require at least some degree of patient adherence to succeed. Despite the relationship between health behaviors and outcomes, little attention is paid to developing proven methods for identifying and addressing patient non-adherence. Improving Patient Treatment Adherence: A Clinician's Guide offers new and updated information on the subject by focusing on practical tactics for clinicians that can improve patient adherence to a wide variety of treatments. This book is organized by behaviors-looking at topics that range from dietary adherence and smoking cessation to chronic pain, HIV and substance abuse-and examines the impact of patient non-adherence, including costs, clinical outcomes, and health-related quality of life. Helpful tables, questions, and scoring algorithms make this book a useful guide for any practicing physician. © Springer Science+Business Media, LLC 2010. All rights reserved.

Authors
Bosworth, H
MLA Citation
Bosworth, H. "Improving patient treatment adherence: A clinician's guide." Improving Patient Treatment Adherence: A Clinician's Guide (December 1, 2010): 1-358.
Source
scopus
Published In
Improving Patient Treatment Adherence: A Clinician's Guide
Publish Date
2010
Start Page
1
End Page
358
DOI
10.1007/978-1-4419-5866-2

Health services research and how it can inform the current state of ophthalmology.

Authors
Muir, KW; Bosworth, HB; Lee, PP
MLA Citation
Muir, KW, Bosworth, HB, and Lee, PP. "Health services research and how it can inform the current state of ophthalmology." Am J Ophthalmol 150.6 (December 2010): 761-763.
PMID
21094708
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
150
Issue
6
Publish Date
2010
Start Page
761
End Page
763
DOI
10.1016/j.ajo.2010.07.006

Telephone-based self-management of osteoarthritis: A randomized trial.

BACKGROUND: Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized. OBJECTIVE: To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthritis in a primary care setting. DESIGN: Randomized clinical trial with equal assignment to osteoarthritis self-management, health education (attention control), and usual care control groups. (ClinicalTrials.gov registration number: NCT00288912) SETTING: Primary care clinics in a Veterans Affairs Medical Center. PATIENTS: 515 patients with symptomatic hip or knee osteoarthritis. INTERVENTION: The osteoarthritis self-management intervention involved educational materials and 12 monthly telephone calls to support individualized goals and action plans. The health education intervention involved nonosteoarthritis educational materials and 12 monthly telephone calls related to general health screening topics. MEASUREMENTS: The primary outcome was score on the Arthritis Impact Measurement Scales-2 pain subscale (range, 0 to 10). Pain was also assessed with a 10-cm visual analog scale. Measurements were collected at baseline and 12 months. RESULTS: 461 participants (90%) completed the 12-month assessment. The mean Arthritis Impact Measurement Scales-2 pain score in the osteoarthritis self-management group was 0.4 point lower (95% CI, -0.8 to 0.1 point; P = 0.105) than in the usual care group and 0.6 point lower (CI, -1.0 to -0.2 point; P = 0.007) than in the health education group at 12 months. The mean visual analog scale pain score in the osteoarthritis self-management group was 1.1 points lower (CI, -1.6 to -0.6 point; P < 0.001) than in the usual care group and 1.0 point lower (CI, -1.5 to -0.5 point; P < 0.001) than in the health education group. Health care use did not differ across the groups. LIMITATION: The study was conducted at 1 Veterans Affairs Medical Center, and the sample consisted primarily of men. CONCLUSION: A telephone-based osteoarthritis self-management program produced moderate improvements in pain, particularly compared with a health education control group. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs Health Services Research and Development Service.

Authors
Allen, KD; Oddone, EZ; Coffman, CJ; Datta, SK; Juntilla, KA; Lindquist, JH; Walker, TA; Weinberger, M; Bosworth, HB
MLA Citation
Allen, KD, Oddone, EZ, Coffman, CJ, Datta, SK, Juntilla, KA, Lindquist, JH, Walker, TA, Weinberger, M, and Bosworth, HB. "Telephone-based self-management of osteoarthritis: A randomized trial." Ann Intern Med 153.9 (November 2, 2010): 570-579.
PMID
21041576
Source
pubmed
Published In
Annals of internal medicine
Volume
153
Issue
9
Publish Date
2010
Start Page
570
End Page
579
DOI
10.7326/0003-4819-153-9-201011020-00006

Patient self-management support: novel strategies in hypertension and heart disease.

Cardiovascular diseases (CVDs) have become the leading cause of death and disability in most countries in the world. This article addresses how patient self-management is a crucial component of effective high-quality health care for hypertension and CVD. The patient must be a collaborator in this process, and methods of improving patients' ability and confidence for self-management are needed. Successful self-management programs have often supplemented the traditional patient-physician encounter by using nonphysician providers, remote patient encounters (telephone or Internet), group settings, and peer support for promoting self-management. Several factors need to be considered in self-management. Given the health care system's inability to achieve several quality indicators using traditional office-based physician visits, further consideration is needed to determine the degree to which these interventions and programs can be integrated into primary care, their effectiveness in different groups, and their sustainability for improving chronic disease care.

Authors
Bosworth, HB; Powers, BJ; Oddone, EZ
MLA Citation
Bosworth, HB, Powers, BJ, and Oddone, EZ. "Patient self-management support: novel strategies in hypertension and heart disease." Cardiol Clin 28.4 (November 2010): 655-663. (Review)
PMID
20937448
Source
pubmed
Published In
Cardiology Clinics
Volume
28
Issue
4
Publish Date
2010
Start Page
655
End Page
663
DOI
10.1016/j.ccl.2010.07.003

Study protocol: the Adherence and Intensification of Medications (AIM) study--a cluster randomized controlled effectiveness study.

BACKGROUND: Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. METHODS: In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP) measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL), medication adherence determined from pharmacy refill data, and medication intensification rates. DISCUSSION: Integration of the three intervention elements--proactive identification, adherence counseling and medication intensification--is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. TRIAL REGISTRATION: The ClinicalTrials.gov registration number is NCT00495794.

Authors
Heisler, M; Hofer, TP; Klamerus, ML; Schmittdiel, J; Selby, J; Hogan, MM; Bosworth, HB; Tremblay, A; Kerr, EA
MLA Citation
Heisler, M, Hofer, TP, Klamerus, ML, Schmittdiel, J, Selby, J, Hogan, MM, Bosworth, HB, Tremblay, A, and Kerr, EA. "Study protocol: the Adherence and Intensification of Medications (AIM) study--a cluster randomized controlled effectiveness study. (Published online)" Trials 11 (October 12, 2010): 95-.
Website
http://hdl.handle.net/10161/4380
PMID
20939913
Source
pubmed
Published In
Trials
Volume
11
Publish Date
2010
Start Page
95
DOI
10.1186/1745-6215-11-95

Individual progress toward self-selected goals among older adults enrolled in a physical activity counseling intervention.

The purpose of this study was to examine what happens to goals over the course of a physical activity counseling trial in older veterans. At baseline, participants (N = 313) identified 1 health-related goal and 1 walking goal for their participation in the study and rated where they perceived themselves to be relative to that goal at the current time. They rated their current status on these same goals again at 6 and 12 mo. Growth-curve analyses were used to examine longitudinal change in perceived goal status. Although both the intervention and control groups demonstrated improvement in their perceived proximity to their health-related and walking goals (L = 1.19, p < .001), the rates of change were significantly greater in the intervention group (β = -.30, p < .05). Our results demonstrate that this physical activity counseling intervention had a positive impact on self-selected goals over the course of the intervention.

Authors
Hall, KS; Crowley, GM; Bosworth, HB; Howard, TA; Morey, MC
MLA Citation
Hall, KS, Crowley, GM, Bosworth, HB, Howard, TA, and Morey, MC. "Individual progress toward self-selected goals among older adults enrolled in a physical activity counseling intervention." J Aging Phys Act 18.4 (October 2010): 439-450.
PMID
20956844
Source
pubmed
Published In
Journal of aging and physical activity
Volume
18
Issue
4
Publish Date
2010
Start Page
439
End Page
450

Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing.

PURPOSE: To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks. METHODS: A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF). RESULTS: The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF. CONCLUSION: After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.

Authors
Hahn, EA; Devellis, RF; Bode, RK; Garcia, SF; Castel, LD; Eisen, SV; Bosworth, HB; Heinemann, AW; Rothrock, N; Cella, D; PROMIS Cooperative Group,
MLA Citation
Hahn, EA, Devellis, RF, Bode, RK, Garcia, SF, Castel, LD, Eisen, SV, Bosworth, HB, Heinemann, AW, Rothrock, N, Cella, D, and PROMIS Cooperative Group, . "Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing." Qual Life Res 19.7 (September 2010): 1035-1044.
PMID
20419503
Source
pubmed
Published In
Quality of Life Research
Volume
19
Issue
7
Publish Date
2010
Start Page
1035
End Page
1044
DOI
10.1007/s11136-010-9654-0

Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients.

BACKGROUND: Few telemedicine programs have undergone cost analyses, impeding their implementation into practice. We report on the economic analysis of a nurse-administered intervention designed to improve blood pressure control among hypertensive veterans. METHODS: We randomized hypertensive patients at the Durham Veterans Affairs Medical Center primary care clinic to behavioral (n = 294) or nonbehavioral (n = 294) interventions. Behavioral intervention patients received tailored information bimonthly for 2 years via telephone. To calculate intervention cost, we microcosted the nurse's labor cost and computer hardware and software costs, applied a direct-to-indirect cost ratio, and distributed the costs over an estimated cohort of patients. We analyzed data from the Veterans Affairs Decision Support System to assess whether the intervention impacted overall health care utilization and costs. We used life expectancy estimates from the literature to develop decision models to calculate cost per life-year saved. RESULTS: The mean annual intervention cost was $112 (range $61-$259). During 2 years of follow-up, patients in the intervention group incurred $7,800 in inpatient costs and $9,741 in outpatient costs; the nonintervention group incurred $6,866 in inpatient costs and $9,599 in outpatient costs. The total cost difference was not statistically significant (P = .56). Cost-effectiveness of the behavioral intervention ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year saved for normal-weight men. CONCLUSIONS: The study results suggest that a nurse-administered, tailored behavioral intervention can be implemented at nominal cost and be cost-effective; however, there was no apparent lowering of health care utilization and costs during the 2 years of follow-up.

Authors
Datta, SK; Oddone, EZ; Olsen, MK; Orr, M; McCant, F; Gentry, P; Bosworth, HB
MLA Citation
Datta, SK, Oddone, EZ, Olsen, MK, Orr, M, McCant, F, Gentry, P, and Bosworth, HB. "Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients." Am Heart J 160.2 (August 2010): 257-263.
PMID
20691830
Source
pubmed
Published In
American Heart Journal
Volume
160
Issue
2
Publish Date
2010
Start Page
257
End Page
263
DOI
10.1016/j.ahj.2010.05.024

Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach.

To determine subtypes of adherence, 636 hypertensive patients (48% White, 34% male) reported adherence to medications, diet, exercise, smoking, and home blood pressure monitoring. A latent class analysis approach was used to identify subgroups that adhere to these five self-management behaviors. Fit statistics suggested two latent classes. The first class (labeled "more adherent") included patients with greater probability of adhering to recommendations compared with the second class (labeled "less adherent") with regard to nonsmoking (97.7% versus 76.3%), medications (75.5% versus 49.5%), diet (70.7% versus 46.9%), exercise (63.4% versus 27.2%), and blood pressure monitoring (32% versus 3.4%). Logistic regression analyses used to characterize the two classes showed that "more adherent" participants were more likely to report full-time employment, adequate income, and better emotional and physical well-being. Results suggest the presence of a less adherent subtype of hypertensive patients. Behavioral interventions designed to improve adherence might best target these at-risk patients for greater treatment efficiency.

Authors
Trivedi, RB; Ayotte, BJ; Thorpe, CT; Edelman, D; Bosworth, HB
MLA Citation
Trivedi, RB, Ayotte, BJ, Thorpe, CT, Edelman, D, and Bosworth, HB. "Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach. (Published online)" Patient Prefer Adherence 4 (July 21, 2010): 255-262.
PMID
20694185
Source
pubmed
Published In
Patient Preference and Adherence
Volume
4
Publish Date
2010
Start Page
255
End Page
262

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Authors
Bosworth, HB; Almirall, D; Weiner, BJ; Maciejewski, M; Kaufman, MA; Powers, BJ; Oddone, EZ; Lee, S-YD; Damush, TM; Smith, V; Olsen, MK; Anderson, D; Roumie, CL; Rakley, S; Del Monte, PS; Bowen, ME; Kravetz, JD; Jackson, GL
MLA Citation
Bosworth, HB, Almirall, D, Weiner, BJ, Maciejewski, M, Kaufman, MA, Powers, BJ, Oddone, EZ, Lee, S-YD, Damush, TM, Smith, V, Olsen, MK, Anderson, D, Roumie, CL, Rakley, S, Del Monte, PS, Bowen, ME, Kravetz, JD, and Jackson, GL. "The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295). (Published online)" Implement Sci 5 (July 16, 2010): 54-.
Website
http://hdl.handle.net/10161/4382
PMID
20637095
Source
pubmed
Published In
Implementation Science
Volume
5
Publish Date
2010
Start Page
54
DOI
10.1186/1748-5908-5-54

Can this patient read and understand written health information?

CONTEXT: Patients with limited literacy are at higher risk for poor health outcomes; however, physicians' perceptions are inaccurate for identifying these patients. OBJECTIVE: To systematically review the accuracy of brief instruments for identifying patients with limited literacy. DATA SOURCES: Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill. STUDY SELECTION: Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard. DATA EXTRACTION: Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer. DATA SYNTHESIS: Ten studies using 6 different instruments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, "How confident are you in filling out medical forms by yourself?" is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of "a little confident" or "not at all confident"; a summary LR of 2.2 (95% CI, 1.5-3.3) for "somewhat confident"; and a summary LR of 0.44 (95% CI, 0.24-0.82) for "quite a bit" or "extremely confident." CONCLUSION: Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy.

Authors
Powers, BJ; Trinh, JV; Bosworth, HB
MLA Citation
Powers, BJ, Trinh, JV, and Bosworth, HB. "Can this patient read and understand written health information?." JAMA 304.1 (July 7, 2010): 76-84. (Review)
PMID
20606152
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
304
Issue
1
Publish Date
2010
Start Page
76
End Page
84
DOI
10.1001/jama.2010.896

Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults.

OBJECTIVES: To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults. DESIGN: Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina. INTERVENTION: The culturally adapted behavioral intervention consisted of six weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally appropriate food choices, and physical activity. MAIN OUTCOMES: Systolic blood pressure (BP), weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted. RESULTS: There were 64 potential participants identified via healthcare provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants 'strongly agreed/agreed' that the group sessions provided them with the tools they needed to achieve weight loss, BP control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic BP decreased an average of -10.4+/-10.6 mmHg, weight decreased 1.5+/-3.2 lbs, BMI decreased 0.3+/-0.5, and physical activity increased 40 minutes per week. CONCLUSION: Our findings suggest that lifestyle interventions for preventing and treating hypertension are feasible and potentially effective in the Hispanic/Latino population.

Authors
Rocha-Goldberg, MDP; Corsino, L; Batch, B; Voils, CI; Thorpe, CT; Bosworth, HB; Svetkey, LP
MLA Citation
Rocha-Goldberg, MDP, Corsino, L, Batch, B, Voils, CI, Thorpe, CT, Bosworth, HB, and Svetkey, LP. "Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults." Ethn Health 15.3 (June 2010): 269-282.
PMID
20379894
Source
pubmed
Published In
Ethnicity & Health
Volume
15
Issue
3
Publish Date
2010
Start Page
269
End Page
282
DOI
10.1080/13557851003674997

Change in goal ratings as a mediating variable between self-efficacy and physical activity in older men.

BACKGROUND: Few studies have examined the associations between exercise self-efficacy, goals, and physical activity over time. PURPOSE: This study examines whether self-selected goals mediate the changes in exercise self-efficacy on physical activity over 12 months. METHODS: Data are derived from 313 older men participating in the Veterans LIFE Study. RESULTS: Changes in exercise self-efficacy were significantly associated with changes in physical activity both directly (betas = 0.25 and 0.24, p < 0.05) and indirectly (betas = 0.24 and 0.30, p < 0.05) through changes in health-related and walking goal ratings (betas = 0.19 and 0.20, p < 0.05). Both types of goal setting continued to partially mediate the relationship between exercise self-efficacy and physical activity when covariates were added to the models. CONCLUSION: This study extends the application of social cognitive and goal-setting theories to physical activity by showing that goals partially mediate the relationship between exercise self-efficacy and physical activity over time.

Authors
Hall, KS; Crowley, GM; McConnell, ES; Bosworth, HB; Sloane, R; Ekelund, CC; Morey, MC
MLA Citation
Hall, KS, Crowley, GM, McConnell, ES, Bosworth, HB, Sloane, R, Ekelund, CC, and Morey, MC. "Change in goal ratings as a mediating variable between self-efficacy and physical activity in older men." Ann Behav Med 39.3 (June 2010): 267-273.
PMID
20387023
Source
pubmed
Published In
Annals of Behavioral Medicine
Volume
39
Issue
3
Publish Date
2010
Start Page
267
End Page
273
DOI
10.1007/s12160-010-9177-5

The impact of self-reported arthritis and diabetes on response to a home-based physical activity counselling intervention.

OBJECTIVES: Physical activity (PA) has the potential to improve outcomes in both arthritis and diabetes, but these conditions are rarely examined together. Our objective was to explore whether persons with arthritis alone or those with both arthritis and diabetes could improve amounts of PA with a home-based counselling intervention. METHODS: As part of the Veterans LIFE (Learning to Improve Fitness and Function in Elders) Study, veterans aged 70-92 were randomized to usual care or a 12-month PA counselling programme. Arthritis and diabetes were assessed by self-report. Mixed models were used to compare trajectories for minutes of endurance and strength training PA for persons with no arthritis (n = 85), arthritis (n = 178), and arthritis plus diabetes (n = 84). RESULTS: Recipients of PA counselling increased minutes of PA per week independent of disease status (treatment arm by time interaction p < 0.05 for both; endurance training time p = 0.0006 and strength training time p < 0.0001). Although PA was lower at each wave among persons with arthritis, and even more so among persons with arthritis plus diabetes, the presence of these conditions did not significantly influence response to the intervention (arthritis/diabetes group x time interactions p > 0.05 for both outcomes) as each group experienced a nearly twofold or greater increase in PA. CONCLUSIONS: A home-based PA intervention was effective in increasing minutes of weekly moderate intensity endurance and strength training PA in older veterans, even among those with arthritis or arthritis plus diabetes. This programme may serve as a useful model to improve outcomes in older persons with these pervasive diseases.

Authors
Huffman, KM; Sloane, R; Peterson, MJ; Bosworth, HB; Ekelund, C; Pearson, M; Howard, T; Pieper, CF; Morey, MC
MLA Citation
Huffman, KM, Sloane, R, Peterson, MJ, Bosworth, HB, Ekelund, C, Pearson, M, Howard, T, Pieper, CF, and Morey, MC. "The impact of self-reported arthritis and diabetes on response to a home-based physical activity counselling intervention." Scand J Rheumatol 39.3 (May 2010): 233-239.
PMID
20429674
Source
pubmed
Published In
Scandinavian Journal of Rheumatology (Informa)
Volume
39
Issue
3
Publish Date
2010
Start Page
233
End Page
239
DOI
10.3109/03009740903348973

Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension.

BACKGROUND: The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention, patient self-monitoring, and both interventions combined compared with usual care on reducing systolic blood pressure during 24 months. The combined intervention led to a significant reduction in systolic blood pressure compared with usual care alone. We examined direct and patient time costs associated with each intervention. METHODS: We conducted a prospective economic evaluation alongside a randomized controlled trial of 636 patients with hypertension participating in the study interventions. Medical costs were estimated using electronic data representing medical services delivered within the health system. Intervention-related costs were derived using information collected during the trial, administrative records, and published unit costs. RESULTS: During 24 months, patients incurred a mean of $6,965 (s.d., $22,054) in inpatient costs and $8,676 (s.d., $9,368) in outpatient costs, with no significant differences among the intervention groups. With base-case assumptions, intervention costs were estimated at $90 (s.d., $2) for home blood pressure monitoring, $345 (s.d., $64) for the behavioral intervention ($31 per telephone encounter), and $416 (s.d., $93) for the combined intervention. Patient time costs were estimated at $585 (s.d., $487) for home monitoring, $55 (s.d., $16) for the behavioral intervention, and $741 (s.d., $529) for the combined intervention. CONCLUSIONS: Our analysis demonstrated that the interventions are cost-additive to the health-care system in the short term and that patients' time costs are nontrivial.

Authors
Reed, SD; Li, Y; Oddone, EZ; Neary, AM; Orr, MM; Grubber, JM; Graham, FL; Olsen, MK; Svetkey, LP; Dolor, RJ; Powers, BJ; Adams, MB; Bosworth, HB
MLA Citation
Reed, SD, Li, Y, Oddone, EZ, Neary, AM, Orr, MM, Grubber, JM, Graham, FL, Olsen, MK, Svetkey, LP, Dolor, RJ, Powers, BJ, Adams, MB, and Bosworth, HB. "Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension." Am J Hypertens 23.2 (February 2010): 142-148.
PMID
19927132
Source
pubmed
Published In
American Journal of Hypertension
Volume
23
Issue
2
Publish Date
2010
Start Page
142
End Page
148
DOI
10.1038/ajh.2009.215

Racial differences in osteoarthritis pain and function: potential explanatory factors.

OBJECTIVE: This study examined factors underlying racial differences in pain and function among patients with hip and/or knee osteoarthritis (OA). METHODS: Participants were n=491 African Americans and Caucasians enrolled in a clinical trial of telephone-based OA self-management. Arthritis Impact Measurement Scales-2 (AIMS2) pain and function subscales were obtained at baseline. Potential explanatory variables included arthritis self-efficacy, AIMS2 affect subscale, problem- and emotion-focused pain coping, demographic characteristics, body mass index, self-reported health, joint(s) with OA, symptom duration, pain medication use, current exercise, and AIMS2 pain subscale (in models of function). Variables associated with both race and pain or function, and which reduced the association of race with pain or function by >or=10%, were included in final multivariable models. RESULTS: In simple linear regression models, African Americans had worse scores than Caucasians on AIMS2 pain (B=0.65, P=0.001) and function (B=0.59, P<0.001) subscales. In multivariable models race was no longer associated with pain (B=0.03, P=0.874) or function (B=0.07, P=0.509), indicating these associations were accounted for by other covariates. Variables associated with worse AIMS2 pain and function were: worse AIMS2 affect scores, greater emotion-focused coping, lower arthritis self-efficacy, and fair or poor self-reported health. AIMS2 pain scores were also significantly associated with AIMS2 function. CONCLUSION: Factors explaining racial differences in pain and function were largely psychological, including arthritis self-efficacy, affect, and use of emotion-focused coping. Self-management and psychological interventions can influence these factors, and greater dissemination among African Americans may be a key step toward reducing racial disparities in pain and function.

Authors
Allen, KD; Oddone, EZ; Coffman, CJ; Keefe, FJ; Lindquist, JH; Bosworth, HB
MLA Citation
Allen, KD, Oddone, EZ, Coffman, CJ, Keefe, FJ, Lindquist, JH, and Bosworth, HB. "Racial differences in osteoarthritis pain and function: potential explanatory factors." Osteoarthritis Cartilage 18.2 (February 2010): 160-167.
PMID
19825498
Source
pubmed
Published In
Osteoarthritis and Cartilage
Volume
18
Issue
2
Publish Date
2010
Start Page
160
End Page
167
DOI
10.1016/j.joca.2009.09.010

Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research.

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.

Authors
Tuerk, PW; Fortney, J; Bosworth, HB; Wakefield, B; Ruggiero, KJ; Acierno, R; Frueh, BC
MLA Citation
Tuerk, PW, Fortney, J, Bosworth, HB, Wakefield, B, Ruggiero, KJ, Acierno, R, and Frueh, BC. "Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research." Telemed J E Health 16.1 (January 2010): 115-117.
Website
http://hdl.handle.net/10161/3294
PMID
20043704
Source
pubmed
Published In
Telemedicine Journal and e-Health
Volume
16
Issue
1
Publish Date
2010
Start Page
115
End Page
117
DOI
10.1089/tmj.2009.0144

Implementing evidence-based patient self-management programs in the Veterans Health Administration: perspectives on delivery system design considerations.

While many patient self-management (PSM) programs have been developed and evaluated for effectiveness, less effort has been devoted to translating and systematically delivering PSM in primary and specialty care. Therefore, the purpose of this paper is to review delivery system design considerations for implementing self-management programs in practice. As lessons are learned about implementing PSM programs in Veterans Health Administration (VHA), resource allocation by healthcare organization for formatting PSM programs, providing patient access, facilitating PSM, and incorporating support tools to foster PSM among its consumers can be refined and tailored. Redesigning the system to deliver and support PSM will be important as implementation researchers translate evidence based PSM practices into routine care and evaluate its impact on the health-related quality of life of veterans living with chronic disease.

Authors
Damush, TM; Jackson, GL; Powers, BJ; Bosworth, HB; Cheng, E; Anderson, J; Guihan, M; LaVela, S; Rajan, S; Plue, L
MLA Citation
Damush, TM, Jackson, GL, Powers, BJ, Bosworth, HB, Cheng, E, Anderson, J, Guihan, M, LaVela, S, Rajan, S, and Plue, L. "Implementing evidence-based patient self-management programs in the Veterans Health Administration: perspectives on delivery system design considerations." J Gen Intern Med 25 Suppl 1 (January 2010): 68-71. (Review)
PMID
20077155
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
25 Suppl 1
Publish Date
2010
Start Page
68
End Page
71
DOI
10.1007/s11606-009-1123-5

Is diabetes associated with poorer self-efficacy and motivation for physical activity in older adults with arthritis?

OBJECTIVES: The primary aim was to explore whether arthritis is associated with poorer self-efficacy and motivation for, and participation in, two specific types of physical activity (PA): endurance training (ET) and strength training (ST). A further objective was to determine whether the added burden of diabetes contributes to a further reduction in these PA determinants and types. METHODS: Self-efficacy and motivation for exercise and minutes per week of ET and ST were measured in 347 older veterans enrolled in a home-based PA counselling intervention. Regression analyses were used to compare high versus low self-efficacy and motivation and PA minutes in persons without arthritis, with arthritis alone, and with arthritis plus diabetes. RESULTS: Persons with arthritis alone reported lower self-efficacy for ET and ST than those without arthritis [odds ratio (OR)ET 0.71, 95% confidence interval (CI) 0.39–1.20; ORST 0.69, 95% CI 0.39–1.20]. A further reduction in self-efficacy for these two types of PA was observed for those with both arthritis and diabetes (ORET 0.65, 95% CI 0.44–0.92; ORST 0.64, 95% CI 0.44–0.93; trend p < 0.001). There was no trend towards a reduction in motivation for PA in those with arthritis alone or with arthritis and diabetes. Persons with arthritis exhibited higher motivation for ET than those without arthritis (ORET 1.85, 95% CI 1.12–3.33). There were no significant differences between the three groups in minutes of ET (p = 0.93), but persons with arthritis plus diabetes reported significantly less ST compared to individuals with arthritis only (p = 0.03). CONCLUSIONS: Despite reduced self-efficacy for ET and ST and less ST in older persons with arthritis, motivation for both PA types remains high, even in the presence of diabetes.

Authors
Huffman, KM; Hall, KS; Sloane, R; Peterson, MJ; Bosworth, HB; Ekelund, C; Pearson, M; Howard, T; Pieper, CF; Morey, MC
MLA Citation
Huffman, KM, Hall, KS, Sloane, R, Peterson, MJ, Bosworth, HB, Ekelund, C, Pearson, M, Howard, T, Pieper, CF, and Morey, MC. "Is diabetes associated with poorer self-efficacy and motivation for physical activity in older adults with arthritis?." Scand J Rheumatol 39.5 (2010): 380-386.
PMID
20604671
Source
pubmed
Published In
Scandinavian Journal of Rheumatology (Informa)
Volume
39
Issue
5
Publish Date
2010
Start Page
380
End Page
386
DOI
10.3109/03009741003605630

Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research.

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.

Authors
Tuerk, PW; Fortney, J; Bosworth, HB; Wakefield, B; Ruggiero, KJ; Acierno, R; Frueh, BC
MLA Citation
Tuerk, PW, Fortney, J, Bosworth, HB, Wakefield, B, Ruggiero, KJ, Acierno, R, and Frueh, BC. "Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research." Telemedicine journal and e-health : the official journal of the American Telemedicine Association 16.1 (2010): 115-117.
Source
scival
Published In
Telemedicine Journal and e-Health
Volume
16
Issue
1
Publish Date
2010
Start Page
115
End Page
117
DOI
10.1089/tmj.2009.0144

Two self-management interventions to improve hypertension control: a randomized trial.

BACKGROUND: Fewer than 40% of persons with hypertension in the United States have adequate blood pressure (BP) control. OBJECTIVE: To compare 2 self-management interventions for improving BP control among hypertensive patients. DESIGN: A 2 x 2 randomized trial, stratified by enrollment site and patient health literacy status, with 2-year follow-up. (ClinicalTrials.gov registration number: NCT00123058). SETTING: 2 university-affiliated primary care clinics. PATIENTS: 636 hypertensive patients. INTERVENTION: A centralized, blinded, and stratified randomization algorithm was used to randomly assign eligible patients to receive usual care, a behavioral intervention (bimonthly tailored, nurse-administered telephone intervention targeting hypertension-related behaviors), home BP monitoring 3 times weekly, or the behavioral intervention plus home BP monitoring. MEASUREMENTS: The primary outcome was BP control at 6-month intervals over 24 months. RESULTS: 475 patients (75%) completed the 24-month BP follow-up. At 24 months, improvements in the proportion of patients with BP control relative to the usual care group were 4.3% (95% CI, -4.5% to 12.9%) in the behavioral intervention group, 7.6% (CI, -1.9% to 17.0%) in the home BP monitoring group, and 11.0% (CI, 1.9%, 19.8%) in the combined intervention group. Relative to usual care, the 24-month difference in systolic BP was 0.6 mm Hg (CI, -2.2 to 3.4 mm Hg) for the behavioral intervention group, -0.6 mm Hg (CI, -3.6 to 2.3 mm Hg) for the BP monitoring group, and -3.9 mm Hg (CI, -6.9 to -0.9 mm Hg) for the combined intervention group; patterns were similar for diastolic BP. LIMITATION: Changes in medication use and diet were monitored only in intervention participants; 24-month outcome data were missing for 25% of participants, BP control was adequate at baseline in 73% of participants, and the study setting was an academic health center. CONCLUSION: Combined home BP monitoring and tailored behavioral telephone intervention improved BP control, systolic BP, and diastolic BP at 24 months relative to usual care. .

Authors
Bosworth, HB; Olsen, MK; Grubber, JM; Neary, AM; Orr, MM; Powers, BJ; Adams, MB; Svetkey, LP; Reed, SD; Li, Y; Dolor, RJ; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Grubber, JM, Neary, AM, Orr, MM, Powers, BJ, Adams, MB, Svetkey, LP, Reed, SD, Li, Y, Dolor, RJ, and Oddone, EZ. "Two self-management interventions to improve hypertension control: a randomized trial." Ann Intern Med 151.10 (November 17, 2009): 687-695.
PMID
19920269
Source
pubmed
Published In
Annals of internal medicine
Volume
151
Issue
10
Publish Date
2009
Start Page
687
End Page
695
DOI
10.7326/0003-4819-151-10-200911170-00148

Diversity, health, and the state of patient care in the US health care system.

Authors
Bosworth, HB; Horner, RD
MLA Citation
Bosworth, HB, and Horner, RD. "Diversity, health, and the state of patient care in the US health care system." J Gen Intern Med 24 Suppl 3 (November 2009): 567-.
PMID
19842008
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
24 Suppl 3
Publish Date
2009
Start Page
567
DOI
10.1007/s11606-009-1124-4

Patient characteristics associated with receipt of lifestyle behavior advice.

BACKGROUND: Lifestyle behaviors such as reducing weight if overweight or obese, reducing salt intake, exercising, reducing alcohol intake, quitting smoking, and eating a healthy diet are related to the prevention and control of chronic diseases. However the amount of lifestyle advice provided by clinicians has been declining over the last decade. METHODS: In 2002, a telephone survey was conducted to assess the quality of preventive care offered by health care providers. The study was a cross-sectional observational study of a randomly selected sample of 516 diverse individuals in Durham County, North Carolina. Information regarding age, sex, race, education, health conditions, and self-reported receipt of lifestyle advice was examined in the study. RESULTS: The odds of receiving advice to engage in preventive lifestyle behaviors were significantly higher for those with a pre-existing diagnosis of diabetes or hypertension and for participants reporting poor health status. For example, the odds of receiving advice to control or lose weight was 8.32 (95% CI, 2.65, 26.75) among individuals reporting a diagnosis of diabetes. Similarly, the odds of reporting "receiving advice to reduce salt intake" was 6.97 (95% CI, 3.74, 13.00) among subjects reporting a diagnosis of hypertension. LIMITATIONS: The results are from a cross-sectional study of a sample of individuals in only one county. Additionally, the results are based on patient self-reported information, which could be subject to recall and social desirability bias. CONCLUSION: Patients with identified health problems were more likely than others to report being advised to adopt healthy lifestyle recommendations. Future research should examine methods to encourage health care providers to offer lifestyle advice to those without pre-existing illness.

Authors
Corsino, L; Svetkey, LP; Ayotte, BJ; Bosworth, HB
MLA Citation
Corsino, L, Svetkey, LP, Ayotte, BJ, and Bosworth, HB. "Patient characteristics associated with receipt of lifestyle behavior advice." N C Med J 70.5 (September 2009): 391-398.
PMID
19999515
Source
pubmed
Published In
North Carolina Medical Journal
Volume
70
Issue
5
Publish Date
2009
Start Page
391
End Page
398

The moderating role of personality factors in the relationship between depression and neuropsychological functioning among older adults.

OBJECTIVE: Depression is often associated with decreased cognitive performance among older adults. The current study focused on the association of neuropsychological functioning and personality traits in depressed and non-depressed older adults. METHODS: Data from 75 depressed and 103 non-depressed adults over the age of 60 were analyzed. All participants underwent standardized clinical assessment for depression prior to participation and completed the NEO-PI-R and a series of neuropsychological assessments. RESULTS: A series of multiple linear regressions were conducted to examine the relationships between personality and neuropsychological performance among depressed and non-depressed older adults. Results indicated that higher Openness to Experience was related to better performance on Parts A and B of the Trail Making Test among depressed older adults, and to better Digit Span Backward performance among all participants. Higher levels of neuroticism were related to poorer performance on Digit Span Backward, but only among depressed older adults. Depressed participants performed more poorly on the Symbol Digit Modalities Test and the Controlled Oral Word Association Test. CONCLUSIONS: Personality characteristics, particularly Openness to Experience, modified the relationship between depression and neuropsychological functioning among older adults. Results indicate that interventions aimed at increasing one's Openness to Experience could potentially attenuate some of the neuropsychological impairments that are associated with depression.

Authors
Ayotte, BJ; Potter, GG; Williams, HT; Steffens, DC; Bosworth, HB
MLA Citation
Ayotte, BJ, Potter, GG, Williams, HT, Steffens, DC, and Bosworth, HB. "The moderating role of personality factors in the relationship between depression and neuropsychological functioning among older adults." Int J Geriatr Psychiatry 24.9 (September 2009): 1010-1019.
PMID
19226526
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
24
Issue
9
Publish Date
2009
Start Page
1010
End Page
1019
DOI
10.1002/gps.2213

The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology.

BACKGROUND: Cardiovascular disease (CVD) and diabetes account for over one third of the mortality difference between African Americans and white patients. The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD risk factors. OBJECTIVES: The current study is aimed at improving CVD outcomes in African-American adults with diabetes by addressing the modifiable risk factors of systolic blood pressure , glycosylated hemoglobin, and low-density lipoprotein cholesterol. METHODS: A sample of African American patients with diabetes (N = 400) will receive written education material at baseline and be randomized to one of 2 arms: (1) usual primary care or (2) nurse-administered disease-management intervention combining patient self-management support and provider medication management. The nurse administered intervention is delivered monthly over the telephone. The nurses also interacts with the primary care providers at 3, 6, and 9 months to provide concise patient updates and facilitate changes in medical management. All patients are followed for 12 months after enrollment. The primary outcomes are change in glycosylated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol over 12-months. Secondary outcomes include change in overall cardiovascular risk, aspirin use, and health behaviors. CONCLUSION: Given the continued racial disparities in CVD, the proposed study could result in significant contributions to cardiovascular risk reduction in African-American patients.

Authors
Powers, BJ; King, JL; Ali, R; Alkon, A; Bowlby, L; Edelman, D; Gentry, P; Grubber, JM; Koropchak, C; Maciejewski, ML; McCant, F; McKoy, G; Newell, M; Oddone, EZ; Olsen, MK; Rose, CM; Trujillo, G; Bosworth, HB
MLA Citation
Powers, BJ, King, JL, Ali, R, Alkon, A, Bowlby, L, Edelman, D, Gentry, P, Grubber, JM, Koropchak, C, Maciejewski, ML, McCant, F, McKoy, G, Newell, M, Oddone, EZ, Olsen, MK, Rose, CM, Trujillo, G, and Bosworth, HB. "The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology." Am Heart J 158.3 (September 2009): 342-348.
PMID
19699855
Source
pubmed
Published In
American Heart Journal
Volume
158
Issue
3
Publish Date
2009
Start Page
342
End Page
348
DOI
10.1016/j.ahj.2009.06.026

The effect of a hypertension self-management intervention on diabetes and cholesterol control.

BACKGROUND: Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C). METHODS: We evaluated patients from the Veterans Study to Improve the Control of Hypertension, a 2-year randomized controlled trial. Patients received either a hypertension self-management intervention delivered by a nurse over the telephone or usual care. Although the study focused on hypertension self-management, we compared changes in HbA1c among a subgroup of 216 patients with diabetes and LDL-C among 528 patients with measurements during the study period. Changes in these laboratory values over time were compared between the 2 treatment groups using linear mixed-effects models. RESULTS: For the patients with diabetes, the hypertension self-management intervention resulted in a 0.46% reduction in HbA1c over 2 years compared with usual care (95% confidence interval, 0.04%-0.89%; P = .03). For LDL-C, there was a minimal 0.9 mg/dL between-group difference that was not statistically significant (95% confidence interval, -7.3-5.6 mg/dL; P = .79). CONCLUSIONS: There was a significant effect of the self-management intervention on the unintended target of HbA1c, but not LDL-C. Chronic disease self-management interventions might have "spill-over" effects on patients' comorbid chronic conditions.

Authors
Powers, BJ; Olsen, MK; Oddone, EZ; Bosworth, HB
MLA Citation
Powers, BJ, Olsen, MK, Oddone, EZ, and Bosworth, HB. "The effect of a hypertension self-management intervention on diabetes and cholesterol control." Am J Med 122.7 (July 2009): 639-646.
PMID
19559166
Source
pubmed
Published In
American Journal of Medicine
Volume
122
Issue
7
Publish Date
2009
Start Page
639
End Page
646
DOI
10.1016/j.amjmed.2008.12.022

The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men.

OBJECTIVES: To determine the effects of primary care-based, multicomponent physical activity counseling (PAC) promoting physical activity (PA) guidelines on gait speed and related measures of PA and function in older veterans. DESIGN: Randomized controlled trial. SETTING: Veterans Affairs Medical Center of Durham, North Carolina. PARTICIPANTS: Three hundred ninety-eight male veterans aged 70 and older. INTERVENTION: Twelve months of usual care (UC) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor, one-time clinical endorsement of PA, monthly automated telephone messaging from the primary care provider, and quarterly tailored mailings of progress in PA. MEASUREMENTS: Gait speed (usual and rapid), self-reported PA, function, and disability at baseline and 3, 6, and 12 months. RESULTS: Although no between-group differences were noted for usual gait speed, rapid gait speed improved significantly more for the PAC group (1.56 +/- 0.41 m/s to 1.68 +/- 0.44 m/s) than with UC (1.57 +/- 0.40 m/sec to 1.59 +/- 0.42 m/sec, P=.04). Minutes of moderate/vigorous PA increased significantly in the PAC group (from 57.1 +/- 99.3 to 126.6 +/- 142.9 min/wk) but not in the UC group (from 60.2 +/- 116.1 to 69.6 +/- 116.1 min/wk, P<.001). Changes in other functional/disability outcomes were small. CONCLUSION: In this group of older male veterans, multicomponent PA significantly improved rapid gait and PA. Translation from increased PA to overall functioning was not observed. Integration with primary care was successful.

Authors
Morey, MC; Peterson, MJ; Pieper, CF; Sloane, R; Crowley, GM; Cowper, PA; McConnell, ES; Bosworth, HB; Ekelund, CC; Pearson, MP
MLA Citation
Morey, MC, Peterson, MJ, Pieper, CF, Sloane, R, Crowley, GM, Cowper, PA, McConnell, ES, Bosworth, HB, Ekelund, CC, and Pearson, MP. "The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men." J Am Geriatr Soc 57.7 (July 2009): 1166-1174.
PMID
19467149
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
57
Issue
7
Publish Date
2009
Start Page
1166
End Page
1174
DOI
10.1111/j.1532-5415.2009.02301.x

Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans.

African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual's cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP.

Authors
Scisney-Matlock, M; Bosworth, HB; Giger, JN; Strickland, OL; Harrison, RV; Coverson, D; Shah, NR; Dennison, CR; Dunbar-Jacob, JM; Jones, L; Ogedegbe, G; Batts-Turner, ML; Jamerson, KA
MLA Citation
Scisney-Matlock, M, Bosworth, HB, Giger, JN, Strickland, OL, Harrison, RV, Coverson, D, Shah, NR, Dennison, CR, Dunbar-Jacob, JM, Jones, L, Ogedegbe, G, Batts-Turner, ML, and Jamerson, KA. "Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans." Postgrad Med 121.3 (May 2009): 147-159. (Review)
PMID
19491553
Source
pubmed
Published In
Postgraduate Medicine
Volume
121
Issue
3
Publish Date
2009
Start Page
147
End Page
159
DOI
10.3810/pgm.2009.05.2015

TRIAL-BASED ECONOMIC EVALUATION ALONGSIDE THE TCYB (TAKE CONTROL OF YOUR BLOOD PRESSURE) TRIAL

Authors
Reed, SD; Li, Y; Oddone, EZ; Neary, AM; Orr, MM; Grubber, JM; Graham, FL; Olsen, MK; Svetkey, LP; Dolor, RJ; Powers, BJ; Adams, MB; Bosworth, HB
MLA Citation
Reed, SD, Li, Y, Oddone, EZ, Neary, AM, Orr, MM, Grubber, JM, Graham, FL, Olsen, MK, Svetkey, LP, Dolor, RJ, Powers, BJ, Adams, MB, and Bosworth, HB. "TRIAL-BASED ECONOMIC EVALUATION ALONGSIDE THE TCYB (TAKE CONTROL OF YOUR BLOOD PRESSURE) TRIAL." VALUE IN HEALTH 12.3 (May 2009): A152-A152.
Source
wos-lite
Published In
Value in Health
Volume
12
Issue
3
Publish Date
2009
Start Page
A152
End Page
A152
DOI
10.1016/S1098-3015(10)73820-1

Medication acquisition and self-reported adherence in veterans with hypertension.

OBJECTIVES: To examine factors associated with oversupply and undersupply of antihypertensive medication, and examine evidence for medication acquisition as distinct from self-reported adherence. RESEARCH DESIGN: Analysis of pharmacy refill records, medical charts, and in-person interviews. SUBJECTS: Five hundred sixty-two male veterans with hypertension enrolled in a randomized controlled trial to improve BP control. MEASURES: Patients were classified as having undersupply (<0.80), appropriate supply (> or = 0.80 and < or = 1.20), or oversupply (>1.20) of antihypertensive medication in the 90 days before trial enrollment based on the ReComp algorithm. Determination of BP control was based on clinic measurements at enrollment. Demographic, clinical, psychosocial, and behavioral factors relevant to medication-taking behavior and BP were assessed at enrollment. RESULTS: Twenty-three percent of the patients had undersupply, 47% had appropriate supply, and 30% had oversupply of antihypertensive medication. Multinomial logistic regression revealed that using fewer classes of antihypertensive medications and greater perceived adherence barriers were independently associated with greater likelihood of undersupply. Current employment was associated with decreased likelihood of oversupply, and greater comorbidity and being married were associated with increased likelihood of oversupply. Agreement between ReComp and self-reported adherence was poor (kappa = 0.19, P < 0.001). Undersupply, oversupply, and self-reported nonadherence were all independently associated with decreased likelihood of BP control after adjusting for each other and patient factors. CONCLUSIONS: Antihypertensive oversupply was common and may arise from different circumstances than undersupply. Measures of medication acquisition and self-reported adherence appear to provide distinct, complementary information about patients' medication-taking behavior.

Authors
Thorpe, CT; Bryson, CL; Maciejewski, ML; Bosworth, HB
MLA Citation
Thorpe, CT, Bryson, CL, Maciejewski, ML, and Bosworth, HB. "Medication acquisition and self-reported adherence in veterans with hypertension." Med Care 47.4 (April 2009): 474-481.
PMID
19330891
Source
pubmed
Published In
Medical Care
Volume
47
Issue
4
Publish Date
2009
Start Page
474
End Page
481

SELF-MANAGEMENT INTERVENTION TO IMPROVE HYPERTENSION CONTROL: THE TAKE CONTROL OF YOUR BLOOD PRESSURE (TCYB) STUDY

Authors
Bosworth, HB; Olsen, MK; Grubber, JM; Neary, A; Orr, M; Powers, BJ; Adams, M; Svetkey, LP; Reed, S; Dolor, RJ; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Grubber, JM, Neary, A, Orr, M, Powers, BJ, Adams, M, Svetkey, LP, Reed, S, Dolor, RJ, and Oddone, EZ. "SELF-MANAGEMENT INTERVENTION TO IMPROVE HYPERTENSION CONTROL: THE TAKE CONTROL OF YOUR BLOOD PRESSURE (TCYB) STUDY." April 2009.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
24
Publish Date
2009
Start Page
167
End Page
168

Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial.

BACKGROUND: Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control. METHODS: This was a 2-level (primary care provider and patient) cluster randomized trial with 2-year follow-up occurring among patients with hypertension enrolled from a Veterans Affairs Medical Center primary care clinic. Primary care providers (n = 17) in the intervention received computer-generated decision support designed to improve guideline concordant medical therapy at each visit; control providers (n = 15) received a reminder at each visit. Patients received usual care or a bimonthly tailored nurse-delivered behavioral telephone intervention to improve hypertension treatment. The primary outcome was proportion of patients who achieved a BP <140/90 mm Hg (<130/85 for diabetic patients) over the 24-month intervention. RESULTS: Of the 816 eligible patients contacted, 190 refused and 38 were excluded. The 588 enrolled patients had a mean age of 63 years, 43% had adequate baseline BP control, and 482 (82%) completed the 24-month follow-up. There were no significant differences in amount of change in BP control in the 3 intervention groups as compared to the hypertension reminder control group. In secondary analyses, rates of BP control for all patients receiving the patient behavioral intervention (n = 294) improved from 40.1% to 54.4% at 24 months (P = .03); patients in the nonbehavioral intervention group improved from 38.2% to 43.9% (P = .38), but there was no between-group differences at the end of the study. CONCLUSION: The brief behavioral intervention showed improved outcomes over time, but there were not significant between group differences.

Authors
Bosworth, HB; Olsen, MK; Dudley, T; Orr, M; Goldstein, MK; Datta, SK; McCant, F; Gentry, P; Simel, DL; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Dudley, T, Orr, M, Goldstein, MK, Datta, SK, McCant, F, Gentry, P, Simel, DL, and Oddone, EZ. "Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial." Am Heart J 157.3 (March 2009): 450-456.
PMID
19249414
Source
pubmed
Published In
American Heart Journal
Volume
157
Issue
3
Publish Date
2009
Start Page
450
End Page
456
DOI
10.1016/j.ahj.2008.11.003

Study protocol: Couples Partnering for Lipid Enhancing Strategies (CouPLES) - a randomized, controlled trial.

BACKGROUND: Almost 50% of Americans have elevated low-density lipoprotein cholesterol (LDL-C). The behaviors required to lower LDL-C levels may be difficult to adhere to if they are inconsistent with spouses' health practices, and, alternatively, may be enhanced by enlisting support from the spouse. This trial extends previous trials by requiring spouse enrollment, teaching spouses how to provide emotional and instrumental support, allowing patients to decide which component of the intervention they would like to receive, and having patients determine their own goals and action plans. METHODS: Veteran outpatients with above-goal LDL-C (N = 250) and their spouses are randomized, as a couple, to receive printed education materials only or the materials plus an 11-month, nurse-delivered, telephone-based intervention. The intervention contains four modules: medication adherence, diet, exercise, and patient-physician communication. Patients decide which modules they complete and in which order; modules may be repeated or omitted. Telephone calls are to patients and spouses separately and occur monthly. During each patient telephone call, patients' progress is reviewed, and patients create goals and action plans for the upcoming month. During spouse telephone calls, which occur within one week of patient calls, spouses are informed of patients' goals and action plans and devise strategies to increase emotional and instrumental support.The primary outcome is patients' LDL-C, measured at baseline, 6 months, and 11 months. Linear mixed models will be used to test the primary hypothesis that an 11-month, telephone-based patient-spouse intervention will result in a greater reduction in LDL-C as compared to printed education materials. Various process measures, including social support, self-efficacy, medication adherence, dietary behavior, and exercise, are also assessed to explain any change, or lack thereof, in LDL-C. DISCUSSION: Given the social context in which self-management occurs, interventions that teach spouses to provide instrumental and emotional support may help patients initiate and adhere to behaviors that lower their LDL-C levels. Moreover, allowing patients to retain autonomy by deciding which behaviors they would like to change and how may improve adherence and clinical outcomes. TRIAL REGISTRATION: The ClinicalTrials.gov registration number is NCT00321789.

Authors
Voils, CI; Yancy, WS; Kovac, S; Coffman, CJ; Weinberger, M; Oddone, EZ; Jeffreys, A; Datta, S; Bosworth, HB
MLA Citation
Voils, CI, Yancy, WS, Kovac, S, Coffman, CJ, Weinberger, M, Oddone, EZ, Jeffreys, A, Datta, S, and Bosworth, HB. "Study protocol: Couples Partnering for Lipid Enhancing Strategies (CouPLES) - a randomized, controlled trial. (Published online)" Trials 10 (February 6, 2009): 10-.
PMID
19200384
Source
pubmed
Published In
Trials
Volume
10
Publish Date
2009
Start Page
10
DOI
10.1186/1745-6215-10-10

The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure.

BACKGROUND: The Support, Education, and Research in Chronic Heart Failure (SEARCH) study was designed to assess the impact of a mindfulness-based psychoeducational intervention on clinical outcomes, depression, and quality of life in patients with chronic heart failure (CHF). Although research has shown that psychosocial factors including depression are important risk factors for adverse events in patients with CHF, no large clinical trials have investigated the efficacy of psychosocial interventions to reduce these factors in this population. METHODS: This was a prospective cohort study of 208 adults with left ventricular ejection fraction < or =40% and CHF geographically assigned to treatment or control groups with follow-up at 3, 6, and 12 months. Treatment groups met weekly for 8 consecutive weeks for training in mindfulness meditation, coping skills, and support group discussion. RESULTS: Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and beta-blockers (86%). At baseline, patients in the treatment group had more severe CHF with higher New York Heart Association class (P = .0209) and more severe psychological distress (Center of Epidemiology - Depression, Profile of Mood States; P < .05). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology - Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year. CONCLUSIONS: An 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression; this effect was attenuated at 1 year. Importantly, the intervention led to significantly better symptoms of CHF at 12 months compared to control subjects. Our results suggest that interventions of this type might have a role in optimal therapy for CHF.

Authors
Sullivan, MJ; Wood, L; Terry, J; Brantley, J; Charles, A; McGee, V; Johnson, D; Krucoff, MW; Rosenberg, B; Bosworth, HB; Adams, K; Cuffe, MS
MLA Citation
Sullivan, MJ, Wood, L, Terry, J, Brantley, J, Charles, A, McGee, V, Johnson, D, Krucoff, MW, Rosenberg, B, Bosworth, HB, Adams, K, and Cuffe, MS. "The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure." Am Heart J 157.1 (January 2009): 84-90.
PMID
19081401
Source
pubmed
Published In
American Heart Journal
Volume
157
Issue
1
Publish Date
2009
Start Page
84
End Page
90
DOI
10.1016/j.ahj.2008.08.033

Feasibility of blood pressure telemonitoring in patients with poor blood pressure control.

We examined the feasibility of using home blood pressure (BP) telemonitoring devices for managing patients with poor BP control. We enrolled 591 subjects with a diagnosis of hypertension. Patients were randomized to usual care (n = 147) or to the intervention arm (n = 441). Those in the intervention arm were issued with a home BP telemonitoring device. The device transmitted BP readings automatically via the home telephone line. Technical alerts were generated if patients did not transmit their BP readings according to the protocol. During the first six months, 693 technical alerts were generated by 267 patients. About half of these patients (112) generated more than two technical alerts. Resolution of the alerts showed that 61% were caused by patient non-adherence. Patients who generated >2 technical alerts were younger (61 vs. 64 years; P = 0.001) and were more likely to be non-Caucasian (64% vs. 47%, P = 0.002) than those generating 2 or fewer alerts. Despite the potential for improving health care using home BP telemonitoring, certain patients will require more support to use the equipment successfully.

Authors
McCant, F; McKoy, G; Grubber, J; Olsen, MK; Oddone, E; Powers, B; Bosworth, HB
MLA Citation
McCant, F, McKoy, G, Grubber, J, Olsen, MK, Oddone, E, Powers, B, and Bosworth, HB. "Feasibility of blood pressure telemonitoring in patients with poor blood pressure control." J Telemed Telecare 15.6 (2009): 281-285.
PMID
19720764
Source
pubmed
Published In
Journal of Telemedicine and Telecare
Volume
15
Issue
6
Publish Date
2009
Start Page
281
End Page
285
DOI
10.1258/jtt.2009.090202

Racial differences in hypertension knowledge: effects of differential item functioning.

Health-related knowledge is an important component in the self-management of chronic illnesses. The objective of this study was to more accurately assess racial differences in hypertension knowledge by using a latent variable modeling approach that controlled for sociodemographic factors and accounted for measurement issues in the assessment of hypertension knowledge. Cross-sectional data from 1,177 participants (45% African American; 35% female) were analyzed using a multiple indicator multiple causes (MIMIC) modeling approach. Available sociodemographic data included race, education, sex, financial status, and age. All participants completed six items on a hypertension knowledge questionnaire. Overall, the final model suggested that females, Whites, and patients with at least a high school diploma had higher latent knowledge scores than males, African Americans, and patients with less than a high school diploma, respectively. The model also detected differential item functioning (DIF) based on race for two of the items. Specifically, the error rate for African Americans was lower than would be expected given the lower level of latent knowledge on the items, on the questions related to: (a) the association between high blood pressure and kidney disease, and (b) the increased risk African Americans have for developing hypertension. Not accounting for DIF resulted in the difference between Whites and African Americans to be underestimated. These results are discussed in the context of the need for careful measurement of health-related constructs, and how measurement-related issues can result in an inaccurate estimation of racial differences in hypertension knowledge.

Authors
Ayotte, BJ; Trivedi, R; Bosworth, HB
MLA Citation
Ayotte, BJ, Trivedi, R, and Bosworth, HB. "Racial differences in hypertension knowledge: effects of differential item functioning." Ethn Dis 19.1 (2009): 23-27.
PMID
19341159
Source
pubmed
Published In
Ethnicity & disease
Volume
19
Issue
1
Publish Date
2009
Start Page
23
End Page
27

The associations of patient demographic characteristics and health information recall: the mediating role of health literacy.

We examined the mediating role of health literacy in the relationships between participant demographic characteristics and health information recall. Baseline data from two studies that focused on hypertensive adults (N = 1190; M = 62.28 years, SD = 11.98; 35.5% female; 45.9% African-American) were analyzed. The final model, which adjusted for recruitment site, indicated that financial status, race, and education were indirectly related to health information recall through health literacy. Increasing education was also directly related to better health information recall. Increasing age was not related to health literacy, but was related to poorer health information recall. The final model fit the data very well, chi(2)(3) = 0.69, p = .36, RMSEA = .000 (90% CI = .000 to .024), CFI = 1.00. The results suggest that health literacy might be one of the mechanisms underlying the relationships between participant demographic characteristics and poor health outcomes due to inaccurate recall of instructions.

Authors
Ayotte, BJ; Allaire, JC; Bosworth, H
MLA Citation
Ayotte, BJ, Allaire, JC, and Bosworth, H. "The associations of patient demographic characteristics and health information recall: the mediating role of health literacy." Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition 16.4 (2009): 419-432.
PMID
19424920
Source
scival
Published In
Aging, Neuropsychology, and Cognition
Volume
16
Issue
4
Publish Date
2009
Start Page
419
End Page
432
DOI
10.1080/13825580902741336

Response to Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression

Authors
Hedayati, SS; Bosworth, HB; Briley, LP; Sloane, R; Pieper, C; Kimmel, PL; Szczech, LA
MLA Citation
Hedayati, SS, Bosworth, HB, Briley, LP, Sloane, R, Pieper, C, Kimmel, PL, and Szczech, LA. "Response to Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression." Kidney International 75.8 (2009): 861-862.
Source
scival
Published In
Kidney international
Volume
75
Issue
8
Publish Date
2009
Start Page
861
End Page
862
DOI
10.1038/ki.2008.672

Strategies for analyzing multilevel cluster-randomized studies with binary outcomes collected at varying intervals of time.

Frequently, studies are conducted in a real clinic setting. When the outcome of interest is collected longitudinally over a specified period of time, this design can lead to unequally spaced intervals and varying numbers of assessments. In our study, these features were embedded in a randomized, factorial design in which interventions to improve blood pressure control were delivered to both patients and providers. We examine the effect of the intervention and compare methods of estimation of both fixed effects and variance components in the multilevel generalized linear mixed model. Methods of comparison include penalized quasi-likelihood (PQL), adaptive quadrature, and Bayesian Monte Carlo methods. We also investigate the implications of reducing the data and analysis to baseline and final measurements. In the full analysis, the PQL fixed-effects estimates were closest to zero and confidence intervals were generally narrower than those of the other methods. The adaptive quadrature and Bayesian fixed-effects estimates were similar, but the Bayesian credible intervals were consistently wider. Variance component estimation was markedly different across methods, particularly for the patient-level random effects. In the baseline and final measurement analysis, we found that estimates and corresponding confidence intervals for the adaptive quadrature and Bayesian methods were very similar. However, the time effect was diminished and other factors also failed to reach statistical significance, most likely due to decreased power. When analyzing data from this type of design, we recommend using either adaptive quadrature or Bayesian methods to fit a multilevel generalized linear mixed model including all available measurements.

Authors
Olsen, MK; DeLong, ER; Oddone, EZ; Bosworth, HB
MLA Citation
Olsen, MK, DeLong, ER, Oddone, EZ, and Bosworth, HB. "Strategies for analyzing multilevel cluster-randomized studies with binary outcomes collected at varying intervals of time." Stat Med 27.29 (December 20, 2008): 6055-6071.
PMID
18825655
Source
pubmed
Published In
Statistics in Medicine
Volume
27
Issue
29
Publish Date
2008
Start Page
6055
End Page
6071
DOI
10.1002/sim.3446

The association of emotional well-being and marital status with treatment adherence among patients with hypertension.

We were interested in examining the relationship between psychosocial factors and hypertension-related behaviors. We hypothesized that lower emotional well-being and unmarried status would be related to higher BP, poorer medication adherence, greater difficulty adhering to diet and exercise, and current smoking. In a cross-sectional design, 636 hypertensive patients completed the Mental Component Summary (MCS) Scale of the SF-12 and rated their difficulty with adherence to diet, exercise, and medication-taking. In logistic regression analyses, lower MCS scores were associated with difficulty adhering to diet (OR = 0.97, p < .05) and exercise (OR = 0.97, p < .01), and current smoking status (OR = 0.98, p < .05). Being married was associated with higher probability of medication adherence (OR = 1.66, p < .01) and a lower probability of being a current smoker (OR = 0.34, p < .0001). Neither MCS scores nor being married were related to BP levels in adjusted analyses. Results emphasize the importance of assessing psychosocial factors to optimize hypertension treatment.

Authors
Trivedi, RB; Ayotte, B; Edelman, D; Bosworth, HB
MLA Citation
Trivedi, RB, Ayotte, B, Edelman, D, and Bosworth, HB. "The association of emotional well-being and marital status with treatment adherence among patients with hypertension." J Behav Med 31.6 (December 2008): 489-497.
PMID
18780175
Source
pubmed
Published In
Journal of Behavioral Medicine
Volume
31
Issue
6
Publish Date
2008
Start Page
489
End Page
497
DOI
10.1007/s10865-008-9173-4

Literacy and blood pressure--do healthcare systems influence this relationship? A cross-sectional study.

BACKGROUND: Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery. METHODS: We conducted a cross-sectional study of 1224 patients with hypertension utilizing baseline data from two separate, but similar randomized controlled trials. Patients were enrolled from primary care clinics in the Veterans Affairs healthcare system (VAHS) and a university healthcare system (UHS) in Durham, North Carolina. We compared the association between literacy and the primary outcome systolic blood pressure (SBP) and secondary outcomes of diastolic blood pressure (DBP) and blood pressure (BP) control across the two different healthcare systems. RESULTS: Patients who read below a 9th grade level comprised 38.4% of patients in the VAHS and 27.5% of the patients in the UHS. There was a significant interaction between literacy and healthcare system for SBP. In adjusted analyses, SBP for patients with limited literacy was 1.2 mmHg lower than patients with adequate literacy in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher than patients with adequate literacy in the UHS (95% CI, 2.1 to 10.1); (p = 0.003 for test of interaction). This literacy by healthcare system interaction was not statistically significant for DBP or BP control. CONCLUSION: The relationship between patient literacy and systolic blood pressure varied significantly across different models of healthcare delivery. The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.

Authors
Powers, BJ; Olsen, MK; Oddone, EZ; Thorpe, CT; Bosworth, HB
MLA Citation
Powers, BJ, Olsen, MK, Oddone, EZ, Thorpe, CT, and Bosworth, HB. "Literacy and blood pressure--do healthcare systems influence this relationship? A cross-sectional study. (Published online)" BMC Health Serv Res 8 (October 23, 2008): 219-.
PMID
18947408
Source
pubmed
Published In
BMC Health Services Research
Volume
8
Publish Date
2008
Start Page
219
DOI
10.1186/1472-6963-8-219

Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression.

Depressive symptoms, assessed using a self-report type of questionnaire, have been associated with poor outcomes in dialysis patients. Here we determined if depressive disorders diagnosed by physicians are also associated with such outcomes. Ninety-eight consecutive patients on chronic hemodialysis underwent the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders administered by a physician. Depression was diagnosed in about a quarter of the patients. Associations adjusted for age, gender, race, time on dialysis and co-morbidity were determined using survival analysis. Using time to event (death or hospitalization) models of analysis the hazard ratios were 2.11 and 2.07 in unadjusted and adjusted models respectively. The finding of poor outcome using a formal structured physician interview suggests that a prospective study is needed to determine whether treatment of depression affects clinical outcomes.

Authors
Hedayati, SS; Bosworth, HB; Briley, LP; Sloane, RJ; Pieper, CF; Kimmel, PL; Szczech, LA
MLA Citation
Hedayati, SS, Bosworth, HB, Briley, LP, Sloane, RJ, Pieper, CF, Kimmel, PL, and Szczech, LA. "Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression." Kidney Int 74.7 (October 2008): 930-936.
PMID
18580856
Source
pubmed
Published In
Kidney international
Volume
74
Issue
7
Publish Date
2008
Start Page
930
End Page
936
DOI
10.1038/ki.2008.311

Patient and social environment factors associated with self blood pressure monitoring by male veterans with hypertension.

Self blood pressure monitoring (SBPM) can facilitate hypertension management, but determinants of SBPM are understudied. The authors examined the relationship of patient and social environment characteristics to monitor possession and frequency of SBPM in 578 male hypertensive veterans. Measures included possession of a monitor; SBPM frequency; concurrent blood pressure control; and patient demographic, clinical, and psychosocial factors. In logistic regression analyses, older age, diabetes, unemployment, and better mental health status were related to greater likelihood of monitor possession. Ordinal logistic regression showed that among patients with a monitor, having diabetes, being unemployed, and having a shorter duration of hypertension were independently related to greater frequency of SBPM. Monitor possession, but not frequency of SBPM, was related to a decreased likelihood of blood pressure control in adjusted analyses. Our results suggest that patient characteristics may influence SBPM and may represent points of leverage for intervening to increase self-monitoring.

Authors
Thorpe, CT; Oddone, EZ; Bosworth, HB
MLA Citation
Thorpe, CT, Oddone, EZ, and Bosworth, HB. "Patient and social environment factors associated with self blood pressure monitoring by male veterans with hypertension." J Clin Hypertens (Greenwich) 10.9 (September 2008): 692-699.
PMID
18844764
Source
pubmed
Published In
Journal of Clinical Hypertension
Volume
10
Issue
9
Publish Date
2008
Start Page
692
End Page
699
DOI
10.1111/j.1751-7176.2008.00005.x

The Self-Management of OsteoArthritis in Veterans (SeMOA) Study: design and methodology.

BACKGROUND: Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behaviors such as exercise and weight management can improve pain and function, these behaviors are vastly underutilized. There is a need to implement effective self-management programs among the growing number of adults with OA. OBJECTIVES: The Self-Management of OsteoArthritis (SeMOA) in Veterans Study examines a 12-month telephone-based OA self-management program in the primary care setting. This manuscript details the design, methodology, and advances of the SeMOA trial. METHODS: Participants (N=519) with hip or knee OA are randomly assigned to one of three groups: OA self-management, health education (attention control), or usual care. The OA self-management group receives written and audio materials regarding OA care (including health behaviors, medical care, and interacting with health care providers). A health educator calls participants monthly to review these materials and provide support for developing individualized goals and action plans related to OA management. The health education group receives written and audio materials and monthly calls from a health educator discussing health issues unrelated to OA. Usual care involves no additional materials or phone calls. The primary outcome is change in the Arthritis Impact Measurement Scales-2 pain subscale from baseline to 12 months. Analysis of covariance models will compare changes in pain across study groups. The cost-effectiveness of the OA self-management program will also be assessed. CONCLUSION: SeMOA is one of the first to examine telephone-based delivery of OA self-management and one of few trials to target the primary care setting. This program has the potential for broad dissemination because it reduces both the costs and barriers that accompany in-person programs. This study will provide important information about its feasibility and effectiveness in a real-world clinical setting.

Authors
Allen, KD; Oddone, EZ; Stock, JL; Coffman, CJ; Lindquist, JH; Juntilla, KA; Lemmerman, DS; Datta, SK; Harrelson, ML; Weinberger, M; Bosworth, HB
MLA Citation
Allen, KD, Oddone, EZ, Stock, JL, Coffman, CJ, Lindquist, JH, Juntilla, KA, Lemmerman, DS, Datta, SK, Harrelson, ML, Weinberger, M, and Bosworth, HB. "The Self-Management of OsteoArthritis in Veterans (SeMOA) Study: design and methodology." Contemp Clin Trials 29.4 (July 2008): 596-607.
PMID
18206425
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
29
Issue
4
Publish Date
2008
Start Page
596
End Page
607
DOI
10.1016/j.cct.2007.11.004

Content validity in the PROMIS social-health domain: a qualitative analysis of focus-group data.

PURPOSE: Our aim was to assess the content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) social health item banks by comparing a prespecified conceptual model with concepts that focus-group participants identified as important social-health-related outcomes. These data will inform the process of improving health-related quality-of-life measures. METHODS: Twenty-five patients with a range of social limitations due to chronic health conditions were recruited at two sites; four focus groups were conducted. Raters independently classified participants' statements using a hierarchical, nested schema that included health-related outcomes, role performance, role satisfaction, family/friends, work, and leisure. RESULTS: Key themes that emerged were fulfilling both family and work responsibilities and the distinction between activities done out of responsibility versus enjoyment. Although focus-group participants identified volunteerism and pet ownership as important social-health-related concepts, these were not in our original conceptual model. The concept of satisfaction was often found to overlap with the concept of performance. CONCLUSION: Our conceptual model appears comprehensive but is being further refined to more appropriately (a) distinguish between responsibilities versus discretionary activities, and (b) situate the outcome of satisfaction as it relates to impairment in social and other domains of health.

Authors
Castel, LD; Williams, KA; Bosworth, HB; Eisen, SV; Hahn, EA; Irwin, DE; Kelly, MAR; Morse, J; Stover, A; DeWalt, DA; DeVellis, RF
MLA Citation
Castel, LD, Williams, KA, Bosworth, HB, Eisen, SV, Hahn, EA, Irwin, DE, Kelly, MAR, Morse, J, Stover, A, DeWalt, DA, and DeVellis, RF. "Content validity in the PROMIS social-health domain: a qualitative analysis of focus-group data." Qual Life Res 17.5 (June 2008): 737-749.
PMID
18478368
Source
pubmed
Published In
Quality of Life Research
Volume
17
Issue
5
Publish Date
2008
Start Page
737
End Page
749
DOI
10.1007/s11136-008-9352-3

Racial differences in blood pressure control: potential explanatory factors.

OBJECTIVE: The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control. DESIGN: The design of the study was a cross-sectional study PATIENTS/PARTICIPANTS: The study included 608 patients with hypertension who were either African American (50%) or white (50%) and who received primary care in Durham, NC. MEASUREMENTS AND MAIN RESULTS: Baseline data were obtained from the Take Control of Your Blood pressure study and included clinical, demographic, and psychosocial variables potentially related to clinic BP measures. African Americans were more likely than whites to have inadequate baseline clinic BP control as defined as greater than or equal to 140/90 mmHg (49% versus 34%; unadjusted odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3-2.5). Among factors that may explain this disparity, being older, reporting hypertension medication nonadherence, reporting a hypertension diagnosis for more than 5 years, reporting high levels of stress, being worried about hypertension, and reporting an increased number of medication side effects were related to inadequate BP control. In adjusted analyses, African Americans continue to have poor BP control relative to whites; the magnitude of the association was reduced (OR = 1.5; 95% CI 1.0-2.1). Medication nonadherence, worries about hypertension, and older age (>70) continued to be related to poor BP control. CONCLUSIONS: In this sample of hypertensive patients, there were a number of factors associated with poor BP control that partially explained the observed racial disparity in hypertension control including age, medication nonadherence, and worry about BP. Medication nonadherence is of particular interest because it is a potentially modifiable factor that might be used to reduce the racial disparity in BP control.

Authors
Bosworth, HB; Powers, B; Grubber, JM; Thorpe, CT; Olsen, MK; Orr, M; Oddone, EZ
MLA Citation
Bosworth, HB, Powers, B, Grubber, JM, Thorpe, CT, Olsen, MK, Orr, M, and Oddone, EZ. "Racial differences in blood pressure control: potential explanatory factors." J Gen Intern Med 23.5 (May 2008): 692-698.
PMID
18288540
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
23
Issue
5
Publish Date
2008
Start Page
692
End Page
698
DOI
10.1007/s11606-008-0547-7

Perceived and actual stroke risk among men with hypertension.

The purposes of this study were to determine whether there is a significant correlation between the perceived and actual stroke risk among hypertensive patients and to identify patient characteristics associated with inaccurate estimation of stroke risk. The authors performed a cross-sectional analysis of 296 men with hypertension who were enrolled in the Veterans Study to Improve the Control of Hypertension (V-STITCH). A patient's actual stroke risk was calculated using the Framingham stroke risk (FSR); patients' perceived risk was measured according to a self-reported 10-point risk scale. The median 10-year FSR was 16%, but the median perceived risk score was 5 (range, 1 [lowest] to 10 [highest]). There was no significant correlation between patients' perceived risk of stroke and their calculated FSR (Spearman rho=-0.08; P=.16; 95% confidence interval, -0.19 to 0.03). Patients who underestimated their stroke risk were significantly less likely to be worried about their blood pressure than patients with accurate risk perception (12.4% vs 69.6%; P<.0001). The lack of correlation between hypertensive patients' perceived stroke risk and FSR supports the need for better patient education on the risks associated with hypertension.

Authors
Powers, BJ; Oddone, EZ; Grubber, JM; Olsen, MK; Bosworth, HB
MLA Citation
Powers, BJ, Oddone, EZ, Grubber, JM, Olsen, MK, and Bosworth, HB. "Perceived and actual stroke risk among men with hypertension." J Clin Hypertens (Greenwich) 10.4 (April 2008): 287-294.
PMID
18401226
Source
pubmed
Published In
Journal of Clinical Hypertension
Volume
10
Issue
4
Publish Date
2008
Start Page
287
End Page
294

Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control.

OBJECTIVE: Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control. METHODS: Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nurse-administered behavioral intervention or usual care. In this ongoing study, patients receive the tailored behavioral intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors. Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge, memory, medical and social support, patients' relationship with their health care provider, adverse effects of medication therapy, weight management, exercise, diet, stress, smoking, and alcohol use. RESULTS: The sample randomized to the behavioral intervention consisted of 319 adults with hypertension (average age=60.5 years; 47% African-American). A comparable sample of adults was assigned to usual care (n=317). We had a 96% retention rate for the overall sample for the first 6 months of the study (93% at 12 months). The average phone call has lasted 18min (range 2-51min). From baseline to 6 months, self-reported medication adherence increased by 9% in the behavioral group vs. 1% in the non-behavioral group. CONCLUSION: The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings. PRACTICE IMPLICATIONS: Despite knowledge of the risks and acceptable evidence, a large number of hypertensive adults still do not have their blood pressure under effective control. This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control.

Authors
Bosworth, HB; Olsen, MK; Neary, A; Orr, M; Grubber, J; Svetkey, L; Adams, M; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Neary, A, Orr, M, Grubber, J, Svetkey, L, Adams, M, and Oddone, EZ. "Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control." Patient Educ Couns 70.3 (March 2008): 338-347.
PMID
18164894
Source
pubmed
Published In
Patient Education and Counseling
Volume
70
Issue
3
Publish Date
2008
Start Page
338
End Page
347
DOI
10.1016/j.pec.2007.11.014

The effect of a hypertension self-management intervention on the unintended targets of diabetes and cholesterol control

Authors
Powers, BJ; Olsen, MK; Oddone, EZ; Bosworth, HB
MLA Citation
Powers, BJ, Olsen, MK, Oddone, EZ, and Bosworth, HB. "The effect of a hypertension self-management intervention on the unintended targets of diabetes and cholesterol control." March 2008.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
23
Publish Date
2008
Start Page
412
End Page
412

The effect of emotional health status on multiple illness self-management behaviors in veterans with hypertension

Authors
Thorpe, C; Powers, BJ; Oddone, EZ; Bosworth, HB
MLA Citation
Thorpe, C, Powers, BJ, Oddone, EZ, and Bosworth, HB. "The effect of emotional health status on multiple illness self-management behaviors in veterans with hypertension." ANNALS OF BEHAVIORAL MEDICINE 35 (March 2008): S79-S79.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
35
Publish Date
2008
Start Page
S79
End Page
S79

Selective adherence to antihypertensive medications as a patient-driven means to preserving sexual potency.

OBJECTIVE: To describe hypertensive patients' experiences with sexual side effects and their consequences for antihypertensive medication adherence. METHODS: Data were from a study conducted to identify facilitators of and barriers to adherence to blood pressure-lowering regimens. Participants were 38 married and unmarried veterans with a diagnosis of hypertension and 13 female spouses. Eight patient and four spouse focus groups were conducted. A directed approach to content analysis was used to determine the facilitators of and barriers to adherence. For this report, all discussion concerning the topic of sexual relations was extracted. RESULTS: Male patients viewed sexual intercourse as a high priority and felt that a lack of sexual intercourse was unnatural. They pursued strategies to preserve their potency, including discontinuing or selectively adhering to their medications and obtaining treatments for impotence. In contrast, spouses felt that sexual intercourse was a low priority and that a lack of sexual intercourse was natural. They discouraged their husbands from seeking treatments for impotence. CONCLUSION: Although the primary study was not designed to explore issues of sexual function, the issue emerged spontaneously in the majority of discussions, indicating that sexuality is important in this context for both male patients and their spouses. Physicians should address sexual side effects of antihypertensive medications with patients, ideally involving spouses.

Authors
Voils, CI; Sandelowski, M; Dahm, P; Blouin, R; Bosworth, HB; Oddone, EZ; Steinhauser, KE
MLA Citation
Voils, CI, Sandelowski, M, Dahm, P, Blouin, R, Bosworth, HB, Oddone, EZ, and Steinhauser, KE. "Selective adherence to antihypertensive medications as a patient-driven means to preserving sexual potency. (Published online)" Patient Prefer Adherence 2 (February 2, 2008): 201-206.
PMID
19920964
Source
pubmed
Published In
Patient Preference and Adherence
Volume
2
Publish Date
2008
Start Page
201
End Page
206

The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults.

OBJECTIVE: To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression. METHODS: Secondary analysis of a prospective cohort study involving 241 older patients undergoing depression treatment using a standardized algorithm. Depression was measured at baseline and 12-months post-baseline. Baseline predictor variables included antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic and instrumental activities of daily living (BADLs and IADLs), and clinical factors including past history of depression and medical comorbidities. RESULTS: Nearly 28% of patients reported being nonadherent with their antidepressant medication. In bivariate analyses, greater antidepressant medication nonadherence, more medication barriers, poorer subjective social support, less non-family interaction, greater BADL and IADL limitations, poor self-rated health, higher baseline depression scores, and not having diabetes were related to higher 12-month depression scores. In multivariable analyses, greater medication nonadherence, not having diabetes, poorer subjective social support, greater BADL limitations, and higher baseline depression scores were related to higher 12-month depression scores. CONCLUSION: Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables.

Authors
Bosworth, HB; Voils, CI; Potter, GG; Steffens, DC
MLA Citation
Bosworth, HB, Voils, CI, Potter, GG, and Steffens, DC. "The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults." Int J Geriatr Psychiatry 23.2 (February 2008): 129-134.
PMID
17563920
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
23
Issue
2
Publish Date
2008
Start Page
129
End Page
134
DOI
10.1002/gps.1852

Project LIFE--Learning to Improve Fitness and Function in Elders: methods, design, and baseline characteristics of randomized trial.

Insufficient levels of physical activity have significant clinical consequences. Primary care settings typically do not emphasize physical activity counseling. We describe the design, methods, and baseline characteristics of "Learning to Improve Fitness and Function in Elders," a two-armed randomized controlled trial that assesses whether physical activity counseling improves the physical function of older veterans. A physical activity counseling program, partially administered by primary care providers, advocating 30 min of walking 5 days a week and 15 min of lower-limb strength training 3 days a week will be compared with usual care. The multicomponent counseling program consists of yearlong (1) telephone counseling, (2) automated and in-person provider counseling, and (3) tailored mailed materials. Physical activity will be assessed with the Community Healthy Activities Model Program for Seniors. Physical function will be assessed by gait speed (primary end point), 400 m walk time, chair stands, balance tests, and self-reported physical function and disability. Self-reports of chronic illness, symptoms, pain, health-related quality of life, self-efficacy, and motivation will also be assessed. A total of 400 veterans, aged 70 to 92, have enrolled and are currently receiving multicomponent physical activity counseling or usual care.

Authors
Morey, MC; Peterson, MJ; Pieper, CF; Sloane, R; Crowley, GM; Cowper, P; McConnell, E; Bosworth, H; Ekelund, C; Pearson, M; Howard, T
MLA Citation
Morey, MC, Peterson, MJ, Pieper, CF, Sloane, R, Crowley, GM, Cowper, P, McConnell, E, Bosworth, H, Ekelund, C, Pearson, M, and Howard, T. "Project LIFE--Learning to Improve Fitness and Function in Elders: methods, design, and baseline characteristics of randomized trial." J Rehabil Res Dev 45.1 (2008): 31-42.
PMID
18566924
Source
pubmed
Published In
Journal of Rehabilitation Research and Development
Volume
45
Issue
1
Publish Date
2008
Start Page
31
End Page
42

The future of health disparities research: 2008 and beyond

Authors
Egede, LE; Bosworth, H
MLA Citation
Egede, LE, and Bosworth, H. "The future of health disparities research: 2008 and beyond." Journal of General Internal Medicine 23.5 (2008): 706-708.
PMID
18392662
Source
scival
Published In
Journal of General Internal Medicine
Volume
23
Issue
5
Publish Date
2008
Start Page
706
End Page
708
DOI
10.1007/s11606-008-0580-6

Five-year trajectories of social networks and social support in older adults with major depression.

BACKGROUND: Research with nondepressed adults suggests that social networks and social support are stable over the life course until very late age. This may not hold true for older adults with depression. We examined baseline status and trajectories of social networks and social support at the group and individual levels over five years. METHODS: The sample consisted of 339 initially depressed adults aged 59 or older (M = 69 years) enrolled in a naturalistic study of depression. Measures of social ties, including social network size, frequency of interaction, instrumental support, and subjective support, were administered at baseline and yearly for five years. RESULTS: Latent growth curve models were estimated for each aspect of social ties. On average, social network size and frequency of interaction were low at baseline and remained stable over time, whereas subjective and instrumental support were high at baseline yet increased over time. There was significant variation in the direction and rate of change over time, which was not predicted by demographic or clinical factors. CONCLUSIONS: Because increasing social networks may be ineffective and may not be possible for a portion of people who already receive maximal support, interventions to increase social support may only work for a portion of older depressed adults.

Authors
Voils, CI; Allaire, JC; Olsen, MK; Steffens, DC; Hoyle, RH; Bosworth, HB
MLA Citation
Voils, CI, Allaire, JC, Olsen, MK, Steffens, DC, Hoyle, RH, and Bosworth, HB. "Five-year trajectories of social networks and social support in older adults with major depression." Int Psychogeriatr 19.6 (December 2007): 1110-1124.
PMID
17433120
Source
pubmed
Published In
International psychogeriatrics / IPA
Volume
19
Issue
6
Publish Date
2007
Start Page
1110
End Page
1124
DOI
10.1017/S1041610207005303

RACIAL DIFFERENCES IN BLOOD PRESSURE CONTROL: POTENTIAL EXPLANATORY FACTORS

Authors
Bosworth, HB; Dudley, T; Orr, M; Oddone, EZ
MLA Citation
Bosworth, HB, Dudley, T, Orr, M, and Oddone, EZ. "RACIAL DIFFERENCES IN BLOOD PRESSURE CONTROL: POTENTIAL EXPLANATORY FACTORS." ANNALS OF BEHAVIORAL MEDICINE 33 (December 2007): S31-S31.
Source
wos-lite
Published In
Annals of Behavioral Medicine
Volume
33
Publish Date
2007
Start Page
S31
End Page
S31

Introduction

Authors
Draelos, ZD
MLA Citation
Draelos, ZD. "Introduction." Journal of Cosmetic Dermatology 6.s1 (December 2007): 1-1.
Source
crossref
Published In
Journal of Cosmetic Dermatology
Volume
6
Issue
s1
Publish Date
2007
Start Page
1
End Page
1
DOI
10.1111/j.1473-2165.2007.00319.x

Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control.

BACKGROUND: Only 31% of Americans with hypertension have their blood pressure (BP) under effective control. We describe a study that tests 3 different interventions in a randomized controlled trial using home BP telemedicine monitoring. METHODS: A sample of hypertensive patients with poor BP control at baseline (N = 600) are randomized to 1 of 4 arms: (1) control group--a group of hypertensive patients who receive usual care; (2) nurse-administered tailored behavioral intervention; (3) nurse-administered medication management according to a hypertension decision support system; (4) combination of the 2 interventions. The interventions are triggered based on home BP values transmitted via telemonitoring devices over standard telephone lines. The tailored behavioral intervention involves promoting adherence with medication and health behaviors. Patients randomized to the medication management or the combined arm have their hypertension regimen changed by the study team using a validated hypertension decision support system based on evidence-based hypertension treatment guidelines and individualized to patients' comorbid illnesses. The primary outcome is BP control: < or = 140/90 mm Hg (nondiabetic) and < or = 130/80 mm Hg (diabetics) measured at 6-month intervals over 18 months (4 total measurements). CONCLUSIONS: Given the increasing prevalence of hypertension and our inability to achieve adequate BP control using traditional models of care, testing novel interventions in patients' homes may improve access, quality, and outcomes.

Authors
Bosworth, HB; Olsen, MK; McCant, F; Harrelson, M; Gentry, P; Rose, C; Goldstein, MK; Hoffman, BB; Powers, B; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, McCant, F, Harrelson, M, Gentry, P, Rose, C, Goldstein, MK, Hoffman, BB, Powers, B, and Oddone, EZ. "Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control." Am Heart J 153.6 (June 2007): 918-924.
PMID
17540191
Source
pubmed
Published In
American Heart Journal
Volume
153
Issue
6
Publish Date
2007
Start Page
918
End Page
924
DOI
10.1016/j.ahj.2007.03.004

Supporting self-management for patients with complex medical needs: recommendations of a working group.

Increasing numbers of persons live with complex chronic medical needs and are at risk for poor health outcomes. These patients require unique self-management support, as they must manage many, often interacting, tasks. As part of a conference on Managing Complexity in Chronic Care sponsored by the Department of Veterans Affairs, a working group was convened to consider self-management issues specific to complex chronic care. In this paper, we assess gaps in current knowledge on self-management support relevant to this population, report on the recommendations of our working group, and discuss directions for future study. We conclude that this population requires specialized, multidimensional self-management support to achieve a range of patient-centred goals. New technologies and models of care delivery may provide opportunities to develop this support. Validation and quantification of these processes will require the development of performance measures that reflect the needs of this population, and research to prove effectiveness.

Authors
Bayliss, EA; Bosworth, HB; Noel, PH; Wolff, JL; Damush, TM; Mciver, L
MLA Citation
Bayliss, EA, Bosworth, HB, Noel, PH, Wolff, JL, Damush, TM, and Mciver, L. "Supporting self-management for patients with complex medical needs: recommendations of a working group." Chronic Illn 3.2 (June 2007): 167-175.
PMID
18083671
Source
pubmed
Published In
Chronic Illness
Volume
3
Issue
2
Publish Date
2007
Start Page
167
End Page
175
DOI
10.1177/1742395307081501

Does participatory decision making improve hypertension self-care behaviors and outcomes?

This study examined patients' perceptions of their providers' participatory decision making (PDM) style and hypertension self-care behaviors and outcomes. Five hundred fifty-four veterans with hypertension enrolled in the Veterans' Study to Improve the Control of Hypertension rated providers' PDM styles using a validated 3-item instrument. Behaviors assessed included presence of a home blood pressure monitor, monitoring frequency, and self-reported antihypertensive medication adherence. Overall, veterans with hypertension rated providers as highly participatory. In adjusted analyses, a lower PDM score was associated with decreased odds of having a home monitor (odds ratio, 0.90 per 10-point decrement in PDM score; 95% confidence interval, 0.83-0.98) but not with monitoring frequency, adherence, or blood pressure control. Providers' involvement of patients in decision making, reflected in ratings of PDM style, may be important to securing patients' participation in their own care, but alone this factor seems insufficient. No relationship between PDM score and blood pressure control was observed.

Authors
Cho, AH; Voils, CI; Yancy, WS; Oddone, EZ; Bosworth, HB
MLA Citation
Cho, AH, Voils, CI, Yancy, WS, Oddone, EZ, and Bosworth, HB. "Does participatory decision making improve hypertension self-care behaviors and outcomes?." J Clin Hypertens (Greenwich) 9.5 (May 2007): 330-336.
PMID
17485968
Source
pubmed
Published In
Journal of Clinical Hypertension
Volume
9
Issue
5
Publish Date
2007
Start Page
330
End Page
336

Perceived and actual risk of stroke among veterans with hypertension

Authors
Powers, BJ; Grubber, JM; Olsen, M; Oddone, EZ; Bosworth, HB
MLA Citation
Powers, BJ, Grubber, JM, Olsen, M, Oddone, EZ, and Bosworth, HB. "Perceived and actual risk of stroke among veterans with hypertension." April 2007.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
22
Publish Date
2007
Start Page
55
End Page
55

Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia.

The present study examined the prevalence of war zone exposure, interpersonal trauma and post-traumatic stress disorder (PTSD) in veterans with primary schizophrenia hospitalized on a VA inpatient psychiatric unit. Data were collected on a sample of male veterans (N=165) with a primary diagnosis of schizophrenia or schizoaffective disorder, who were consecutively admitted to a VAMC inpatient psychiatric unit. The prevalence of interpersonal trauma exposure and comorbid PTSD were assessed. Analyses also explored differences between those patients who had been identified with PTSD to those who screened positive but had not been previously identified as having PTSD. Ninety-six percent of the sample endorsed interpersonal trauma or exposure to a war zone. The prevalence of PTSD was 47% (n=78), although only 14% (n=11) of those who screened positive for PTSD had a diagnosis of PTSD in their medical record. Among those screening positive, having a chart diagnosis of PTSD was associated with more severe PTSD symptoms and combat exposure. Results suggest that PTSD is highly prevalent and under-diagnosed among veterans with schizophrenia. Increased assessment of trauma and PTSD in this population is warranted.

Authors
Calhoun, PS; Stechuchak, KM; Strauss, J; Bosworth, HB; Marx, CE; Butterfield, MI
MLA Citation
Calhoun, PS, Stechuchak, KM, Strauss, J, Bosworth, HB, Marx, CE, and Butterfield, MI. "Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia." Schizophr Res 91.1-3 (March 2007): 210-216.
PMID
17276658
Source
pubmed
Published In
Schizophrenia Research
Volume
91
Issue
1-3
Publish Date
2007
Start Page
210
End Page
216
DOI
10.1016/j.schres.2006.12.011

Executive function deficits in acute stroke.

OBJECTIVES: To establish the frequency of executive dysfunction during acute hospitalization for stroke and to examine the relationship of that dysfunction to stroke severity and premorbid characteristics. DESIGN: Inception cohort study. SETTING: Inpatient wards at a Veterans Affairs hospital. PARTICIPANTS: Consecutive sample of inpatients with radiologically or neurologically confirmed stroke. Final sample included 47 patients screened for aphasia and capable of neuropsychologic testing. Two nonstroke inpatient control samples (n=10 each) with either transient ischemic attack (TIA) or multiple stroke risk factors were administered the same research procedure and tests. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite cognitive impairment ratio (CIR), calculated from 8 scores indicative of executive function on 6 neuropsychologic tests by dividing number of tests completed into the number of scores falling below cutoff point, defined as 1.5 standard deviations below normative population mean. RESULTS: Stroke patients had a mean CIR of .61, compared with .48 for TIAs and .44 for stroke-risk-only. Analysis of variance revealed that CIRs of stroke-risk-only patients but not TIAs were lower than those of the stroke patients (P=.02). Impairment frequencies were at least 50% for stroke patients on most test scores. The Symbol Digit Modalities Test (75% impairment) and a design fluency measure distinguished stroke from nonstroke patients. CIR was not related to stroke severity in the stroke patient sample, but was related to estimated premorbid intelligence. CONCLUSIONS: Executive function deficits are common in stroke patients. The data suggest that limitations in information processing due to these deficits may require environmental and procedural accommodations to increase rehabilitation benefit.

Authors
Zinn, S; Bosworth, HB; Hoenig, HM; Swartzwelder, HS
MLA Citation
Zinn, S, Bosworth, HB, Hoenig, HM, and Swartzwelder, HS. "Executive function deficits in acute stroke." Arch Phys Med Rehabil 88.2 (February 2007): 173-180.
PMID
17270514
Source
pubmed
Published In
Archives of Physical Medicine and Rehabilitation
Volume
88
Issue
2
Publish Date
2007
Start Page
173
End Page
180
DOI
10.1016/j.apmr.2006.11.015

The Take Control of Your Blood pressure (TCYB) study: study design and methodology.

BACKGROUND: Among the 65 million Americans with hypertension, only approximately 31% have their blood pressure under control (<140/90 mm/Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for blood pressure, interventions to improve blood pressure control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a two by two design is being conducted to improve blood pressure control. This five-year trial evaluates two patient-directed interventions designed to improve blood pressure control among patients diagnosed with hypertension in a community-based primary care setting. METHODS: Patients are randomized to one of four groups: usual care, home blood pressure monitoring, tailored behavioral self-management intervention that is administered via telephone by a nurse, or a combination of the home blood pressure monitoring and tailored behavioral intervention. Patients receiving the home blood pressure monitoring are trained in the use of an electronic blood pressure measurement device, are asked to measure their blood pressure 3 times/week, and send in two-month blood pressure recordings throughout the 24-month study duration. The behavioral intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. A nurse delivers all behavioral self-management modules over the telephone bi-monthly for 24 months. The primary outcome is the proportion of patients who achieve control of their blood pressure based on evidence-based guidelines (for patients without diabetes <140/90 mm/Hg, for patients with diabetes <130/80 mm/Hg) evaluated at six-month intervals over 24 months (five measurements) using a random-zero sphygmomanometer. CONCLUSION: Despite the known risk of poor blood pressure control, and the wide availability of effective treatment strategies, a majority of adults still do not have their blood pressure controlled. This study will be an important step in defining two explicit interventions to improve blood pressure control. To our knowledge, this study is the first to combine both a tailored behavioral self-management intervention and self-monitoring home blood pressure intervention to improve blood pressure control among patients in a primary care setting.

Authors
Bosworth, HB; Olsen, MK; Dudley, T; Orr, M; Neary, A; Harrelson, M; Adams, M; Svetkey, LP; Dolor, RJ; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Dudley, T, Orr, M, Neary, A, Harrelson, M, Adams, M, Svetkey, LP, Dolor, RJ, and Oddone, EZ. "The Take Control of Your Blood pressure (TCYB) study: study design and methodology." Contemp Clin Trials 28.1 (January 2007): 33-47.
PMID
16996808
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
28
Issue
1
Publish Date
2007
Start Page
33
End Page
47
DOI
10.1016/j.cct.2006.08.006

Studying complexity is complex

Authors
Whittle, J; Bosworth, H
MLA Citation
Whittle, J, and Bosworth, H. "Studying complexity is complex." Journal of General Internal Medicine 22.SUPPL. 3 (2007): 379-381.
PMID
18026805
Source
scival
Published In
Journal of General Internal Medicine
Volume
22
Issue
SUPPL. 3
Publish Date
2007
Start Page
379
End Page
381
DOI
10.1007/s11606-007-0380-4

Association of antihypertensive therapy and diastolic hypotension in chronic kidney disease

The extent to which chronic kidney disease (CKD) affects achievement of blood pressure targets is not comprehensively understood. We evaluated the effects of CKD (estimated glomerular filtration rate: <60 mL/min per 1.73 m) on achievement of blood pressure control (nondiabetic: <140/90 mm Hg; diabetic: <130/85 mm Hg) using data from the Guidelines for Drug Therapy of Hypertension Trial. This 15-month study obtained outpatient blood pressures from 3 Veteran's Affairs institutions. Among 9985 subjects with hypertension, we evaluated the association of CKD with achieved control and antihypertensive medication use. We also explored the association between the number of antihypertensives and systolic, diastolic, and pulse pressure. After 15 months, 41% of participants met blood pressure targets. CKD was not associated with control (adjusted odds ratio: 1.04; 95% CI: 0.93 to 1.15). However, CKD was associated with higher odds of use of ≥3 medications among nondiabetic subjects (odds ratio: 1.46; 95% CI: 1.25 to 1.71) and diabetic subjects (odds ratio: 1.40; 95% CI: 1.17 to 1.66). A significant interaction was observed between CKD and the number of antihypertensives as determinants of diastolic and pulse pressures. Among non-CKD participants, a greater number of antihypertensives (0 compared with 4) was associated with wider pulse pressure (Δ5.2 mm Hg; P<0.001), mainly because of higher systolic pressures (Δ3.6 mm Hg; P=0.001). Among participants with CKD, although greater numbers of antihypertensives were associated with even wider pulse pressures (Δ8.3 mm Hg; P<0.001), this was primarily because of lower diastolic pressures (Δ4.8 mm Hg; P<0.01). Among participants with CKD, greater use of antihypertensives was associated with lower diastolic pressures. Given recent evidence suggesting adverse effects of diastolic hypotension, these results suggest potential risks in patients with CKD from aggressive attempts to control systolic blood pressure. © 2007 American Heart Association, Inc.

Authors
Peralta, CA; Shlipak, MG; Wassel-Fyr, C; Bosworth, H; Hoffman, B; Martins, S; Oddone, E; Goldstein, MK
MLA Citation
Peralta, CA, Shlipak, MG, Wassel-Fyr, C, Bosworth, H, Hoffman, B, Martins, S, Oddone, E, and Goldstein, MK. "Association of antihypertensive therapy and diastolic hypotension in chronic kidney disease." Hypertension 50.3 (2007): 474-480.
PMID
17664397
Source
scival
Published In
Hypertension
Volume
50
Issue
3
Publish Date
2007
Start Page
474
End Page
480
DOI
10.1161/HYPERTENSIONAHA.107.088088

Reply

Authors
Bosworth, HB; Rockey, DC
MLA Citation
Bosworth, HB, and Rockey, DC. "Reply." Gastroenterology 132.2 (2007): 811--.
Source
scival
Published In
Gastroenterology
Volume
132
Issue
2
Publish Date
2007
Start Page
811-
DOI
10.1053/j.gastro.2006.12.056

The importance of spirituality/religion and health-related quality of life among individuals with HIV/AIDS.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "The importance of spirituality/religion and health-related quality of life among individuals with HIV/AIDS." J Gen Intern Med 21 Suppl 5 (December 2006): S3-S4.
PMID
17083498
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
21 Suppl 5
Publish Date
2006
Start Page
S3
End Page
S4
DOI
10.1111/j.1525-1497.2006.00649.x

Revisiting literacy and adherence: future clinical and research directions.

Authors
Powers, BJ; Bosworth, HB
MLA Citation
Powers, BJ, and Bosworth, HB. "Revisiting literacy and adherence: future clinical and research directions." J Gen Intern Med 21.12 (December 2006): 1341-1342. (Review)
PMID
17105531
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
21
Issue
12
Publish Date
2006
Start Page
1341
End Page
1342
DOI
10.1111/j.1525-1497.2006.00633.x

Prospective comparison of patient experience with colon imaging tests.

PURPOSE: Patient experience varies with the currently available colon imaging tests, including air contrast barium enema, computed tomographic colonography, and colonoscopy. We examined differences in patient experience with colon imaging tests and whether they varied with gender, age, and race. SUBJECTS AND METHODS: Patients with fecal occult blood, hematochezia, iron-deficiency anemia, or a family history of colon cancer underwent air contrast barium enema followed 7 to 14 days later by computed tomographic colonography and colonoscopy. Validated patient experience questionnaires that measured the experience for each test and a separate questionnaire that obtained an overall summary measure were administered after testing. Eleven patient experiences including pain, embarrassment, difficulty with bowel preparation, and satisfaction with tests were examined. RESULTS: A total of 614 subjects completed all 3 imaging tests. The test most patients were willing to repeat was colonoscopy; it also was reported to be the least painful procedure. Patients were least satisfied with air contrast barium enema, and fewer would undergo air contrast barium enema compared with computed tomographic colonography or colonoscopy. There were limited racial and gender differences in perceptions of the tests. Younger adults perceived air contrast barium enema to be more painful than older adults. CONCLUSION: Taking into account a wide variety of patient experience measures, patients preferred colonoscopy to air contrast barium enema and computed tomographic colonography. This finding has important implications for physicians considering different colon imaging tests.

Authors
Bosworth, HB; Rockey, DC; Paulson, EK; Niedzwiecki, D; Davis, W; Sanders, LL; Yee, J; Henderson, J; Hatten, P; Burdick, S; Sanyal, A; Rubin, DT; Sterling, M; Akerkar, G; Bhutani, MS; Binmoeller, K; Garvie, J; Bini, EJ; McQuaid, K; Foster, WL; Thompson, WM; Dachman, A; Halvorsen, R
MLA Citation
Bosworth, HB, Rockey, DC, Paulson, EK, Niedzwiecki, D, Davis, W, Sanders, LL, Yee, J, Henderson, J, Hatten, P, Burdick, S, Sanyal, A, Rubin, DT, Sterling, M, Akerkar, G, Bhutani, MS, Binmoeller, K, Garvie, J, Bini, EJ, McQuaid, K, Foster, WL, Thompson, WM, Dachman, A, and Halvorsen, R. "Prospective comparison of patient experience with colon imaging tests." Am J Med 119.9 (September 2006): 791-799.
PMID
16945615
Source
pubmed
Published In
American Journal of Medicine
Volume
119
Issue
9
Publish Date
2006
Start Page
791
End Page
799
DOI
10.1016/j.amjmed.2006.02.013

Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses.

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group x Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

Authors
Morey, MC; Ekelund, C; Pearson, M; Crowley, G; Peterson, M; Sloane, R; Pieper, C; McConnell, E; Bosworth, H
MLA Citation
Morey, MC, Ekelund, C, Pearson, M, Crowley, G, Peterson, M, Sloane, R, Pieper, C, McConnell, E, and Bosworth, H. "Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses." J Aging Phys Act 14.3 (July 2006): 324-343.
PMID
17090809
Source
pubmed
Published In
Journal of aging and physical activity
Volume
14
Issue
3
Publish Date
2006
Start Page
324
End Page
343

The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia.

The present study examined the impact of comorbid posttraumatic stress disorder (PTSD) on health-related quality of life and objective measures of health service utilization in 165 male veterans who have primary schizophrenia. Comorbid PTSD was assessed with the PTSD Checklist. Comorbid PTSD was significantly associated with decreased quality of life and increased medical service utilization, including increased psychiatric hospitalization and increased outpatient physical health visits, even after controlling for other clinical and demographic variables among this sample of patients who had primary schizophrenia. Veterans who have schizophrenia should be screened carefully for exposure to trauma and posttraumatic stress disorder.

Authors
Calhoun, PS; Bosworth, HB; Stechuchak, KA; Strauss, J; Butterfield, MI
MLA Citation
Calhoun, PS, Bosworth, HB, Stechuchak, KA, Strauss, J, and Butterfield, MI. "The impact of posttraumatic stress disorder on quality of life and health service utilization among veterans who have schizophrenia." J Trauma Stress 19.3 (June 2006): 393-397.
PMID
16789002
Source
pubmed
Published In
Journal of Traumatic Stress
Volume
19
Issue
3
Publish Date
2006
Start Page
393
End Page
397
DOI
10.1002/jts.20114

The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients.

The prevalence of depression in end-stage renal disease (ESRD) patients on hemodialysis has not been definitively determined. We examined the prevalence of depression and the sensitivity, specificity, positive, and negative likelihood ratios (+LR and -LR) of self-report scales using the physician-administered Structured Clinical Interview for Depression (SCID) as the comparison. Ninety-eight consecutive patients completed the Beck Depression Inventory (BDI) and the Center for Epidemiological Study of Depression (CESD) scales. A physician blinded to BDI and CESD scores administered the SCID. Receiver/responder operating characteristic curves determined the best BDI and CESD cutoffs for depression. Depressed patients had more co-morbidities and lower quality of life, P<0.05. The prevalence of depression by SCID was 26.5% and of major depression was 17.3%. The CESD cutoff with the best diagnostic accuracy was 18, with sensitivity 69% (95% confidence interval (CI) (51%, 87%)), specificity 83% (95% CI (74%, 92%)), positive predictive value (PPV) 60%, negative predictive value (NPV) 88%, +LR 4.14, and -LR 0.37. The best BDI cutoff was 14, with sensitivity 62% (95% CI (43%, 81%)), specificity 81% (95% CI (72%, 90%)), PPV 53%, NPV 85%, +LR 3.26, and -LR 0.47. Self-report scales have high +LR but low -LR for diagnosis of depression. When used for screening, the threshold for depression should be higher for ESRD compared with non-ESRD patients. Identifying depression using physician interview is important, given the low -LR of self-report scales.

Authors
Hedayati, SS; Bosworth, HB; Kuchibhatla, M; Kimmel, PL; Szczech, LA
MLA Citation
Hedayati, SS, Bosworth, HB, Kuchibhatla, M, Kimmel, PL, and Szczech, LA. "The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients." Kidney Int 69.9 (May 2006): 1662-1668.
PMID
16598203
Source
pubmed
Published In
Kidney international
Volume
69
Issue
9
Publish Date
2006
Start Page
1662
End Page
1668
DOI
10.1038/sj.ki.5000308

Knowledge and risks of human immunodeficiency virus transmission among veterans with severe mental illness.

This study is among the first to examine knowledge about human immunodeficiency virus (HIV) and behavioral risks for HIV transmission among veterans with severe mental illness (SMI), a group at high risk for HIV infection. This study examined associations between accuracy of HIV knowledge, risk behaviors, and clinical and demographic characteristics in a sample of male veteran psychiatric inpatients diagnosed with SMI (N = 353). Results showed high rates of inaccurate HIV knowledge, with > 40% of patients demonstrating some inaccuracies, particularly those related to the progression and symptoms of acquired immunodeficiency syndrome. Inaccurate HIV knowledge was associated with older age, minority status, education level, marital status, no homelessness within the previous 6 months, and no reported history of illicit intranasal drug use. There is a need for more effective HIV prevention interventions for persons with SMI.

Authors
Strauss, JL; Bosworth, HB; Stechuchak, KM; Meador, KM; Butterfield, MI
MLA Citation
Strauss, JL, Bosworth, HB, Stechuchak, KM, Meador, KM, and Butterfield, MI. "Knowledge and risks of human immunodeficiency virus transmission among veterans with severe mental illness." Mil Med 171.4 (April 2006): 325-330.
PMID
16673748
Source
pubmed
Published In
Military medicine
Volume
171
Issue
4
Publish Date
2006
Start Page
325
End Page
330

Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control.

Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.

Authors
Hong, TB; Oddone, EZ; Dudley, TK; Bosworth, HB
MLA Citation
Hong, TB, Oddone, EZ, Dudley, TK, and Bosworth, HB. "Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control." Psychol Health Med 11.1 (February 2006): 20-28.
PMID
17129892
Source
pubmed
Published In
Psychology, Health & Medicine
Volume
11
Issue
1
Publish Date
2006
Start Page
20
End Page
28
DOI
10.1080/14786430500228580

"Are you at peace?": one item to probe spiritual concerns at the end of life.

BACKGROUND: Physicians may question their role in probing patients' spiritual distress and the practicality of addressing such issues in the time-limited clinical encounter. Yet, patients' spirituality often influences treatment choices during a course of serious illness. A practical, evidence-based approach to discussing spiritual concerns in a scope suitable to a physician-patient relationship may improve the quality of the clinical encounter. METHODS: Analysis of the construct of being "at peace" using a sample of patients with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease. Descriptive statistics were used to compare response distributions among patient subgroups. Construct validity of the concept of being "at peace" was evaluated by examining Spearman rank correlations between the item and existing spirituality and quality-of-life subscales. RESULTS: Variation in patient responses was not explained by demographic categories or diagnosis, indicating broad applicability across patients. Construct validity showed that feeling at peace was strongly correlated with emotional and spiritual well-being. It was equally correlated with faith and purpose subscales, indicating applicability to traditional and nontraditional definitions of spirituality. CONCLUSIONS: Asking patients about the extent to which they are at peace offers a brief gateway to assessing spiritual concerns. Although these issues may be heightened at the end of life, research suggests they influence medical decision making throughout a lifetime of care.

Authors
Steinhauser, KE; Voils, CI; Clipp, EC; Bosworth, HB; Christakis, NA; Tulsky, JA
MLA Citation
Steinhauser, KE, Voils, CI, Clipp, EC, Bosworth, HB, Christakis, NA, and Tulsky, JA. ""Are you at peace?": one item to probe spiritual concerns at the end of life." Arch Intern Med 166.1 (January 9, 2006): 101-105.
PMID
16401817
Source
pubmed
Published In
Archives of internal medicine
Volume
166
Issue
1
Publish Date
2006
Start Page
101
End Page
105
DOI
10.1001/archinte.166.1.101

Racial differences in blood pressure control: potential explanatory factors.

PURPOSE: Poor blood pressure control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among African Americans. We explored antihypertensive medication adherence and other factors that may explain racial differences in blood pressure control. METHODS: Baseline data were obtained from the Veteran's Study to Improve The Control of Hypertension, a randomized controlled trial designed to improve blood pressure control. Clinical, demographic, and psychosocial factors relating to blood pressure control were examined. RESULTS: A total of 569 patients who were African American (41%) or white (59%) were enrolled in the study. African Americans were more likely to have inadequate baseline blood pressure control than whites (63% vs 50%; odds ratio = 1.70; 95% confidence interval [CI] 1.20-2.41). Among 20 factors related to blood pressure control, African Americans also had a higher odds ratio of being nonadherent to their medication, being more functionally illiterate, and having a family member with hypertension compared with whites. Compared with whites, African Americans also were more likely to perceive high blood pressure as serious and to experience the side effect of increased urination compared with whites. Adjusting for these differences reduced the odds ratio of African Americans having adequate blood pressure control to 1.59 (95% confidence interval 1.09-2.29). CONCLUSIONS: In this sample of hypertensive patients who have good access to health care and medication benefits, African Americans continued to have lower levels of blood pressure control despite considering more than 20 factors related to blood pressure control. Interventions designed to improve medication adherence need to take race into account. Patients' self-reports of failure to take medications provide an opportunity for clinicians to explore reasons for medication nonadherence, thereby improving adherence and potentially blood pressure control.

Authors
Bosworth, HB; Dudley, T; Olsen, MK; Voils, CI; Powers, B; Goldstein, MK; Oddone, EZ
MLA Citation
Bosworth, HB, Dudley, T, Olsen, MK, Voils, CI, Powers, B, Goldstein, MK, and Oddone, EZ. "Racial differences in blood pressure control: potential explanatory factors." Am J Med 119.1 (January 2006): 70.e9-70.15.
PMID
16431192
Source
pubmed
Published In
American Journal of Medicine
Volume
119
Issue
1
Publish Date
2006
Start Page
70.e9
End Page
70.15
DOI
10.1016/j.amjmed.2005.08.019

Racial differences in health concern.

An understanding of racial differences in risk-related affect may help explain racial differences in health behaviors and outcomes and provide additional opportunities for intervention. In phone interviews with a random community sample of 197 whites, 155 blacks and 163 Latinos, we assessed concern that respondents' health would be hurt by their diet, an inability to exercise, an inability to follow a doctor's recommendations and disease. A multivariate analysis of variance with follow-up profile analysis revealed that whites were less concerned than blacks and Latinos about an inability to follow their doctors' recommendations (ps < 0.01). There were no racial differences in the other health concern variables. Interventions to inform blacks and Latinos about their health risks must strike a balance between creating enough health concern to encourage health behavior but not so much that it interferes with health-promoting behaviors.

Authors
Voils, CI; Oddone, EZ; Weinfurt, KP; Friedman, JY; Bright, CM; Schulman, KA; Bosworth, HB
MLA Citation
Voils, CI, Oddone, EZ, Weinfurt, KP, Friedman, JY, Bright, CM, Schulman, KA, and Bosworth, HB. "Racial differences in health concern." J Natl Med Assoc 98.1 (January 2006): 36-42.
PMID
16532976
Source
pubmed
Published In
Journal of the National Medical Association
Volume
98
Issue
1
Publish Date
2006
Start Page
36
End Page
42

Identifying barriers to hypertension guideline adherence using clinician feedback at the point of care.

Factors contributing to low adherence to clinical guidelines by clinicians are not well understood. The user interface of ATHENA-HTN, a guideline-based decision support system (DSS) for hypertension, presents a novel opportunity to collect clinician feedback on recommendations displayed at the point of care. We analyzed feedback from 46 clinicians who received ATHENA advisories as part of a 15-month randomized trial to identify potential reasons clinicians may not intensify hypertension therapy when it is recommended. Among the 368 visits for which feedback was provided, clinicians commonly reported they did not follow recommendations because: recorded blood pressure was not representative of the patient's typical blood pressure; hypertension was not a clinical priority for the visit; or patients were nonadherent to medications. For many visits, current quality-assurance algorithms may incorrectly identify clinically appropriate decisions as guideline nonadherent due to incomplete capture of relevant information. We present recommendations for how automated DSSs may help identify "apparent" barriers and better target decision support.

Authors
Lin, ND; Martins, SB; Chan, AS; Coleman, RW; Bosworth, HB; Oddone, EZ; Shankar, RD; Musen, MA; Hoffman, BB; Goldstein, MK
MLA Citation
Lin, ND, Martins, SB, Chan, AS, Coleman, RW, Bosworth, HB, Oddone, EZ, Shankar, RD, Musen, MA, Hoffman, BB, and Goldstein, MK. "Identifying barriers to hypertension guideline adherence using clinician feedback at the point of care." AMIA Annu Symp Proc (2006): 494-498.
PMID
17238390
Source
pubmed
Published In
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
Publish Date
2006
Start Page
494
End Page
498

Nurse administered telephone intervention for blood pressure control: A patient-tailored multifactorial intervention

Authors
Bosworth, HB; Olsen, MK; Dudley, T; Goldstein, M; Alto, P; Orr, M; Gentry, P; McCant, F; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Dudley, T, Goldstein, M, Alto, P, Orr, M, Gentry, P, McCant, F, and Oddone, EZ. "Nurse administered telephone intervention for blood pressure control: A patient-tailored multifactorial intervention." October 25, 2005.
Source
wos-lite
Published In
Circulation
Volume
112
Issue
17
Publish Date
2005
Start Page
U589
End Page
U589

Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis.

OBJECTIVE: To compare the ability of 3 database-derived comorbidity scores, the Charlson Score, Elixhauser method, and RxRisk-V, in predicting health service use among individuals with osteoarthritis (OA). METHODS: The study population comprised 306 patients who were under care for OA in the Veterans Affairs (VA) health care system. Comorbidity scores were calculated using 1 year of data from VA inpatient and outpatient databases (Charlson Score, Elixhauser method), as well as pharmacy data (RxRisk-V). Model selection was used to identify the best comorbidity index for predicting 3 health service use variables: number of physician visits, number of prescriptions used, and hospitalization probability. Specifically, Akaike's Information Criterion (AIC) was used to determine the best model for each health service outcome variable. Model fit was also evaluated. RESULTS: All 3 comorbidity indices were significant predictors of each health service outcome (P < 0.01). However, based on AIC values, models using the RxRisk-V and Elixhauser indices as predictor variables were better than models using the Charlson Score. The model using the RxRisk-V index as a predictor was the best for the outcome of prescription medication use, and the model with the Elixhauser index was the best for the outcome of physician visits. CONCLUSION: The Rx-Risk-V and Elixhauser are suitable comorbidity measures for examining health services use among patients with OA. Both indices are derived from administrative databases and can efficiently capture comorbidity among large patient populations.

Authors
Dominick, KL; Dudley, TK; Coffman, CJ; Bosworth, HB
MLA Citation
Dominick, KL, Dudley, TK, Coffman, CJ, and Bosworth, HB. "Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis." Arthritis Rheum 53.5 (October 15, 2005): 666-672.
PMID
16208675
Source
pubmed
Published In
Arthritis and Rheumatism
Volume
53
Issue
5
Publish Date
2005
Start Page
666
End Page
672
DOI
10.1002/art.21440

Subjective and objective evaluations of health among middle-aged and older veterans with hypertension.

OBJECTIVE: The congruence between self-rated health and objective health was examined for associations with health factors related to hypertension (health behaviors, medication barriers, and perceived blood-pressure control). METHODS: The Charlson Comorbidity Index was cross classified with self-rated health, producing four health-congruence groups: good health realists, poor health realists, health optimists, and health pessimists. Data for this study were obtained from 588 hypertensive veterans (mean age = 63) at baseline of a clinical trial to improve blood-pressure control before randomization to an intervention. RESULTS: Optimists had higher perceived control of their hypertension when compared to pessimists. Additionally, optimists had higher levels of exercise and fewer medication barriers when compared to poor health realists. DISCUSSION: Health congruence classification could be a useful tool to alert practitioners of patients who may be having difficulties managing their hypertension.

Authors
Hong, TB; Oddone, EZ; Dudley, TK; Bosworth, HB
MLA Citation
Hong, TB, Oddone, EZ, Dudley, TK, and Bosworth, HB. "Subjective and objective evaluations of health among middle-aged and older veterans with hypertension." J Aging Health 17.5 (October 2005): 592-608.
PMID
16177452
Source
pubmed
Published In
Journal of Aging and Health
Volume
17
Issue
5
Publish Date
2005
Start Page
592
End Page
608
DOI
10.1177/0898264305279780

Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis.

BACKGROUND: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. METHODS: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. RESULTS: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. CONCLUSION: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.

Authors
Hedayati, SS; Grambow, SC; Szczech, LA; Stechuchak, KM; Allen, AS; Bosworth, HB
MLA Citation
Hedayati, SS, Grambow, SC, Szczech, LA, Stechuchak, KM, Allen, AS, and Bosworth, HB. "Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis." Am J Kidney Dis 46.4 (October 2005): 642-649.
PMID
16183419
Source
pubmed
Published In
American Journal of Kidney Diseases
Volume
46
Issue
4
Publish Date
2005
Start Page
642
End Page
649
DOI
10.1053/j.ajkd.2005.07.002

Lifetime sexual and physical victimization among male veterans with combat-related post-traumatic stress disorder.

Because of the high prevalence of post-traumatic stress disorder (PTSD) among veteran men and the limited research on victimization in this group, we recruited 133 male veterans with combat-related PTSD from a psychiatric inpatient unit and assessed them for lifetime physical and sexual trauma. Results indicated that 96% of the sample had experienced some form of victimization over their lifetimes; 60% reported childhood physical abuse, 41% childhood sexual abuse, 93% adulthood physical assault, and 20% adulthood sexual assault. In the preceding year alone, 46% experienced either physical or sexual assault. These findings support the need for routine inquiry into the histories of noncombat victimization in this cohort. Determining the lifetime history of trauma exposure may have implications for vulnerability to subsequent development of PTSD and the risk of future violence.

Authors
Lapp, KG; Bosworth, HB; Strauss, JL; Stechuchak, KM; Horner, RD; Calhoun, PS; Meador, KG; Lipper, S; Butterfield, MI
MLA Citation
Lapp, KG, Bosworth, HB, Strauss, JL, Stechuchak, KM, Horner, RD, Calhoun, PS, Meador, KG, Lipper, S, and Butterfield, MI. "Lifetime sexual and physical victimization among male veterans with combat-related post-traumatic stress disorder." Mil Med 170.9 (September 2005): 787-790.
PMID
16261985
Source
pubmed
Published In
Military medicine
Volume
170
Issue
9
Publish Date
2005
Start Page
787
End Page
790

Patient adherence in rehabilitationAdherence to diet recommendationsImplications of nonadherence for economic evaluation and health policyAdherence to physical activityNonadherence in pediatricsIntroduction

Authors
Zinn, S; Yancy, WS; Boan, J; Van Houtven, CH; Weinberger, M; Carey, T; Dominick, KL; Morey, M; Cheng, J; Walter, EC; Bosworth, HB; Weinberger, M; Oddone, EZ
MLA Citation
Zinn, S, Yancy, WS, Boan, J, Van Houtven, CH, Weinberger, M, Carey, T, Dominick, KL, Morey, M, Cheng, J, Walter, EC, Bosworth, HB, Weinberger, M, and Oddone, EZ. "Patient adherence in rehabilitationAdherence to diet recommendationsImplications of nonadherence for economic evaluation and health policyAdherence to physical activityNonadherence in pediatricsIntroduction (PublishedPublishedPublishedPublishedPublishedPublished)." Patient Treatment Adherence: Concepts, Interventions, and Measurement. August 21, 2005. 195-236.
Source
scopus
Publish Date
2005
Start Page
195
End Page
236
DOI
10.4324/9781410615626

Conclusion

Authors
Bosworth, HB; Weinberger, M; Oddone, EZ
MLA Citation
Bosworth, HB, Weinberger, M, and Oddone, EZ. "Conclusion." Patient Treatment Adherence: Concepts, Interventions, and Measurement. August 21, 2005. 519-526.
Source
scopus
Publish Date
2005
Start Page
519
End Page
526
DOI
10.4324/9781410615626

Patient treatment adherence: Concepts, interventions, and measurement

This new book summarizes the adherence literature for a number of specific health behaviors and populations. It provides a comprehensive source on the conceptualization, interventions, and measurement of treatment adherence and a synthesis of the research across demographic and chronic diseases. The text presents problems associated with treatment adherence; theoretical models that have commonly been used to understand, predict, and/or improve adherence; adherence with specific behaviors including exercise, diet, rehabilitation, medication, and psychological therapies; and strategies in enhancing adherence. Because chronic diseases involve similar behaviors, the handbook is organized by specific behaviors and special populations, and not by disease. Every chapter is sub-organized by specific diseases to ensure easy access for the readers and features a discussion of adherence across demographic and chronic conditions, a review of previous interventions directed at the particular behavior or population, questions and scoring algorithms for widely used measures of treatment adherence, a discussion of the clinical research, and where appropriate, policy implications. Patient Treatment Adherence addresses: practical recommendations to improve adherence; the impact of non-adherence including costs and health-related quality of life; methodological issues such as assessing cost-effectiveness; and the use of technological advances to improve adherence. Intended for health service professionals, health, clinical, social, and cognitive psychologists, primary care physicians, pharmacists, and policy-makers, this text is also an excellent resource for graduate courses on health psychology and public health. © 2006 by Lawrence Erlbaum Associates, Inc. All rights reserved.

Authors
Bosworth, HB; Weinberger, M; Oddone, EZ
MLA Citation
Bosworth, HB, Weinberger, M, and Oddone, EZ. "Patient treatment adherence: Concepts, interventions, and measurement." Patient Treatment Adherence: Concepts, Interventions, and Measurement (August 21, 2005): 1-582.
Source
scopus
Published In
Patient Treatment Adherence: Concepts, Interventions, and Measurement
Publish Date
2005
Start Page
1
End Page
582
DOI
10.4324/9781410615626

Medication treatment adherence

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "Medication treatment adherence." (August 21, 2005): 147-194. (Chapter)
Source
scopus
Publish Date
2005
Start Page
147
End Page
194
DOI
10.4324/9781410615626

Theoretical models to understand treatment adherence

Authors
Bosworth, HB; Voils, CI
MLA Citation
Bosworth, HB, and Voils, CI. "Theoretical models to understand treatment adherence." (August 21, 2005): 13-46. (Chapter)
Source
scopus
Publish Date
2005
Start Page
13
End Page
46
DOI
10.4324/9781410615626

Patient preference and validity of randomized controlled trials.

Authors
Cho, AH; Jackson, GL; Bosworth, HB
MLA Citation
Cho, AH, Jackson, GL, and Bosworth, HB. "Patient preference and validity of randomized controlled trials." JAMA 294.1 (July 6, 2005): 41-. (Letter)
PMID
15998887
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
294
Issue
1
Publish Date
2005
Start Page
41
DOI
10.1001/jama.294.1.41-a

Perceived discrimination and reported delay of pharmacy prescriptions and medical tests.

BACKGROUND: Access to health care varies according to a person's race and ethnicity. Delaying treatment is one measure of access with important health consequences. OBJECTIVE: Determine whether perceptions of unfair treatment because of race or ethnicity are associated with reported treatment delays, controlling for economic constraints, self-reported health, depression, and demographics. DESIGN: Cross-sectional, observational study. PARTICIPANTS: A randomly selected community sample of 181 blacks, 148 Latinos, and 193 whites in Durham County, NC. MEASUREMENTS: A phone survey conducted in 2002 to assess discrimination, trust in medical care, quality of care, and access to care. Treatment delays were measured by whether or not a person reported delaying or forgoing filling a prescription and delaying or forgoing having a medical test/treatment in the past 12 months. Perceived discrimination was measured as unfair treatment in health care and as racism in local health care institutions. RESULTS: The odds of delaying filling prescriptions were significantly higher (odds ratio (OR)=2.02) for persons who perceived unfair treatment, whereas the odds of delaying tests or treatments were significantly higher (OR=2.42) for persons who thought racism was a problem in health care locally. People with self-reported depression and people who reported not working had greater odds of delaying both types of care. CONCLUSIONS: A prospective cohort study with both personal and macro measures of discrimination, as well as more refined measures of treatment delays, would help us better understand the relationship between perceived discrimination and treatment delays.

Authors
Van Houtven, CH; Voils, CI; Oddone, EZ; Weinfurt, KP; Friedman, JY; Schulman, KA; Bosworth, HB
MLA Citation
Van Houtven, CH, Voils, CI, Oddone, EZ, Weinfurt, KP, Friedman, JY, Schulman, KA, and Bosworth, HB. "Perceived discrimination and reported delay of pharmacy prescriptions and medical tests." J Gen Intern Med 20.7 (July 2005): 578-583.
PMID
16050850
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
20
Issue
7
Publish Date
2005
Start Page
578
End Page
583
DOI
10.1111/j.1525-1497.2005.0123.x

Perceived racial/ethnic bias in healthcare in Durham County, North Carolina: a comparison of community and national samples.

BACKGROUND: We sought to compare findings of a national survey of perceptions of racial/ethnic discrimination in healthcare to those of a community survey, with emphasis on the perceptions of Latinos. METHODS: Responses from a national survey were compared to a telephone survey of residents of Durham County, North Carolina. RESULTS: Black respondents in the Durham sample were more likely than those in the national sample to feel that a healthcare provider had treated them with disrespect because of health insurance status (28% vs 14%; P < 0.001). Approximately one third of Durham Latinos and 14% of Latinos in the national sample felt they had been treated with disrespect because of their English-language ability (P < 0.01). Compared to a national sample of white participants, white respondents in Durham were more likely to believe that black persons are worse off in terms of receiving routine medical care (40% vs 27%; P < 0.01) and having health insurance (58% vs 43%; P < 0.01). As compared to their national counterparts, there was a similar trend for how white respondents in Durham perceived how Latinos fared (P < 0.001 for all comparisons). CONCLUSIONS: Overall the perception of bias in healthcare was greater among Durham residents, especially among newly immigrated Latinos, than among their national counterparts.

Authors
Friedman, JY; Anstrom, KJ; Weinfurt, KP; McIntosh, M; Bosworth, HB; Oddone, EZ; Bright, CM; Schulman, KA
MLA Citation
Friedman, JY, Anstrom, KJ, Weinfurt, KP, McIntosh, M, Bosworth, HB, Oddone, EZ, Bright, CM, and Schulman, KA. "Perceived racial/ethnic bias in healthcare in Durham County, North Carolina: a comparison of community and national samples." N C Med J 66.4 (July 2005): 267-275.
PMID
16206530
Source
pubmed
Published In
North Carolina Medical Journal
Volume
66
Issue
4
Publish Date
2005
Start Page
267
End Page
275

Hormone therapy does not affect depression severity in older women.

OBJECTIVE: Although estrogens are thought to have a beneficial effect on menopausal symptoms, the role of estrogen in the etiology and treatment of depression in older women remains unclear. The authors examined the relationship between hormone therapy (HT) use and depressive symptom severity. METHODS: Authors report the findings from a cross-sectional analysis of baseline data from the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) Study, using data from 1,160 women age 60 years and older. RESULTS: Women who were taking HT were likely to be younger, White, married, and to have had at least some college education. They were also more likely to report good or better health and to have taken antidepressant medications in the past 3 months. Although HT use was associated with more severe depressive symptoms in the unadjusted analysis, it was not associated with depression severity in adjusted analyses. Although there was a trend for a differential effect of college education with HT use on depression scores, no significant interaction was found between HT and race. CONCLUSION: There was no evidence to suggest that women HT users differ from non-HT users in depressive symptom severity.

Authors
Goldstein, KM; Harpole, LH; Stechuchak, KM; Coffman, CJ; Bosworth, HB; Steffens, DC; Bastian, LA
MLA Citation
Goldstein, KM, Harpole, LH, Stechuchak, KM, Coffman, CJ, Bosworth, HB, Steffens, DC, and Bastian, LA. "Hormone therapy does not affect depression severity in older women." Am J Geriatr Psychiatry 13.7 (July 2005): 616-623.
PMID
16009738
Source
pubmed
Published In
American Journal of Geriatric Psychiatry
Volume
13
Issue
7
Publish Date
2005
Start Page
616
End Page
623
DOI
10.1176/appi.ajgp.13.7.616

Intentional and unintentional nonadherence to antihypertensive medication.

BACKGROUND: Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each. OBJECTIVE: To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients. METHODS: Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence. RESULTS: Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting > or = 5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse. CONCLUSIONS: Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.

Authors
Lowry, KP; Dudley, TK; Oddone, EZ; Bosworth, HB
MLA Citation
Lowry, KP, Dudley, TK, Oddone, EZ, and Bosworth, HB. "Intentional and unintentional nonadherence to antihypertensive medication." Ann Pharmacother 39.7-8 (July 2005): 1198-1203.
PMID
15956238
Source
pubmed
Published In
The Annals of pharmacotherapy
Volume
39
Issue
7-8
Publish Date
2005
Start Page
1198
End Page
1203
DOI
10.1345/aph.1E594

How well do clinic-based blood pressure measurements agree with the mercury standard?

BACKGROUND: Obtaining accurate blood pressure (BP) readings is a challenge faced by health professionals. Clinical trials implement strict protocols, whereas clinical practices and studies that assess quality of care utilize a less rigorous protocol for BP measurement. OBJECTIVE: To examine agreement between real-time clinic-based assessment of BP and the standard mercury assessment of BP. DESIGN: Prospective reliability study. PATIENTS: One hundred patients with an International Classification of Diseases-9th edition code for hypertension were enrolled. MEASURES: Two BP measurements were obtained with the Hawksley random-zero mercury sphygmomanometer and averaged. The clinic-based BP was extracted from the computerized medical records. RESULTS: Agreement between the mercury and clinic-based systolic blood pressure (SBP) was good, intraclass correlation coefficient (ICC)=0.91 (95% confidence interval (CI): 0.83 to 0.94); the agreement for the mercury and clinic-based diastolic blood pressure (DBP) was satisfactory, ICC=0.77 (95% CI: 0.62 to 0.86). Overall, clinic-based readings overestimated the mercury readings, with a mean overestimation of 8.3 mmHg for SBP and 7.1 mmHg for DBP. Based on the clinic-based measure, 21% of patients were misdiagnosed with uncontrolled hypertension. CONCLUSIONS: Health professionals should be aware of this potential difference when utilizing clinic-based BP values for making treatment decisions and/or assessing quality of care.

Authors
Kim, JW; Bosworth, HB; Voils, CI; Olsen, M; Dudley, T; Gribbin, M; Adams, M; Oddone, EZ
MLA Citation
Kim, JW, Bosworth, HB, Voils, CI, Olsen, M, Dudley, T, Gribbin, M, Adams, M, and Oddone, EZ. "How well do clinic-based blood pressure measurements agree with the mercury standard?." J Gen Intern Med 20.7 (July 2005): 647-649.
PMID
16050862
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
20
Issue
7
Publish Date
2005
Start Page
647
End Page
649
DOI
10.1111/j.1525-1497.2005.0105.x

Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity.

We prospectively tested the quantitative myasthenia gravis score (QMG) for responsiveness and longitudinal construct validity in 53 patients with myasthenia gravis. Index of responsiveness was high. Longitudinal construct validity was confirmed by the correlation between changes in QMG and manual muscle testing and by a difference in QMG changes across patients that were clinically unchanged, improved, or worse between two visits. Our results support QMG use for assessing clinical change in trials.

Authors
Bedlack, RS; Simel, DL; Bosworth, H; Samsa, G; Tucker-Lipscomb, B; Sanders, DB
MLA Citation
Bedlack, RS, Simel, DL, Bosworth, H, Samsa, G, Tucker-Lipscomb, B, and Sanders, DB. "Quantitative myasthenia gravis score: assessment of responsiveness and longitudinal validity." Neurology 64.11 (June 14, 2005): 1968-1970.
PMID
15955957
Source
pubmed
Published In
Neurology
Volume
64
Issue
11
Publish Date
2005
Start Page
1968
End Page
1970
DOI
10.1212/01.WNL.0000163988.28892.79

Improving blood pressure control by tailored feedback to patients and clinicians.

Authors
Bosworth, HB; Olsen, MK; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, and Oddone, EZ. "Improving blood pressure control by tailored feedback to patients and clinicians." Am Heart J 149.5 (May 2005): 795-803. (Review)
PMID
15894959
Source
pubmed
Published In
American Heart Journal
Volume
149
Issue
5
Publish Date
2005
Start Page
795
End Page
803
DOI
10.1016/j.ahj.2005.01.039

Impact Of Intercurrent Illness On Functional Outcomes In A Clinical Trial To Improve Elder Fitness

Authors
Morey, MC; Sloane, R; Ekelund, CC; Pearson, MP; Crowley, GM; Peterson, MJ; Pieper, CF; McConnell, E; Bosworth, HB; Chapman, J
MLA Citation
Morey, MC, Sloane, R, Ekelund, CC, Pearson, MP, Crowley, GM, Peterson, MJ, Pieper, CF, McConnell, E, Bosworth, HB, and Chapman, J. "Impact Of Intercurrent Illness On Functional Outcomes In A Clinical Trial To Improve Elder Fitness." MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 37 (May 2005): S338-S338.
Source
wos-lite
Published In
Medicine and Science in Sports and Exercise
Volume
37
Publish Date
2005
Start Page
S338
End Page
S338
DOI
10.1097/00005768-200505001-01747

Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention.

OBJECTIVES: A randomized controlled trial involving a nurse administered patient-tailored intervention is being conducted to improve blood pressure (BP) control. METHODS: Veterans with hypertension from an outpatient primary care clinic completed a baseline assessment and were randomly allocated to either a nurse administered intervention or to usual care. In this ongoing study, intervention patients receive the tailored intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote adherence with medication and improve health behaviors. Patient factors targeted for intervention include perceived risk of hypertension, memory, literacy, social support, patients' relationship with their health care provider, side effects of therapy, pill refill, missed appointments, and health behaviors. RESULTS: The sample randomized to the nurse intervention consisted of 294 veterans with hypertension (average age = 63 years; 41% African-American). A comparable sample of veterans was assigned to usual care (n = 294). We have maintained a 97% retention rate for the first 12 months of the study. The average phone call has lasted 3.7 min ranging from less than 1 to 40 min. At 6-month post-enrollment, individuals receiving the nurse intervention had a greater increase in confidence with following hypertension treatment (P < 0.007) than the usual care group. DISCUSSION: The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings.

Authors
Bosworth, HB; Olsen, MK; Gentry, P; Orr, M; Dudley, T; McCant, F; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Gentry, P, Orr, M, Dudley, T, McCant, F, and Oddone, EZ. "Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention." Patient Educ Couns 57.1 (April 2005): 5-14.
PMID
15797147
Source
pubmed
Published In
Patient Education and Counseling
Volume
57
Issue
1
Publish Date
2005
Start Page
5
End Page
14
DOI
10.1016/j.pec.2004.03.011

Religiosity/spirituality and pain in patients with sickle cell disease.

Religion/spirituality has been identified by individuals with sickle cell disease (SCD) as an important factor in coping with stress and in determining quality of life. Research has demonstrated positive associations between religiosity/spirituality and better physical and mental health outcomes. However, few studies have examined the influence religiosity/spirituality has on the experience of pain in chronically ill patients. Our aim was to examine three domains of religiosity/spirituality (church attendance, prayer/Bible study, intrinsic religiosity) and evaluate their association with measures of pain. We studied a consecutive sample of 50 SCD outpatients and found that church attendance was significantly associated with measures of pain. Attending church once or more per week was associated with the lowest scores on pain measures. These findings were maintained after controlling for age, gender, and disease severity. Prayer/Bible study and intrinsic religiosity were not significantly related to pain in our study. Positive associations are consistent with recent literature, but our results expose new aspects of the relationship for African American patients. We conclude that religious involvement likely plays a significant role in modulating the pain experience of African American patients with SCD and may be an important factor for future study in other populations of chronically ill pain sufferers.

Authors
Harrison, MO; Edwards, CL; Koenig, HG; Bosworth, HB; Decastro, L; Wood, M
MLA Citation
Harrison, MO, Edwards, CL, Koenig, HG, Bosworth, HB, Decastro, L, and Wood, M. "Religiosity/spirituality and pain in patients with sickle cell disease." J Nerv Ment Dis 193.4 (April 2005): 250-257.
PMID
15805821
Source
pubmed
Published In
Journal of Nervous and Mental Disease
Volume
193
Issue
4
Publish Date
2005
Start Page
250
End Page
257

The veterans' study to improve the control of hypertension (V-STITCH): design and methodology.

BACKGROUND: Among the 60 million Americans with hypertension, only approximately 31% have their blood pressure (BP) under control (<140/90 mm Hg). Despite the damaging impact of hypertension and the availability of evidence-based target values for BP, interventions to improve BP control have had limited success. OBJECTIVES: A randomized controlled health services intervention trial with a split-plot design is being conducted to improve BP control. This 4-year trial evaluates both a patient and a provider intervention in a primary care setting among diagnosed hypertensive veterans. METHODS: In a cluster-randomization, 30 primary care providers in the Durham VAMC Primary Care Clinic were randomly assigned to receive the provider intervention or control. The provider intervention is a patient-specific electronically generated hypertension decision support system (DSS) delivering guideline-based recommendations to the provider at each patient's visit, designed to improve guideline-concordant therapy. For these providers, a sample of their hypertensive patients (n=588) was randomly assigned to receive a telephone-administered patient intervention or usual care. The patient intervention incorporates patients' need assessments and involves tailored behavioral and education modules to promote medication adherence and improve specific health behaviors. All modules are delivered over the telephone bi-monthly for 24 months. In this trial, the primary outcome is the proportion of patients who achieve a BP < or =140/90 mm Hg at each outpatient clinic visit over 24 months. CONCLUSION: Despite the known risk of poor BP control, a majority of adults still do not have their BP controlled. This study is an important step in testing the effectiveness of a patient and provider intervention to improve BP control among veterans in the primary care setting.

Authors
Bosworth, HB; Olsen, MK; Goldstein, MK; Orr, M; Dudley, T; McCant, F; Gentry, P; Oddone, EZ
MLA Citation
Bosworth, HB, Olsen, MK, Goldstein, MK, Orr, M, Dudley, T, McCant, F, Gentry, P, and Oddone, EZ. "The veterans' study to improve the control of hypertension (V-STITCH): design and methodology." Contemp Clin Trials 26.2 (April 2005): 155-168.
PMID
15837438
Source
pubmed
Published In
Contemporary Clinical Trials
Volume
26
Issue
2
Publish Date
2005
Start Page
155
End Page
168
DOI
10.1016/j.cct.2004.12.006

Prostate Cancer: A Significant Risk Factor for Late-Life Suicide

Authors
Llorente, MD; Burke, M; Gregory, GR; Bosworth, HB; Grambow, SC; Horner, RD; Golden, A; Olsen, EJ
MLA Citation
Llorente, MD, Burke, M, Gregory, GR, Bosworth, HB, Grambow, SC, Horner, RD, Golden, A, and Olsen, EJ. "Prostate Cancer: A Significant Risk Factor for Late-Life Suicide." The American Journal of Geriatric Psychiatry 13.3 (March 2005): 195-201.
Source
crossref
Published In
American Journal of Geriatric Psychiatry
Volume
13
Issue
3
Publish Date
2005
Start Page
195
End Page
201
DOI
10.1097/00019442-200503000-00004

Prostate cancer: a significant risk factor for late-life suicide.

OBJECTIVE: The authors sought to determine the incidence of suicide and its relevant correlates among men with prostate cancer. METHODS: This was a population-based, retrospective cohort review of men age 65 and older, residing in South Florida between 1983 and 1993. Average annual suicide rate was calculated for prostate cancer-related suicides and contrasted with age and gender-specific rates in the same geographic area. RESULTS: Of 667 completed suicides, 20 were prostate cancer-related (3% of the total male suicide sample). The average annual incidence of suicide for men was 55.32 per 100,000 persons, but for men with prostate cancer, the rate was 274.7 per 100,000. The risk of suicide in men with prostate cancer was 4.24 times that of an age- and gender-specific cohort. The clinical correlates included depression (70%), cancer diagnosis within 6 months of suicide (80%), physician visit within 1 month of suicide (60%), and being foreign-born (70%). CONCLUSION: The incidence of suicide among older men with prostate cancer is higher than previously recognized. Depression, recent diagnosis, pain, and being foreign-born are important clinical correlates. Screens for depression and suicide in older men with prostate cancer should be done after diagnosis and redone during the first 6 months regularly, particularly in the primary-care setting. Public education is needed to decrease the stigma associated with having a cancer diagnosis.

Authors
Llorente, MD; Burke, M; Gregory, GR; Bosworth, HB; Grambow, SC; Horner, RD; Golden, A; Olsen, EJ
MLA Citation
Llorente, MD, Burke, M, Gregory, GR, Bosworth, HB, Grambow, SC, Horner, RD, Golden, A, and Olsen, EJ. "Prostate cancer: a significant risk factor for late-life suicide." Am J Geriatr Psychiatry 13.3 (March 2005): 195-201.
PMID
15728750
Source
pubmed
Published In
American Journal of Geriatric Psychiatry
Volume
13
Issue
3
Publish Date
2005
Start Page
195
End Page
201
DOI
10.1176/appi.ajgp.13.3.195

Biological and social predictors of long-term geriatric depression outcome.

OBJECTIVE: In this study, we examined 204 older depressed individuals for up to 64 months to determine factors related to depression outcome. We hypothesized that both presence of vascular brain lesions seen on baseline magnetic resonance imaging (MRI) scans and lower baseline social support measures would be related to worse depression outcome. METHOD: At study entry, all subjects were at least 59 years old, had a diagnosis of major depression, and were free of other major psychiatric illness and primary neurological illness, including dementia and stroke. Depression was diagnosed via structured interview and clinical assessment by a geriatric psychiatrist who completed a Montgomery Asberg Depression Rating Scale (MADRS) to determine severity of depression. Subjects provided self-report data on social support variables and ability to perform basic and instrumental activities of daily living (ADL, IADL). All subjects agreed to have a baseline standardized MRI brain scan. Ratings of severity of hyperintensities were determined for the periventricular white matter, deep white matter, and subcortical gray matter by two readers who decided by consensus. Treatment was provided by geropsychiatrists following clinical guidelines. Using mixed models to analyze the data, we determined the effect of a variety of demographic, social and imaging variables on the trajectory of MADRS score, the outcome variable of interest. RESULTS: MADRS scores decreased steadily over time. In a final HLM model, in which time since entry, a baseline time indicator, age, gender, education and Mini-mental State Examination score were controlled, subjective social support, instrumental ADL impairment, subcortical gray matter severity, and the interactions of time with social network and with subcortical gray matter lesions remained significantly associated with MADRS score. CONCLUSIONS: Both social and biological factors at baseline are associated with longitudinal depression severity in geriatric depression.

Authors
Steffens, DC; Pieper, CF; Bosworth, HB; MacFall, JR; Provenzale, JM; Payne, ME; Carroll, BJ; George, LK; Krishnan, KRR
MLA Citation
Steffens, DC, Pieper, CF, Bosworth, HB, MacFall, JR, Provenzale, JM, Payne, ME, Carroll, BJ, George, LK, and Krishnan, KRR. "Biological and social predictors of long-term geriatric depression outcome." Int Psychogeriatr 17.1 (March 2005): 41-56.
PMID
15948303
Source
pubmed
Published In
International psychogeriatrics / IPA
Volume
17
Issue
1
Publish Date
2005
Start Page
41
End Page
56

Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population.

OBJECTIVE: The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS: A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS: Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION: The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over one's illness.

Authors
Voils, CI; Steffens, DC; Flint, EP; Bosworth, HB
MLA Citation
Voils, CI, Steffens, DC, Flint, EP, and Bosworth, HB. "Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population." Am J Geriatr Psychiatry 13.2 (February 2005): 157-165.
PMID
15703325
Source
pubmed
Published In
American Journal of Geriatric Psychiatry
Volume
13
Issue
2
Publish Date
2005
Start Page
157
End Page
165
DOI
10.1176/appi.ajgp.13.2.157

Initiation and discontinuation of hormone therapy for menopausal symptoms: results from a community sample.

Factors related to initiation and discontinuation of hormonal therapy (HT) for treatment of menopausal symptoms were examined in a community sample of 533 peri/postmenopausal women aged 45-54 by telephone three times. Over 40 variables including: sociodemographic characteristics, clinical reasons to start HT use, HT contraindications, HT attitudes/knowledge, and health behaviors were examined in logistic regression models comparing women who discontinued HT to women who continued using HT over 9 months (discontinuers) and women who initiated HT versus women who never used HT over 9 months (initiators). Increased understanding of HT, confidence, mental health symptoms, perception that menopause is natural, and having gynecological surgery were related to decreased likelihood of HT discontinuation. Increased understanding about risks of HT, vasomotor symptoms, mood symptoms, and having gynecological surgery were related to increased likelihood of HT Initiation. These findings highlight the importance of physicians discussing HT with their patients, particularly because of recent clinical trial developments.

Authors
Bosworth, HB; Bastian, LA; Grambow, SC; McBride, CM; Skinner, CS; Fish, L; Rimer, BK; Siegler, IC
MLA Citation
Bosworth, HB, Bastian, LA, Grambow, SC, McBride, CM, Skinner, CS, Fish, L, Rimer, BK, and Siegler, IC. "Initiation and discontinuation of hormone therapy for menopausal symptoms: results from a community sample." J Behav Med 28.1 (February 2005): 105-114.
PMID
15887880
Source
pubmed
Published In
Journal of Behavioral Medicine
Volume
28
Issue
1
Publish Date
2005
Start Page
105
End Page
114

Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison.

BACKGROUND: The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests. METHODS: Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies--ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests. FINDINGS: 614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0.1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0.0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0.0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0.0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0.996) than for either ACBE (0.90) or CTC (0.96) and declined for ACBE and CTC when smaller lesions were considered. INTERPRETATION: Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

Authors
Rockey, DC; Paulson, E; Niedzwiecki, D; Davis, W; Bosworth, HB; Sanders, L; Yee, J; Henderson, J; Hatten, P; Burdick, S; Sanyal, A; Rubin, DT; Sterling, M; Akerkar, G; Bhutani, MS; Binmoeller, K; Garvie, J; Bini, EJ; McQuaid, K; Foster, WL; Thompson, WM; Dachman, A; Halvorsen, R
MLA Citation
Rockey, DC, Paulson, E, Niedzwiecki, D, Davis, W, Bosworth, HB, Sanders, L, Yee, J, Henderson, J, Hatten, P, Burdick, S, Sanyal, A, Rubin, DT, Sterling, M, Akerkar, G, Bhutani, MS, Binmoeller, K, Garvie, J, Bini, EJ, McQuaid, K, Foster, WL, Thompson, WM, Dachman, A, and Halvorsen, R. "Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison." Lancet 365.9456 (January 22, 2005): 305-311.
PMID
15664225
Source
pubmed
Published In
The Lancet
Volume
365
Issue
9456
Publish Date
2005
Start Page
305
End Page
311
DOI
10.1016/S0140-6736(05)17784-8

Effect of health-related stereotypes on physiological responses of hypertensive middle-aged and older men.

This study examined the influence of health stereotypes on stress response among middle-aged and older men. It was hypothesized that anxiety and cardiovascular reactivity would increase when health stereotypes were activated among veterans seeking care in an outpatient setting. Among a sample of 122 veteran patients with hypertension, the level of stereotype activation varied by means of reference to either their health status (health stereotypes) or, conversely, some personally valued leisure activities (no stereotype activation). Predicted stereotype-related increases in anxiety, galvanized skin conductance, and blood pressure were evident. Potential explanations for these results are explored, including those relating to the negative health stereotypes associated with being a patient.

Authors
Auman, C; Bosworth, HB; Hess, TM
MLA Citation
Auman, C, Bosworth, HB, and Hess, TM. "Effect of health-related stereotypes on physiological responses of hypertensive middle-aged and older men." J Gerontol B Psychol Sci Soc Sci 60.1 (January 2005): P3-P10.
PMID
15643036
Source
pubmed
Published In
Journals of Gerontology: Series B
Volume
60
Issue
1
Publish Date
2005
Start Page
P3
End Page
P10

For the patient. Who trusts healthcare institutions? Results from a community-based sample.

Authors
Voils, CI; Oddone, EZ; Weinfurt, KP; Friedman, JY; Schulman, KA; Bosworth, HB
MLA Citation
Voils, CI, Oddone, EZ, Weinfurt, KP, Friedman, JY, Schulman, KA, and Bosworth, HB. "For the patient. Who trusts healthcare institutions? Results from a community-based sample." Ethn Dis 15.1 (2005): 150-.
PMID
15720061
Source
pubmed
Published In
Ethnicity & disease
Volume
15
Issue
1
Publish Date
2005
Start Page
150

Who trusts healthcare institutions? Results from a community-based sample.

OBJECTIVE: The goal of this research was to examine racial differences in trust in various healthcare institutions. METHOD: In telephone interviews, 195 Whites, 183 Blacks, and 171 Latinos from Durham, NC indicated how often they trust various institutions (community doctors, local hospitals, county health department, insurance companies, and state and federal government) to do what is best for patients. RESULTS: In bivariate analyses, trust in various healthcare institutions was associated with race; Whites and Latinos trusted physicians more often than Blacks, and Latinos trusted the health department, insurance companies, and both government entities more often than Whites and Blacks (Ps < .01). In adjusted analyses controlling for marital status, financial status, and education, race was still associated with trust. Whites trusted physicians more often than Blacks, and Latinos trusted insurance companies, the state government, and the federal government more often than Whites and Blacks (Ps < .01). CONCLUSIONS: Racial differences in trust of healthcare institutions vary by institution type. Future studies of trust and interventions designed to improve trust must account for race and target institution differences.

Authors
Voils, CI; Oddone, EZ; Weinfurt, KP; Friedman, JY; Schulman, KA; Bosworth, HB
MLA Citation
Voils, CI, Oddone, EZ, Weinfurt, KP, Friedman, JY, Schulman, KA, and Bosworth, HB. "Who trusts healthcare institutions? Results from a community-based sample." Ethn Dis 15.1 (2005): 97-103.
PMID
15720055
Source
pubmed
Published In
Ethnicity & disease
Volume
15
Issue
1
Publish Date
2005
Start Page
97
End Page
103

For the patient. Do patients use prescribed medicine for osteoarthritis?

Authors
Dominick, KL; Golightly, YM; Bosworth, HB
MLA Citation
Dominick, KL, Golightly, YM, and Bosworth, HB. "For the patient. Do patients use prescribed medicine for osteoarthritis?." Ethn Dis 15.1 (2005): 152-.
PMID
15720064
Source
pubmed
Published In
Ethnicity & disease
Volume
15
Issue
1
Publish Date
2005
Start Page
152

Racial differences in analgesic/anti-inflammatory medication adherence among patients with osteoarthritis.

OBJECTIVES: This study examined the prevalence of self-reported adherence to medications for osteoarthritis (OA) and racial differences in adherence. METHODS: This was a cross-sectional survey of 156 Black and White veterans who were taking medications for OA. RESULTS: One quarter of participants reported sometimes forgetting to take their OA medications, 16% were sometimes careless about taking medications, and 27% sometimes stopped taking their medications when they felt better. Overall, 44% of participants reported at least one of these three behaviors. In a multivariable logistic regression model adjusting for demographic factors, OA severity, participatory decision making (PDM), and side effects, Black patients were more likely to report at least one nonadherent behavior (odds ratio [OR] = 2.25, 95% CI = 1.03-4.91). Patients with greater PDM scores were slightly less likely to report nonadherent behavior (OR = 0.95, 95% CI = 0.91-0.99). DISCUSSION: Additional research is needed to examine factors underlying racial differences in adherence, to guide effective interventions.

Authors
Dominick, KL; Golightly, YM; Bosworth, HB
MLA Citation
Dominick, KL, Golightly, YM, and Bosworth, HB. "Racial differences in analgesic/anti-inflammatory medication adherence among patients with osteoarthritis." Ethn Dis 15.1 (2005): 116-122.
PMID
15720058
Source
pubmed
Published In
Ethnicity & disease
Volume
15
Issue
1
Publish Date
2005
Start Page
116
End Page
122

Patient preference and validity of randomized controlled trials [3] (multiple letters)

Authors
Cho, AH; Jackson, GL; Bosworth, HB; Torgerson, D; Moffett, JK; King, M; Nazareth, I; Lampe, F; Bower, P
MLA Citation
Cho, AH, Jackson, GL, Bosworth, HB, Torgerson, D, Moffett, JK, King, M, Nazareth, I, Lampe, F, and Bower, P. "Patient preference and validity of randomized controlled trials [3] (multiple letters)." Journal of the American Medical Association 294.1 (2005): 41-42.
PMID
15998886
Source
scival
Published In
JAMA : the journal of the American Medical Association
Volume
294
Issue
1
Publish Date
2005
Start Page
41
End Page
42

Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care

• Objective: To develop a valid, reproducible scale that quantifies a provider's reaction to uncontrolled blood pressure. • Design: Retrospective chart review. • Setting and participants: 70 patients with hypertension who were treated with antihypertensive medication at the Durham Veterans Affairs Medical Center primary care clinic. • Methods: Three raters blinded to each other's assessments rated each patient visit using the hypertension quality of care scale. This scale includes 4 categories reflecting the extent of provider recognition of elevated blood pressure and action to lower it (0: blood pressure not recorded at visit; 1: blood pressure not controlled, not mentioned in the medical record, and nothing further done; 2: blood pressure not controlled, mentioned in the medical record, but nothing further done; 3: blood pressure not controlled and the provider acted in some manner to lower it). • Results: Providers failed to recognize or act on inadequately controlled blood pressure at 48% of visits. The average frequency of scores for all raters was 2.9% (no blood pressure recorded), 30.5% (blood pressure recorded but not mentioned), 14.3% (blood pressure recorded, provider recognized elevation, but no action), and 25.3% (provider acted to lower blood pressure); blood pressure was adequately controlled in 27.1% of patients. Inter-rater agreement was excellent (Kendall's W = 0.92). Scale scores were moderately related to the extent of systolic blood pressure elevation (r = 0.29, averaged across raters). • Conclusion: The scale demonstrated excellent interrater agreement and moderate correlation with elevation in systolic blood pressure. The scale could be used to measure the effectiveness of interventions designed to prompt providers to respond to inadequately controlled hypertension.

Authors
Henderson, W; Bosworth, HB; Voils, CI; Dudley, TK; McCant, FA; Gentry, PW; Oddone, EZ
MLA Citation
Henderson, W, Bosworth, HB, Voils, CI, Dudley, TK, McCant, FA, Gentry, PW, and Oddone, EZ. "Overcoming clinical inertia: A visit-specific scale for measuring quality in hypertension care." Journal of Clinical Outcomes Management 12.3 (2005): 147-150.
Source
scival
Published In
Journal of Clinical Outcomes Management
Volume
12
Issue
3
Publish Date
2005
Start Page
147
End Page
150

Clinician awareness of adherence to hypertension guidelines.

PURPOSE: Little is known about how well clinicians are aware of their own adherence to clinical guidelines, an important indicator of quality. We compared clinicians' beliefs about their adherence to hypertension guidelines with data on their actual performance. METHODS: We surveyed 139 primary care clinicians at three Veterans Affairs medical centers, asking them to assess their own adherence to hypertension guidelines. We then extracted data from the centers' clinical databases on guideline-concordant medication use and blood pressure control for patients cared for by these providers during a 6-month period. Data were collected for patients with hypertension and diabetes, hypertension and coronary disease, or hypertension with neither of these comorbid conditions. RESULTS: Eighty-six clinicians (62%) completed the survey. Each clinician saw a median of 94 patients with hypertension (mean age, 65 years). Patients were treated with an average of 1.6 antihypertensive medications. Overall, clinicians overestimated the proportion of their patients who were prescribed guideline-concordant medications (75% perceived vs. 67% actual, P <0.001) and who had blood pressure levels <140/90 mm Hg on their last visit (68% perceived vs. 43% actual, P <0.001). Among individual clinicians, there were no significant correlations between perceived and actual guideline adherence (r = 0.18 for medications, r = 0.14 for blood pressure control; P > or =0.10 for both). Clinicians with relatively low actual guideline performance were most likely to overestimate their adherence to medication recommendations and blood pressure targets. CONCLUSION: Clinicians appear to overestimate their adherence to hypertension guidelines, particularly with regards to the proportion of their patients with controlled blood pressure. This limited awareness may represent a barrier to successful implementation of guidelines, and could be addressed through the use of provider profiles and point-of-service feedback to clinicians.

Authors
Steinman, MA; Fischer, MA; Shlipak, MG; Bosworth, HB; Oddone, EZ; Hoffman, BB; Goldstein, MK
MLA Citation
Steinman, MA, Fischer, MA, Shlipak, MG, Bosworth, HB, Oddone, EZ, Hoffman, BB, and Goldstein, MK. "Clinician awareness of adherence to hypertension guidelines." Am J Med 117.10 (November 15, 2004): 747-754.
PMID
15541324
Source
pubmed
Published In
The American Journal of Medicine
Volume
117
Issue
10
Publish Date
2004
Start Page
747
End Page
754
DOI
10.1016/j.amjmed.2004.03.035

Racial/ethnic variations in non-steroidal anti-inflammatory drug (NSAID) use among patients with osteoarthritis.

PURPOSE: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for the treatment of osteoarthritis (OA). While there are documented racial differences in the use of opioid analgesics, little is known about racial differences in the use of NSAIDs. METHODS: This was a retrospective cohort study among a national sample of 6038 veterans with OA. Patients were new NSAID users, followed for approximately 6 months. Primary outcomes included: type of NSAID prescribed (COX-2 selective or preferentially COX-2 selective NSAIDs vs other NSAIDs), days' supply of initial prescription and time to discontinuation of the index NSAID. RESULTS: In an analysis adjusted for demographic and gastrointestinal (GI) bleeding risk factors (age, sex, geographic region, history of GI bleeding, comorbid illnesses, use of anti-coagulants and glucocorticoids), Hispanics were less likely than whites to be prescribed an NSAID with some degree of COX-2 selectivity (odds ratio (OR): 0.47, p < 0.01). The days' supply of the initial prescription was lower for both blacks and Hispanics compared to whites (mean: 38, 31 and 43 days respectively, p < 0.01). In an analysis adjusted for demographics, GI bleeding risk factors and type of NSAID prescribed, blacks discontinued use of the index NSAID earlier than whites (hazard ratio = 1.19, p < 0.001) and there was a similar trend for Hispanics. CONCLUSION: Minorities with OA were prescribed NSAIDs with less COX-2 selectivity and lower days' supply than whites. Further research should address underlying reasons and whether these differences impact outcomes such as pain control, side effects and cost-effectiveness of care.

Authors
Dominick, KL; Bosworth, HB; Jeffreys, AS; Grambow, SC; Oddone, EZ; Horner, RD
MLA Citation
Dominick, KL, Bosworth, HB, Jeffreys, AS, Grambow, SC, Oddone, EZ, and Horner, RD. "Racial/ethnic variations in non-steroidal anti-inflammatory drug (NSAID) use among patients with osteoarthritis." Pharmacoepidemiol Drug Saf 13.10 (October 2004): 683-694.
PMID
15386734
Source
pubmed
Published In
Pharmacoepidemiology and Drug Safety
Volume
13
Issue
10
Publish Date
2004
Start Page
683
End Page
694
DOI
10.1002/pds.904

Pilot study of home-based strength training for knee osteoarthritis.

Authors
Dominick, KL; Golightly, YM; Bosworth, HB
MLA Citation
Dominick, KL, Golightly, YM, and Bosworth, HB. "Pilot study of home-based strength training for knee osteoarthritis." September 2004.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
50
Issue
9
Publish Date
2004
Start Page
S469
End Page
S470

Depression increases in women during early to late menopause but decreases after menopause.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "Depression increases in women during early to late menopause but decreases after menopause." Evid Based Ment Health 7.3 (August 2004): 90-.
PMID
15273234
Source
pubmed
Published In
Evidence-Based Mental Health
Volume
7
Issue
3
Publish Date
2004
Start Page
90

Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery?

BACKGROUND AND PURPOSE: Patient risk perception for surgery may be central to their willingness to undergo surgery. This study examined potential factors associated with patient aversion of surgery. METHODS: This is a secondary data analysis of a prospective cohort study that examined patients referred for evaluation of carotid artery stenosis at five Veterans Affairs Medical Centers. The study collected demographic, clinical, and psychosocial information related to surgery. This analysis focused on patient response to a question assessing their aversion to surgery. RESULTS: Among the 1065 individuals, at the time of evaluation for carotid endarterectomy (CEA), 66% of patients had no symptoms, 16% had a transient ischemic attack, and 18% had stroke. Twelve percent of patients referred for CEA evaluation were averse to surgery. In adjusted analyses, increased age, black race, no previous surgery, lower level of chance locus of control, less trust of physicians, and less social support were significantly related to greater likelihood of surgery aversion among individuals referred for CEA evaluation. Patient degree of medical comorbidity and a validated measure of preoperative risk score were not associated with increased aversion to surgery. CONCLUSIONS: In previous work, aversion to CEA was associated with lack of receipt of CEA even after accounting for patient clinical appropriateness for surgery. We identified important patient characteristics associated with aversion to CEA. Interventions designed to assist patient decision making should focus on these more complex factors related to CEA aversion rather than the simple explanation of clinical usefulness.

Authors
Bosworth, HB; Stechuchak, KM; Grambow, SC; Oddone, EZ
MLA Citation
Bosworth, HB, Stechuchak, KM, Grambow, SC, and Oddone, EZ. "Patient risk perceptions for carotid endarterectomy: which patients are strongly averse to surgery?." J Vasc Surg 40.1 (July 2004): 86-91.
PMID
15218467
Source
pubmed
Published In
Journal of Vascular Surgery
Volume
40
Issue
1
Publish Date
2004
Start Page
86
End Page
91
DOI
10.1016/j.jvs.2004.03.040

The effect of poststroke cognitive impairment on rehabilitation process and functional outcome.

OBJECTIVES: To determine whether cognitive impairment affects access to, or quality of, rehabilitation services, and to examine the effects of functional outcomes in stroke patients. DESIGN: Secondary analysis of prospective cohort of stroke patients followed for 6 months after stroke. SETTINGS: Eleven large-volume US Department of Veterans Affairs hospitals nationwide. PARTICIPANTS: Stroke patients (N=272) who were candidates for rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score. Functional outcomes were performance of activities of daily living (ADLs), measured by the FonFIM, and instrumental activities of daily living (IADLs), measured by Lawton, at 6-month follow-up. RESULTS: Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients. Although most cognition-related treatment elements were similar for both groups, cognitive goals were more frequently charted in impaired patients. Controlling for baseline function and rehabilitation process, cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients; cognition did not significantly influence ADL performance. CONCLUSIONS: Quality of, and access to, rehabilitative care was equivalent for patients with and without cognitive impairment. Despite a similar rehabilitation process, cognitively impaired stroke patients experienced worse recovery of IADLs.

Authors
Zinn, S; Dudley, TK; Bosworth, HB; Hoenig, HM; Duncan, PW; Horner, RD
MLA Citation
Zinn, S, Dudley, TK, Bosworth, HB, Hoenig, HM, Duncan, PW, and Horner, RD. "The effect of poststroke cognitive impairment on rehabilitation process and functional outcome." Arch Phys Med Rehabil 85.7 (July 2004): 1084-1090.
PMID
15241754
Source
pubmed
Published In
Archives of Physical Medicine and Rehabilitation
Volume
85
Issue
7
Publish Date
2004
Start Page
1084
End Page
1090

Racial differences in analgesic/anti-inflammatory medication use and perceptions of efficacy.

BACKGROUND AND OBJECTIVE: Pharmacotherapy is a key component to osteoarthritis (OA) treatment. Research has shown important racial differences in pain thresholds and perceptions, but little is known about racial variations in responses to pain medications. The purpose of this study was to compare perceptions of efficacy of pain medications among African-American and Caucasian veterans with OA. METHODS: Participants (N = 202; 70% Caucasian, 30% African-American) were under care for OA within the VA healthcare system. Participants rated the helpfulness of current analgesic/anti-inflammatory medications (scale of 1--not at all helpful to 10--very helpful). RESULTS: The mean rating of medication helpfulness was 6.1. African-American participants reported significantly greater ratings of medication helpfulness than Caucasians (6.6 vs. 5.9), controlling for demographics, disease severity, total number of analgesic/anti-inflammatory medications being taken, and the class of the medication. CONCLUSION: African Americans had somewhat more favorable perceptions of medication helpfulness than Caucasians. However, overall ratings of medication helpfulness were relatively low. Further research is needed to examine whether modifiable factors (such as low dosing or patient nonadherence to prescription instructions) contribute to perceptions of poor efficacy.

Authors
Dominick, KL; Bosworth, HB; Hsieh, JB; Moser, BK
MLA Citation
Dominick, KL, Bosworth, HB, Hsieh, JB, and Moser, BK. "Racial differences in analgesic/anti-inflammatory medication use and perceptions of efficacy." J Natl Med Assoc 96.7 (July 2004): 928-932.
PMID
15253323
Source
pubmed
Published In
Journal of the National Medical Association
Volume
96
Issue
7
Publish Date
2004
Start Page
928
End Page
932

Nonsteroidal antiinflammatory drug use among patients with GI bleeding.

BACKGROUND: Previous studies have suggested that recommended gastroprotective strategies such as gastroprotective agents (GPAs) and cyclooxygenase (COX) 2 inhibitors may be underutilized among individuals at risk for nonsteroidal antiinflammatory drug (NSAID)-related gastrointestinal (GI) bleeding. OBJECTIVE: To examine the use of traditional NSAIDs, COX-2 inhibitors, and GPAs among patients recently hospitalized for GI bleeding. METHODS: This was a retrospective cohort study of a national sample of 4338 veterans hospitalized for GI bleeding between January and June 1999. Prescription drug use was examined for 6 months following hospitalization. We examined relationships of subject characteristics (age, race, gender, geographic region, diagnosis of arthritis) to prescription of a high-risk NSAID, defined as a traditional NSAID but no GPA within 60 days before or after the NSAID. RESULTS: Approximately 20% of subjects were prescribed an NSAID or COX-2 inhibitor, but only 5% were prescribed a traditional NSAID with no GPA. In a multivariable analysis, subjects <65 years of age and those with arthritis were more likely to be prescribed a traditional NSAID without a GPA. No other subject characteristics were related to receipt of a high-risk prescription. CONCLUSIONS: In a national sample of veterans with a recent hospitalization for GI bleeding, high-risk NSAID prescriptions were uncommon. Underuse of gastroprotective strategies may be more common in patients with less recent GI bleeding-related hospitalization. Strategies to remind physicians and pharmacists to screen for GI risk factors may help to sustain appropriate prescribing and reduce NSAID-related adverse events.

Authors
Dominick, KL; Bosworth, HB; Jeffreys, AS; Grambow, SC; Oddone, EZ; Horner, RD
MLA Citation
Dominick, KL, Bosworth, HB, Jeffreys, AS, Grambow, SC, Oddone, EZ, and Horner, RD. "Nonsteroidal antiinflammatory drug use among patients with GI bleeding." Ann Pharmacother 38.7-8 (July 2004): 1159-1164.
PMID
15187205
Source
pubmed
Published In
The Annals of pharmacotherapy
Volume
38
Issue
7-8
Publish Date
2004
Start Page
1159
End Page
1164
DOI
10.1345/aph.1E052

Use of psychiatric and medical health care by veterans with severe mental illness.

Risk behaviors and health care use among 396 initially hospitalized veterans with severe mental illnesses were examined. Health care use was abstracted from Veterans Affairs databases (March 1998 to June 2000) for one year after hospital discharge. Lifetime intravenous drug use was related to increased use of outpatient services, and current alcohol use was related to decreased health care use. Patients with posttraumatic stress disorder had greater use of medical outpatient services than patients with schizophrenia-spectrum disorders, although they had longer hospital stays. These results highlight that veterans with severe mental illness receive more treatment in medical than psychiatric health clinics.

Authors
Bosworth, HB; Calhoun, PS; Stechuchak, KM; Butterfield, MI
MLA Citation
Bosworth, HB, Calhoun, PS, Stechuchak, KM, and Butterfield, MI. "Use of psychiatric and medical health care by veterans with severe mental illness." Psychiatr Serv 55.6 (June 2004): 708-710.
PMID
15175472
Source
pubmed
Published In
Psychiatric Services
Volume
55
Issue
6
Publish Date
2004
Start Page
708
End Page
710
DOI
10.1176/appi.ps.55.6.708

Barriers to clinician hypertension guideline adherence identified from clinician comments entered into an automated decision support system

Authors
Chan, AS; Martins, SB; Coleman, RW; Shiplak, MG; Bosworth, HB; Oddone, E; Hoffman, BB; Goldstein, MK
MLA Citation
Chan, AS, Martins, SB, Coleman, RW, Shiplak, MG, Bosworth, HB, Oddone, E, Hoffman, BB, and Goldstein, MK. "Barriers to clinician hypertension guideline adherence identified from clinician comments entered into an automated decision support system." May 25, 2004.
Source
wos-lite
Published In
Circulation
Volume
109
Issue
20
Publish Date
2004
Start Page
E283
End Page
E283

Clinician experience with the athena DSS hypertension management system: Facilitators and barriers to guideline compliance

Authors
Chan, AS; Steinman, MA; Fischer, MA; Shlipak, MG; Bosworth, HB; Oddone, E; Martins, SB; Coleman, RW; Hoffman, BB; Goldstein, MK
MLA Citation
Chan, AS, Steinman, MA, Fischer, MA, Shlipak, MG, Bosworth, HB, Oddone, E, Martins, SB, Coleman, RW, Hoffman, BB, and Goldstein, MK. "Clinician experience with the athena DSS hypertension management system: Facilitators and barriers to guideline compliance." May 25, 2004.
Source
wos-lite
Published In
Circulation
Volume
109
Issue
20
Publish Date
2004
Start Page
E292
End Page
E292

Recruitment of frail veterans into exercise clinical trial: Escalating strategies and effect of health status

Authors
Pearson, MP; Ekelund, CC; Sloane, R; Peterson, MJ; Crowley, GM; Pieper, CF; McConnell, E; Bosworth, HB; Morey, MC
MLA Citation
Pearson, MP, Ekelund, CC, Sloane, R, Peterson, MJ, Crowley, GM, Pieper, CF, McConnell, E, Bosworth, HB, and Morey, MC. "Recruitment of frail veterans into exercise clinical trial: Escalating strategies and effect of health status." May 2004.
Source
wos-lite
Published In
Medicine and Science in Sports and Exercise
Volume
36
Issue
5
Publish Date
2004
Start Page
S29
End Page
S29

Physiological arousal among women veterans with and without posttraumatic stress disorder.

The purpose of this study was to assess baseline physiological arousal in women veterans with posttraumatic stress disorder (PTSD) in a nonresearch setting. Heart rate, blood pressure, sublingual temperature, and weight were obtained from a retrospective chart review of the medical records of 92 women veterans with and without a diagnosis of PTSD who were seen in an outpatient Veterans Affairs medical center. Women veterans with PTSD had statistically significantly higher mean baseline heart rates compared with women veterans without PTSD. The two groups did not differ statistically in blood pressure measures, sublingual temperature, or body mass index. Based on our analyses, this difference is not likely to be an artifact of age, race, body mass index, smoking status, or medication. The mean resting heart rate of women with PTSD was 83.9 beats per minute; it was 77.5 beats per minute in those without PTSD. This elevation in heart rate among women veterans with PTSD suggests an increase in baseline physiological arousal compared with women veterans without PTSD. Faster resting heart rate has been shown to be associated with a higher risk of developing hypertension and a greater incidence of cardiovascular morbidity and mortality in non-PTSD samples. Further research is needed to determine the physiological effects of PTSD in women.

Authors
Forneris, CA; Butterfield, MI; Bosworth, HB
MLA Citation
Forneris, CA, Butterfield, MI, and Bosworth, HB. "Physiological arousal among women veterans with and without posttraumatic stress disorder." Mil Med 169.4 (April 2004): 307-312.
PMID
15132235
Source
pubmed
Published In
Military medicine
Volume
169
Issue
4
Publish Date
2004
Start Page
307
End Page
312

How well do clinic-based blood pressure measurements agree with rigorous standards?

Authors
Kim, J; Bosworth, HB; Voils, C; Olsen, MK; Dudley, TK; Gribbin, M; Oddone, EZ
MLA Citation
Kim, J, Bosworth, HB, Voils, C, Olsen, MK, Dudley, TK, Gribbin, M, and Oddone, EZ. "How well do clinic-based blood pressure measurements agree with rigorous standards?." April 2004.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
19
Publish Date
2004
Start Page
161
End Page
161

Will physicians accept a decision support system for hypertention management (ATHENA DSS)?

Authors
Chan, AS; Steinman, M; Fischer, MA; Shlipak, M; Bosworth, HB; Oddone, EZ; Hoffman, BB; Goldstein, MK
MLA Citation
Chan, AS, Steinman, M, Fischer, MA, Shlipak, M, Bosworth, HB, Oddone, EZ, Hoffman, BB, and Goldstein, MK. "Will physicians accept a decision support system for hypertention management (ATHENA DSS)?." April 2004.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
19
Publish Date
2004
Start Page
240
End Page
240

Visit-specific Hypertension Quality of Care Scale.

Authors
Henderson, W; Bosworth, HB; Voils, C; Dudley, TK; McCant, F; Gentry, P; Oddone, EZ
MLA Citation
Henderson, W, Bosworth, HB, Voils, C, Dudley, TK, McCant, F, Gentry, P, and Oddone, EZ. "Visit-specific Hypertension Quality of Care Scale." April 2004.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
19
Publish Date
2004
Start Page
236
End Page
236

Innovation in practice: Athena DSS hypertension management system.

Authors
Goldstein, MK; Chan, AS; Martins, SB; Coleman, R; Shlipak, M; Bosworth, HB; Oddone, EZ; Musen, MA; Hoffman, BB
MLA Citation
Goldstein, MK, Chan, AS, Martins, SB, Coleman, R, Shlipak, M, Bosworth, HB, Oddone, EZ, Musen, MA, and Hoffman, BB. "Innovation in practice: Athena DSS hypertension management system." April 2004.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
19
Publish Date
2004
Start Page
107
End Page
107

Measuring quality of life at the end of life: validation of the QUAL-E.

OBJECTIVES: To validate the QUAL-E, a new measure of quality of life at the end of life. METHODS: We conducted a cross-sectional study to assess the instrument's psychometric properties, including the QUAL-E's associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time. The study was conducted at the VA and Duke University Medical Centers, Durham, North Carolina, in 248 patients with stage IV cancer, congestive heart failure with ejection fraction < or = 20%, chronic obstructive pulmonary disease with FEV1 < or = 1.0 1, or dialysis-dependent end stage renal disease. The main outcome measures included QUAL-E and five comparison measures: FACIT quality of life measure, Missoula-VITAS Quality of Life Index, FACIT-SP spirituality measures, Participatory Decision Making Scale (MOS), and Duke EPESE social support scales. RESULTS: QUAL-E analyses confirmed a four-domain structure (25 items): life completion (alpha = 0.80), symptoms impact (alpha = 0.87), relationship with health care provider (alpha = 0.71), and preparation for end of life (alpha = 0.68). Convergent and discriminant validity were demonstrated with multiple comparison measures. Test-retest reliability assessment showed stable scores over a 1-week period. SIGNIFICANCE OF RESULTS: The QUAL-E, a brief measure of quality of life at the end of life, demonstrates acceptable validity and reliability, is easy to administer, performs consistently across diverse demographic and disease groups, and is acceptable to seriously ill patients. It is offered as a new instrument to assist in the evaluation of the quality and effectiveness of interventions targeting improved care at the end of life.

Authors
Steinhauser, KE; Clipp, EC; Bosworth, HB; McNeilly, M; Christakis, NA; Voils, CI; Tulsky, JA
MLA Citation
Steinhauser, KE, Clipp, EC, Bosworth, HB, McNeilly, M, Christakis, NA, Voils, CI, and Tulsky, JA. "Measuring quality of life at the end of life: validation of the QUAL-E." Palliat Support Care 2.1 (March 2004): 3-14.
PMID
16594230
Source
pubmed
Published In
Palliative & Supportive Care
Volume
2
Issue
1
Publish Date
2004
Start Page
3
End Page
14

Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness.

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (CI)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI--particularly African-American veterans--have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.

Authors
Butterfield, MI; Bosworth, HB; Stechuchak, KM; Frothingham, R; Bastian, LA; Meador, KG; Swartz, M; Horner, RD
MLA Citation
Butterfield, MI, Bosworth, HB, Stechuchak, KM, Frothingham, R, Bastian, LA, Meador, KG, Swartz, M, and Horner, RD. "Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness." J Natl Med Assoc 96.1 (January 2004): 43-52.
PMID
14746353
Source
pubmed
Published In
Journal of the National Medical Association
Volume
96
Issue
1
Publish Date
2004
Start Page
43
End Page
52

Congestive heart failure patients' perceptions of quality of life: the integration of physical and psychosocial factors.

Congestive heart failure (CHF) lowers survival and worsens the quality of life (QOL) of over four million older Americans. Both clinicians and standardized instruments used to assess the QOL of patients with CHF focus primarily on physical symptoms rather than capturing the full range of psychosocial concerns. The purpose of this study was to gather descriptions of the components of QOL as understood by patients living with CHF. Focus groups were conducted with patients with known CHF, New York Heart Association (NYHA) class I-IV, and left ventricular fraction of <40%. Focus groups were audiotaped, transcribed, and reviewed for common and recurrent themes using the methods of constant comparisons. We conducted three focus groups (n = 15) stratified by NYHA stage with male patients ranging in age from 47-82 years of age. Five patients were classified with NYHA stage III/IV and ten with NYHA stage I/II. Thirty attributes of QOL were identified which fell into five broad domains: symptoms, role loss, affective response, coping, and social support. Expectedly, patients reported the importance of physical symptoms; however, participants also identified concern for family, the uncertainty of prognosis, and cognitive function as dimensions of QOL. Changes in patients' lives attributed to CHF were not always considered deficiencies; rather, methods of coping with CHF were identified as important attributes representing possible opportunities for personal growth. Clinicians must understand the full range of concerns affecting the QOL of their older patients with CHF. The findings suggest that psychosocial aspects and patient uncertainty about their prognosis are important components of QOL among CHF patients.

Authors
Bosworth, HB; Steinhauser, KE; Orr, M; Lindquist, JH; Grambow, SC; Oddone, EZ
MLA Citation
Bosworth, HB, Steinhauser, KE, Orr, M, Lindquist, JH, Grambow, SC, and Oddone, EZ. "Congestive heart failure patients' perceptions of quality of life: the integration of physical and psychosocial factors." Aging Ment Health 8.1 (January 2004): 83-91.
PMID
14690872
Source
pubmed
Published In
Aging & Mental Health
Volume
8
Issue
1
Publish Date
2004
Start Page
83
End Page
91
DOI
10.1080/13607860310001613374

Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension.

Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intention of the guideline and different ways providers attempt to satisfy the guideline. During our work with a guideline-based decision support system for hypertension, ATHENA DSS, we document a number of subtle deviations from the strict hypertension guideline recommendations that ultimately demonstrate provider adherence. We believe that understanding these complexities is crucial to any valid evaluation of provider adherence. We also describe the development of an advisory evaluation engine that automates the interpretation of clinician adherence with the DSS on multiple levels, facilitating the high volume of complex data analysis that is created in a clinical trial of a guideline-based DSS.

Authors
Chan, AS; Coleman, RW; Martins, SB; Advani, A; Musen, MA; Bosworth, HB; Oddone, EZ; Shlipak, MG; Hoffman, BB; Goldstein, MK
MLA Citation
Chan, AS, Coleman, RW, Martins, SB, Advani, A, Musen, MA, Bosworth, HB, Oddone, EZ, Shlipak, MG, Hoffman, BB, and Goldstein, MK. "Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension." Medinfo 11.Pt 1 (2004): 125-129.
Source
scival
Published In
Medinfo
Volume
11
Issue
Pt 1
Publish Date
2004
Start Page
125
End Page
129

Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension.

Measurement of provider adherence to a guideline-based decision support system (DSS) presents a number of important challenges. Establishing a causal relationship between the DSS and change in concordance requires consideration of both the primary intention of the guideline and different ways providers attempt to satisfy the guideline. During our work with a guideline-based decision support system for hypertension, ATHENA DSS, we document a number of subtle deviations from the strict hypertension guideline recommendations that ultimately demonstrate provider adherence. We believe that understanding these complexities is crucial to any valid evaluation of provider adherence. We also describe the development of an advisory evaluation engine that automates the interpretation of clinician adherence with the DSS on multiple levels, facilitating the high volume of complex data analysis that is created in a clinical trial of a guideline-based DSS.

Authors
Chan, AS; Coleman, RW; Martins, SB; Advani, A; Musen, MA; Bosworth, HB; Oddone, EZ; Shlipak, MG; Hoffman, BB; Goldstein, MK
MLA Citation
Chan, AS, Coleman, RW, Martins, SB, Advani, A, Musen, MA, Bosworth, HB, Oddone, EZ, Shlipak, MG, Hoffman, BB, and Goldstein, MK. "Evaluating provider adherence in a trial of a guideline-based decision support system for hypertension." Stud Health Technol Inform 107.Pt 1 (2004): 125-129.
PMID
15360788
Source
pubmed
Published In
Studies in health technology and informatics
Volume
107
Issue
Pt 1
Publish Date
2004
Start Page
125
End Page
129

Patterns of opioid analgesic prescription among patients with osteoarthritis.

This study describes patterns of opioid analgesic prescription during a one-year period among a sample of patients with osteoarthritis (OA). The study sample included 3,061 patients with prior ICD-9 codes indicating a diagnosis of OA who were treated at a federal Veterans Affairs Medical Center. Specific opioid variables included: any opioid prescription, number of specific opioid drugs prescribed, total number of opioid prescriptions, total number of days supply of opioids, and daily opioid doses. We also examined relationships of demographic characteristics to opioid variables. Results revealed that 41% of patients received at least one opioid prescription. Opioids were prescribed significantly less frequently among African-Americans than Caucasians and the number of opioid prescriptions declined with increasing age. The mean annual supply of opioids was 104 days. Days' supply of opioids was also lower for African Americans and older patients. Daily opioid doses were, on average, below recommended daily doses for the treatment of OA. Findings of this study suggest that opioids are frequently prescribed to individuals with OA and that these drugs may be gaining acceptability for the treatment of chronic musculoskeletal pain. Additional research is needed to examine reasons for racial differences in opioid prescribing, as well as the prescription of these medications at fairly low doses.

Authors
Dominick, KL; Bosworth, HB; Dudley, TK; Waters, SJ; Campbell, LC; Keefe, FJ
MLA Citation
Dominick, KL, Bosworth, HB, Dudley, TK, Waters, SJ, Campbell, LC, and Keefe, FJ. "Patterns of opioid analgesic prescription among patients with osteoarthritis." J Pain Palliat Care Pharmacother 18.1 (2004): 31-46.
PMID
15148007
Source
pubmed
Published In
Journal of Pain & Palliative Care Pharmacotherapy (Haworth)
Volume
18
Issue
1
Publish Date
2004
Start Page
31
End Page
46

The relationship between perceived barriers to healthcare and self-rated health

The main purpose of the current investigation is to examine the extent to which health care barriers are uniquely associated with individual differences in self-rated health. Self-rated health can be easily assessed and is predictive of mortality, health care use and other health outcomes. In this sample of 586 community residents, the six healthcare barriers examined uniquely accounted for 12% of the variance in self-rated health and demographic variables uniquely accounted for an additional 11% of the variance in self-rated health. In conclusion, healthcare barriers were just as important as age, race, gender, and education when accounting for explained variance in self-rated health. Future studies should consider intervening on health care barriers to improve self appraisals of health and subsequently improve health outcomes.

Authors
Hong, TB; Oddone, EZ; Weinfurt, KP; Friedman, JY; Schulman, KA; Bosworth, HB
MLA Citation
Hong, TB, Oddone, EZ, Weinfurt, KP, Friedman, JY, Schulman, KA, and Bosworth, HB. "The relationship between perceived barriers to healthcare and self-rated health." Psychology, Health and Medicine 9.4 (2004): 476-482.
Source
scival
Published In
Psychology, Health and Medicine
Volume
9
Issue
4
Publish Date
2004
Start Page
476
End Page
482
DOI
10.1080/13548500412331298966

Telemedicine and hypertension

• Objective: To review telemedicine approaches for management of hypertension. • Methods: Review of studies that illustrate the use of telemedicine in hypertension and discussion of an ongoing clinical trial, the Take Control of Your Blood Pressure study, an example of a telemedicine intervention to improve blood pressure control. • Results: Hypertension places a significant burden on patients and health care systems; less than one third of patients on medication for hypertension have adequate blood pressure control. The adequate management of hypertension requires a potential complex interaction between patients, their social support, providers, and the health care system. Applications of medical informatics may facilitate the management of hypertension. • Conclusion: Although the number of controlled trials examining telecommunication-based interventions of hypertension remains small, there are examples where informatics applications may have a demonstrated clinical value.

Authors
Bosworth, HB; Oddone, EZ
MLA Citation
Bosworth, HB, and Oddone, EZ. "Telemedicine and hypertension." Journal of Clinical Outcomes Management 11.8 (2004): 517-522.
Source
scival
Published In
Journal of Clinical Outcomes Management
Volume
11
Issue
8
Publish Date
2004
Start Page
517
End Page
522

The association of psychosocial factors and depression with hypertension among older adults.

OBJECTIVE: To examine the relationship between depression and hypertension in an elderly population and how psychosocial variables influence this relationship. METHODS: The study included 293 subjects, who met DSM-IV criteria for unipolar depression, and 151 subjects with no psychiatric disorder. All subjects were over the age of 58. Participants were administered the Duke Depression Evaluation Schedule at baseline and at yearly intervals for 3 years. RESULTS: Cross-sectional analyses of baseline data showed that hypertensive patients were more likely to be depressed and of non-white race. Bivariate analyses provided evidence that hypertension was associated with higher amounts of total stressors and lower social support. No differences in the prevalence of hypertension were found between men and women. In addition, there was no evidence of change in hypertension status over time. CONCLUSION: Patients, especially minorities, who experience depression, stress, or a lack of social support, are at an increased likelihood of having hypertension and clinicians should consider this risk when treating this population.

Authors
Bosworth, HB; Bartash, RM; Olsen, MK; Steffens, DC
MLA Citation
Bosworth, HB, Bartash, RM, Olsen, MK, and Steffens, DC. "The association of psychosocial factors and depression with hypertension among older adults." Int J Geriatr Psychiatry 18.12 (December 2003): 1142-1148.
PMID
14677147
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
18
Issue
12
Publish Date
2003
Start Page
1142
End Page
1148
DOI
10.1002/gps.1026

The impact of religious practice and religious coping on geriatric depression.

OBJECTIVE: Both religiousness and social support have been shown to influence depression outcome, yet some researchers have theorized that religiousness largely reflects social support. We set out to determine the relationship of religiousness with depression outcome after considering clinical factors. METHODS: Elderly patients (n=114) in the MHCRC for the Study of Depression in Late Life while undergoing treatment using a standardized algorithm were examined. Patients completed measures of public and religious practice, a modified version of Pargament's RCOPE to measure religious coping, and subjective and instrument social support measures. A geriatric psychiatrist completed the Montgomery-Asberg Depression Rating Scale (MADRS) at baseline and six months. RESULTS: Both positive and negative religious coping were related to MADRS scores in treated individuals, and positive coping was related to MADRS six months later, independent of social support measures, demographic, and clinical measures (e.g. use of electro-convulsive therapy, number of depressed episodes). Public religious practice, but not private religious practice was independently related to MADRS scores at the time of completion of the religiousness measures. Religious coping was related to social support, but was independently related to depression outcome. CONCLUSIONS: Clinicians caring for older depressives should consider inquiring about spirituality and religious coping as a way of improving depressive outcomes.

Authors
Bosworth, HB; Park, K-S; McQuoid, DR; Hays, JC; Steffens, DC
MLA Citation
Bosworth, HB, Park, K-S, McQuoid, DR, Hays, JC, and Steffens, DC. "The impact of religious practice and religious coping on geriatric depression." Int J Geriatr Psychiatry 18.10 (October 2003): 905-914.
PMID
14533123
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
18
Issue
10
Publish Date
2003
Start Page
905
End Page
914
DOI
10.1002/gps.945

Racial differences in health care utilization among patients with osteoarthritis.

OBJECTIVE: Research has identified racial variations in certain aspects of osteoarthritis (OA) related medical care. We compared health services utilization between African American and white veteran outpatients with OA. METHODS: Subjects were 1612 white and 861 African American patients receiving medical care for OA at the Durham VAMC, Durham, NC, USA. Two major components of OA related medical care were examined during a one-year period: physician visits and use of analgesic and antiinflammatory medications. RESULTS: There were no racial differences in overall frequency of OA related physician visits or visits to rheumatologists. About 86% of both African American and white patients were prescribed some analgesic or antiinflammatory medication. There were, however, racial differences in the use of specific drug classes. African Americans were more likely to be prescribed nonselective nonsteroidal antiinflammatory drugs (69% vs 60%), but less likely to be prescribed COX-2 inhibitors (4% vs 7%) and narcotic analgesics (33% vs 40%) than whites (all p < 0.05). African Americans also had a shorter annual mean days' supply for several common medications, including acetaminophen, acetaminophen combined with codeine, and acetaminophen combined with oxycodone (all p < 0.05). CONCLUSION: African Americans and white veterans with OA did not differ substantially in their use of physician services. However, within this equal access health care system that requires minimal co-payments for medications, there were racial differences in prescription medication use. These differences may have implications for both quality of pain relief and risk of side effects.

Authors
Dominick, KL; Dudley, TK; Grambow, SC; Oddone, EZ; Bosworth, HB
MLA Citation
Dominick, KL, Dudley, TK, Grambow, SC, Oddone, EZ, and Bosworth, HB. "Racial differences in health care utilization among patients with osteoarthritis." J Rheumatol 30.10 (October 2003): 2201-2206.
PMID
14528518
Source
pubmed
Published In
The Journal of rheumatology
Volume
30
Issue
10
Publish Date
2003
Start Page
2201
End Page
2206

The Veterans Affairs Learners' Perceptions Survey: the foundation for educational quality improvement.

PURPOSE: The U.S. Department of Veterans Affairs (VA) supports 8,700 resident positions nationally to enhance quality of care for veterans and to educate physicians. This study sought to establish a yearly quality indicator to identify and follow strengths and opportunities for improvement in VA clinical training programs. METHOD: In March 2001, the VA Learners' Perceptions Survey, a validated 57-item questionnaire, was mailed to 3,338 residents registered at 130 VA facilities. They were asked to rate their overall satisfaction with the VA clinical training experience and their satisfaction in four domains: faculty/preceptor, learning, working, and physical environments using a five-point Likert scale. Questionnaires were received from 1,775 residents (53.2%). A full analysis was conducted using 1,436 of these questionnaires, whose respondents were categorized in four training programs: medicine (n = 706), surgery (n = 291), subspecialty (n = 266), and psychiatry (n = 173). RESULTS: On a scale of 0 to 100, residents gave their clinical training experience an average score of 79. Eighty-four percent would have recommended VA training to peers, and 81% would have chosen VA training again. Overall, 87% were satisfied with their faculty/preceptors, 78% with the learning environment, and 67% with the working and physical environments. The survey was sensitive to differences in satisfaction among the trainee groups, with residents in internal medicine (IM) the least satisfied. CONCLUSION: The VA Learners' Perceptions Survey is the first validated survey to address comprehensive satisfaction issues in clinical training. The survey highlights strengths and opportunities for improvement in VA clinical training and is the first step toward improving education.

Authors
Keitz, SA; Holland, GJ; Melander, EH; Bosworth, HB; Pincus, SH; VA Learners' Perceptions Working Group,
MLA Citation
Keitz, SA, Holland, GJ, Melander, EH, Bosworth, HB, Pincus, SH, and VA Learners' Perceptions Working Group, . "The Veterans Affairs Learners' Perceptions Survey: the foundation for educational quality improvement." Acad Med 78.9 (September 2003): 910-917.
PMID
14507624
Source
pubmed
Published In
Academic Medicine
Volume
78
Issue
9
Publish Date
2003
Start Page
910
End Page
917

Perceptions of analgesic and anti-inflammatory medication helpfulness among patients with osteoarthritis

Authors
Dominick, KL; Bosworth, HB; Hsieh, JB; Moser, BK
MLA Citation
Dominick, KL, Bosworth, HB, Hsieh, JB, and Moser, BK. "Perceptions of analgesic and anti-inflammatory medication helpfulness among patients with osteoarthritis." September 2003.
Source
wos-lite
Published In
Arthritis and Rheumatism
Volume
48
Issue
9
Publish Date
2003
Start Page
S423
End Page
S423

Performance of recently detoxified patients with alcoholism on a neuropsychological screening test.

OBJECTIVE: Early in recovery from alcoholism, cognitive deficits may compromise patients' utilization of rehabilitative information. Cognitive impairment in a sample of newly detoxified inpatients with alcoholism was examined using the Neurobehavioral Cognitive Status Examination (NCSE). METHODS: Consecutively admitted psychiatric inpatients (N=233) with an alcohol-related primary diagnosis (63% male, mean age 46.3) were administered the NCSE following medical stabilization. Within-samples differences between age and diagnostic groups were examined and scores were compared to normative samples. RESULTS: Inpatients older than 50 demonstrated significant cognitive deficits for all scales except Attention. In comparison with normative samples, patients with alcoholism produced lower scores, with the most pronounced deficits among middle-aged patients. In alcohol-abusing patients with medical comorbidities, language deficits and more severe memory deficits were observed. Abuse severity or comorbid psychiatric disorder produced no differences in NCSE scores. CONCLUSIONS: Neuropsychological screening following detoxification in patients diagnosed with an alcohol disorder reflected the effects of increased age and medical comorbidity. Our finding of frequent deficits in abstraction, comprehension, and memory suggests that cognitive-behavioral treatments for inpatients may be less effective if cognitive impairment is not considered.

Authors
Zinn, S; Bosworth, HB; Edwards, CL; Logue, PE; Swartzwelder, HS
MLA Citation
Zinn, S, Bosworth, HB, Edwards, CL, Logue, PE, and Swartzwelder, HS. "Performance of recently detoxified patients with alcoholism on a neuropsychological screening test." Addict Behav 28.5 (July 2003): 837-849.
PMID
12788260
Source
pubmed
Published In
Addictive Behaviors
Volume
28
Issue
5
Publish Date
2003
Start Page
837
End Page
849

Regular sources of medical care among persons with severe mental illness at risk of hepatitis C infection.

OBJECTIVE: An estimated 19.6 percent of persons with severe mental illness are infected with the hepatitis C virus. Given the pressing need to identify and treat persons with severe mental illness who are at risk of hepatitis C infection and transmission, the authors sought to estimate the proportion of hepatitis C-positive and -negative persons with severe mental illness who have a regular source of medical care. METHOD: S: Data for this study were obtained from 777 adults with severe mental illness at four diverse geographic sites at which respondents with severe mental illness participated in a structured interview and laboratory testing for HIV infection, AIDS, hepatitis B infection, and hepatitis C infection. RESULTS: In bivariate analyses, 54.2 percent of hepatitis C-positive and 62.5 percent of hepatitis C-negative study participants with severe mental illness had a regular source of medical care. In multivariate analyses in which potential confounders were statistically controlled for, hepatitis C-positive persons with severe mental illness were less than half as likely as hepatitis C-negative persons to have a regular source of care. Being older, married, insured, or employed or having self-reported health problems increased the likelihood of receiving care. Being black or male or living in a community with high exposure to community violence lowered those odds. CONCLUSION: There is an urgent need to improve access to medical care for persons with severe mental illness, especially those who may be at high risk of or are already infected with the hepatitis C virus.

Authors
Swartz, MS; Swanson, JW; Hannon, MJ; Bosworth, HS; Osher, FC; Essock, SM; Rosenberg, SD; Five-Site Health and Risk Study Research Committee,
MLA Citation
Swartz, MS, Swanson, JW, Hannon, MJ, Bosworth, HS, Osher, FC, Essock, SM, Rosenberg, SD, and Five-Site Health and Risk Study Research Committee, . "Regular sources of medical care among persons with severe mental illness at risk of hepatitis C infection." Psychiatr Serv 54.6 (June 2003): 854-859.
PMID
12773600
Source
pubmed
Published In
Psychiatric Services
Volume
54
Issue
6
Publish Date
2003
Start Page
854
End Page
859
DOI
10.1176/appi.ps.54.6.854

Gender differences in hepatitis C infection and risks among persons with severe mental illness.

OBJECTIVES: The authors assessed gender differences in hepatitis C infection and associated risk behaviors among persons with severe mental illness. METHOD: S: The sample consisted of 777 patients (251 women and 526 men) from four sites. RESULTS: Across sites, the rate of hepatitis C infection among men was nearly twice that among women. Clear differences were noted in hepatitis C risk behaviors. Men had higher rates of lifetime drug-related risk behaviors: needle use (23.1 percent compared with 12.5 percent), needle sharing (17.6 percent compared with 7.7 percent), and crack cocaine use (45.2 percent compared with 30.8 percent). Women had significantly higher rates of lifetime sexual risk behaviors: unprotected sex in exchange for drugs (17.8 percent compared with 11.2 percent), unprotected sex in exchange for money or gifts (30.6 percent compared with 17 percent), unprotected vaginal sex (94 percent compared with 89.7 percent), and anal sex (33.7 percent compared with 22.6 percent). Gender appeared to modify some sex risks. Unprotected sex in exchange for drugs increased the risk of hepatitis C seropositivity for both men and women. In the multivariate model, gender was not significantly associated with hepatitis C seropositivity after adjustment for other risk factors. CONCLUSION: S: Gender differences in the lifetime rates of drug risks explain the higher rates of hepatitis C infection among men with severe mental illness.

Authors
Butterfield, MI; Bosworth, HB; Meador, KG; Stechuchak, KM; Essock, SM; Osher, FC; Goodman, LA; Swanson, JW; Bastian, LA; Horner, RD; Five-Site Health and Risk Study Research Committee,
MLA Citation
Butterfield, MI, Bosworth, HB, Meador, KG, Stechuchak, KM, Essock, SM, Osher, FC, Goodman, LA, Swanson, JW, Bastian, LA, Horner, RD, and Five-Site Health and Risk Study Research Committee, . "Gender differences in hepatitis C infection and risks among persons with severe mental illness." Psychiatr Serv 54.6 (June 2003): 848-853.
PMID
12773599
Source
pubmed
Published In
Psychiatric Services
Volume
54
Issue
6
Publish Date
2003
Start Page
848
End Page
853
DOI
10.1176/appi.ps.54.6.848

Are clinicians aware of their adherence to hypertension guidelines?

Authors
Steinman, MA; Fischer, MA; Shlipak, M; Bosworth, HB; Oddone, E; Goldstein, MK
MLA Citation
Steinman, MA, Fischer, MA, Shlipak, M, Bosworth, HB, Oddone, E, and Goldstein, MK. "Are clinicians aware of their adherence to hypertension guidelines?." April 2003.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
18
Publish Date
2003
Start Page
297
End Page
297

Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients.

BACKGROUND AND PURPOSE: The greater mortality and residual physical impairments among black stroke patients may be attributable to differential utilization of rehabilitation services. This report examines, within an equal-access healthcare system, racial differences in time to initiation of stroke rehabilitation services and in the trajectory of physical function recovery. METHODS: This study was a secondary analysis of data from an inception cohort of 1073 stroke patients hospitalized between April 1995 and March 1997 and followed up for up to 1 year. Inpatient data came from medical record reviews; follow-up data came from telephone interviews at 1, 6, and 12 months after stroke. The study included consecutive acute ischemic or intracerebral hemorrhagic stroke patients from 9 VA medical centers. The main outcome measures were time to initiation of inpatient rehabilitation services and ability to perform activities of daily living. RESULTS: There were no racial differences in receipt of inpatient rehabilitation services (blacks, 76%; whites, 70%) or in the proportion of patients referred within 3 days of admission (blacks, 43.5%; whites, 42.0%). Among patients who experienced delay in initiation of rehabilitation, only low-income blacks experienced worse functional recovery over 12 months. CONCLUSIONS: Low-income black stroke patients who experience delay in initiation of inpatient rehabilitation have a worse trajectory of functional recovery in the first year after stroke. Poverty-associated factors in the postdischarge setting may explain this phenomenon.

Authors
Horner, RD; Swanson, JW; Bosworth, HB; Matchar, DB; VA Acute Stroke (VAST) Study Team,
MLA Citation
Horner, RD, Swanson, JW, Bosworth, HB, Matchar, DB, and VA Acute Stroke (VAST) Study Team, . "Effects of race and poverty on the process and outcome of inpatient rehabilitation services among stroke patients." Stroke 34.4 (April 2003): 1027-1031.
PMID
12624220
Source
pubmed
Published In
Stroke
Volume
34
Issue
4
Publish Date
2003
Start Page
1027
End Page
1031
DOI
10.1161/01.STR.0000060028.60365.5D

Barriers to use of clinical practice guidelines: Pre-implementation data from the athena project.

Authors
Fischer, MA; Steinman, MA; Bosworth, HB; Oddone, EZ; Shlipak, M; Goldstein, MK
MLA Citation
Fischer, MA, Steinman, MA, Bosworth, HB, Oddone, EZ, Shlipak, M, and Goldstein, MK. "Barriers to use of clinical practice guidelines: Pre-implementation data from the athena project." April 2003.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
18
Publish Date
2003
Start Page
282
End Page
282

A three-factor analytic model of the MADRS in geriatric depression.

OBJECTIVE: Major depression is a heterogeneous disorder, perhaps comprising several clinical subtypes or subgroups of symptoms. This study examined whether items on the Montgomery-Asberg Depression Rating Scale (MADRS) form distinct symptom subgroups among geriatric depressive patients that might form the basis of new outcome measures for tracking treatment effects. METHOD: The study examined a sample of 225 adults age 59 and older diagnosed with major depression. Factor analysis with oblique rotation was used to analyze baseline MADRS item scores. RESULTS: Three distinct interpretable factors were obtained; all ten items loaded <0.60 on a domain. The first factor, dysphoric apathy/retardation, comprised five items: apparent sadness, reported sadness, lassitude, reduced concentration, and inability to feel. Psychic anxiety, the second factor, included three items: inner tension, pessimistic thoughts, and suicidal thoughts. The third factor, vegetative symptoms, resulted from items involving sleep and appetite. CONCLUSIONS: The study produced three interpretable MADRS factors reflecting geriatric depression dimensions that may be useable to monitor focused treatment outcomes.

Authors
Parker, RD; Flint, EP; Bosworth, HB; Pieper, CF; Steffens, DC
MLA Citation
Parker, RD, Flint, EP, Bosworth, HB, Pieper, CF, and Steffens, DC. "A three-factor analytic model of the MADRS in geriatric depression." Int J Geriatr Psychiatry 18.1 (January 2003): 73-77.
PMID
12497559
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
18
Issue
1
Publish Date
2003
Start Page
73
End Page
77
DOI
10.1002/gps.776

Coping styles and personality domains related to menopausal stress.

PURPOSE: Examine the role of coping styles and personality domains in relationship to stress associated with menopause. DATA/INFORMATION: Data are from 170 women ages 45 to 54 who completed a mailed questionnaire and a telephone interview that assessed women's stress associated with menopause, coping style, personality, menopausal symptoms, depressive symptoms, and use of hormone replacement therapy. RESULTS: Rating menopause as stressful was associated with higher levels of neuroticism, seeking social support, and avoidance, and lower levels of agreeableness in unadjusted analyses. In a multivariate model, menopausal symptoms, seeking social support, and neuroticism accounted for 21% of the variance in rating menopause as stressful. CONCLUSIONS: Health care providers treating women going through menopause should be aware that the stress response to the menopause transition is multifactorial and is associated with women's individual personalities and coping styles.

Authors
Bosworth, HB; Bastian, LA; Rimer, BK; Siegler, IC
MLA Citation
Bosworth, HB, Bastian, LA, Rimer, BK, and Siegler, IC. "Coping styles and personality domains related to menopausal stress." Womens Health Issues 13.1 (January 2003): 32-38.
PMID
12598057
Source
pubmed
Published In
Women's Health Issues
Volume
13
Issue
1
Publish Date
2003
Start Page
32
End Page
38

Provider characteristics and mammography recommendation among women in their 40s and 50s.

OBJECTIVES: Healthcare provider recommendation for mammography is one of the strongest predictors of women's mammography use, but few studies have examined the association of provider characteristics with mammography recommendations. We examined the relationship of provider gender, age, medical specialty, and duration of relationship with the patient to report mammography recommendation. METHODS: Participants were women ages 40-45 and 50-55 who were part of a larger intervention study of decision making about mammography. We examined the relationship of provider characteristics to patient-reported mammography recommendations at baseline and at 24-month follow-up. RESULTS: At baseline, 74% of women in their 40s and 79% of women in their 50s reported provider mammography recommendations within the prior 2 years. Proportions were similar at the 24-month follow-up. In multivariate logistic regression models including both patient and provider characteristics, women in their 40s who had female providers were more likely to report mammography recommendations than those with male providers at baseline (OR=1.83, p=0.01) and follow-up (OR=1.74, p=0.03). Among women in their 50s, participants whose regular providers were primary care physicians were more likely to report recommendations at baseline than those whose regular providers were obstetrician/gynecologists (OR=1.68, p=0.03). CONCLUSIONS: About one fourth of women in this study reported not having been advised by a healthcare provider to have a mammogram. All women in the study had health insurance. Among women in their 40s, for whom mammography guidelines were controversial at the time of data collection, provider gender was an important predictor of patient-reported mammography recommendation.

Authors
Dominick, KL; Skinner, CS; Bastian, LA; Bosworth, HB; Strigo, TS; Rimer, BK
MLA Citation
Dominick, KL, Skinner, CS, Bastian, LA, Bosworth, HB, Strigo, TS, and Rimer, BK. "Provider characteristics and mammography recommendation among women in their 40s and 50s." J Womens Health (Larchmt) 12.1 (January 2003): 61-71.
PMID
12639370
Source
pubmed
Published In
Journal of Women's Health
Volume
12
Issue
1
Publish Date
2003
Start Page
61
End Page
71
DOI
10.1089/154099903321154158

Medical service utilization by veterans seeking help for posttraumatic stress disorder.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been associated with higher rates of health complaints and medical conditions diagnosed by physicians, yet research examining the relationship between PTSD and health care utilization has been limited. This study compared the health service use of veterans with PTSD to that of help-seeking veterans without PTSD. The relationship between severity of PTSD and service utilization was also examined. METHOD: Data were collected from 996 veterans seeking an evaluation at a Veterans Affairs (VA) Medical Center specialty PTSD clinic in the southeastern United States between March 1992 and September 1998. Data included sociodemographic characteristics, severity of PTSD, and disability status. The outcome variable, VA health service utilization, was prospectively assessed 1 year from the date of the initial PTSD assessment. RESULTS: Although the use of VA mental health services by patients with PTSD was substantial (a median of seven clinic stops), these patients used more services in general physical health clinics that provided predominantly nonmental health services (a median of 18 clinic stops). Negative binomial regression models revealed that younger veterans with PTSD had greater health care utilization than those without PTSD who also sought services. Greater severity of PTSD was related to higher rates of mental and physical health service use among veterans without a service-connected disability. CONCLUSIONS: PTSD is associated with substantial health service use. The results highlight the importance of increased collaboration between primary care and mental health specialists, given that patients with PTSD are more likely to receive treatment in nonmental health clinics.

Authors
Calhoun, PS; Bosworth, HB; Grambow, SC; Dudley, TK; Beckham, JC
MLA Citation
Calhoun, PS, Bosworth, HB, Grambow, SC, Dudley, TK, and Beckham, JC. "Medical service utilization by veterans seeking help for posttraumatic stress disorder." Am J Psychiatry 159.12 (December 2002): 2081-2086.
PMID
12450960
Source
pubmed
Published In
American Journal of Psychiatry
Volume
159
Issue
12
Publish Date
2002
Start Page
2081
End Page
2086
DOI
10.1176/appi.ajp.159.12.2081

Initial assessment of a new instrument to measure quality of life at the end of life.

PURPOSE: We conducted this study to pilot a new multidimensional instrument to assess the quality of life at the end of life. METHODS: Items were derived from focus groups and a national survey identifying attributes of the quality of dying. Fifty-four items measured on a five-point Likert scale covered six domains. We administered the instrument to equal numbers of Veteran's Administration (VA) and university medical center outpatients with advanced serious illness. We assessed psychometric properties using factor analysis. RESULTS: Two hundred patients completed the instrument (response rate, 85%). Diagnoses included cancer (64%), congenital heart failure (CHF) (19.5%), end-stage renal disease (ESRD) (10%) and chronic obstructive pulmonary disease (COPD) (6.5%). Seventy-four percent were male, 64% were caucasian, and 34% African American. Item reduction and factor analysis yielded a final instrument with 24 items in 5 distinct domains (overall Cronbach a = 0.83). The first factor (6 items; a = 0.84) measured a sense of completion, particularly through contributions to others. The second factor (7 items; alpha = 0.77) measured relations with the health care system. The third factor (6 items; alpha = 0.77) measured preparation. The fourth factor (4 items; alpha = 0.77) measured symptom severity, and the final factor (2 items; alpha = 0.60) measured affective social support. CONCLUSIONS: We have developed a new instrument to measure the quality of life at the end of life that assesses empirically derived domains that are of demonstrated importance to dying patients, is acceptable to a seriously ill population, and exhibits excellent psychometric properties. Some items related to completion and preparation represent particularly new contributions to quality-of-life measurement.

Authors
Steinhauser, KE; Bosworth, HB; Clipp, EC; McNeilly, M; Christakis, NA; Parker, J; Tulsky, JA
MLA Citation
Steinhauser, KE, Bosworth, HB, Clipp, EC, McNeilly, M, Christakis, NA, Parker, J, and Tulsky, JA. "Initial assessment of a new instrument to measure quality of life at the end of life." J Palliat Med 5.6 (December 2002): 829-841.
PMID
12685529
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
5
Issue
6
Publish Date
2002
Start Page
829
End Page
841
DOI
10.1089/10966210260499014

Relationship between obesity and health-related quality of life in men.

OBJECTIVE: Few studies examining the relationship between obesity and health-related quality of life (HRQOL) have used a medical outpatient population or demonstrated a relationship in men. Furthermore, most studies have not adequately considered comorbid illness. The goal of this study was to examine the relationship between body mass index (BMI) and HRQOL in male outpatients while considering comorbid illness. RESEARCH METHODS AND PROCEDURES: This cross-sectional study examined 1168 male outpatients from Durham Veterans' Affairs Medical Center. Multiple linear regression was used to examine the relationship of BMI with each subscale from the Medical Outcomes Study Short Form 36 while adjusting for age, race, comorbid illness, depression, and physical activity. RESULTS: Participants had a mean age of 54.7 +/- 5.6 years; 69% were white and 29% were African American. The distribution for BMI was as follows: 18.5 to <25 kg/m(2) (21%), 25 to <30 kg/m(2) (43%), 30 to <35 kg/m(2) (25%), 35 to <40 kg/m(2) (8%), and > or =40 kg/m(2) (3%). Mean Short Form 36 subscale scores were lower than U.S. norms by an average of 27%. Individuals with BMI > or =40 kg/m(2) had significantly lower scores compared with normal weight individuals on the Role-Physical and Vitality subscales. On the Physical Functioning and Physical Component subscales, lower scores were observed at BMI > or =35 kg/m(2). On the Bodily Pain subscale, lower scores were observed at BMI > or =25 kg/m(2). DISCUSSION: An inverse relationship between BMI and physical aspects of HRQOL exists in a population of male outpatients. Increased BMI was most prominently associated with bodily pain; this relationship should receive more attention in clinical care and research.

Authors
Yancy, WS; Olsen, MK; Westman, EC; Bosworth, HB; Edelman, D
MLA Citation
Yancy, WS, Olsen, MK, Westman, EC, Bosworth, HB, and Edelman, D. "Relationship between obesity and health-related quality of life in men." Obes Res 10.10 (October 2002): 1057-1064.
PMID
12376587
Source
pubmed
Published In
Obesity research
Volume
10
Issue
10
Publish Date
2002
Start Page
1057
End Page
1064
DOI
10.1038/oby.2002.143

Quality of life in patients with Barrett's esophagus undergoing surveillance.

OBJECTIVES: Practice guidelines recommend surveillance for Barrett's esophagus (BE) because of the risk of esophageal cancer. The quality of life of patients undergoing surveillance is unknown. The objectives of this study were to develop a new utility instrument to measure quality of life of patients undergoing BE surveillance and determine if Quality of Life in Reflux and Dyspepsia (QOLRD) scores correlate with utility ratings. METHODS: Fifteen patients were administered 16 scenarios describing possible BE surveillance outcomes. Each scenario was rated from 0 (equivalent to being dead) to 10 (equivalent to being in perfect health). Each patient also completed the QOLRD, a validated instrument. A t test was performed to compare the QOLRD means with published means. The Spearman's rank correlation coefficient was calculated for the median QOLRD score and the median utility rating. RESULTS: QOLRD means ranged from 5.80 to 6.65 (previously published means 4.3-5.4). Lower scores denoted a worsened quality of life. The difference was significant (p < 0.001). The correlation coefficient of median QOLRD score (6.8) and median utility rating (4.0) was 0.10 (p = 0.71). CONCLUSIONS: This population of BE patients had significantly higher QOLRD scores than a previously published population referred for endoscopy. Quality of life using the utility measure was reduced. The utility measure did not correlate with the disease-specific instrument, suggesting that the concerns of patients undergoing surveillance are distinct from their reflux symptoms.

Authors
Fisher, D; Jeffreys, A; Bosworth, H; Wang, J; Lipscomb, J; Provenzale, D
MLA Citation
Fisher, D, Jeffreys, A, Bosworth, H, Wang, J, Lipscomb, J, and Provenzale, D. "Quality of life in patients with Barrett's esophagus undergoing surveillance." Am J Gastroenterol 97.9 (September 2002): 2193-2200.
PMID
12358232
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
97
Issue
9
Publish Date
2002
Start Page
2193
End Page
2200
DOI
10.1111/j.1572-0241.2002.05972.x

Time-to-remission from geriatric depression: psychosocial and clinical factors.

OBJECTIVE: The authors examined psychosocial and clinical predictors of time-to-remission in a sample of initially clinically depressed elderly patients. METHODS: Using a standardized algorithm, a prospective cohort study enrolled 239 patients undergoing treatment. Patients were followed for up to 4.5 years, until death or withdrawal from the study. Baseline predictor variables included psychosocial factors, such as four domains of social support; basic and instrumental activities of daily living; and clinical factors, including use of electroconvulsive therapy (ECT), past history of depression, comorbidities, and antidepressant treatment. RESULTS: Only 33% of the sample (n=79) met our classification for depression remission. A lack of instrumental and subjective social support, poor self-rated health, the use of antipsychotic medication, or use of an antidepressant in the last 7 days were predictors of longer time-to-remission. Use of ECT in the last year was related to shorter time-to-remission. CONCLUSION: Baseline psychosocial factors were just as important, as predictors of depression remission, as were clinical and diagnostic variables. Interventions directed toward social support resources, in addition to clinical intervention, including the use of ECT where appropriate, are likely to improve rates of depression remission.

Authors
Bosworth, HB; McQuoid, DR; George, LK; Steffens, DC
MLA Citation
Bosworth, HB, McQuoid, DR, George, LK, and Steffens, DC. "Time-to-remission from geriatric depression: psychosocial and clinical factors." Am J Geriatr Psychiatry 10.5 (September 2002): 551-559.
PMID
12213689
Source
pubmed
Published In
American Journal of Geriatric Psychiatry
Volume
10
Issue
5
Publish Date
2002
Start Page
551
End Page
559

Are women worrying about heart disease?

Women at risk for coronary artery disease (CAD) may not be worried about the disease. In this study, demographic, CAD-risk, and CAD-worry data collected from Durham Veterans' Affairs Medical Center women veterans were examined using bivariate and multivariate analysis with worry as the outcome. Excluding CAD patients (N = 64) and incomplete data (N = 17) of 328 women, 42% worried about CAD. Younger age, single marital status, obesity, family history, and hyperlipidemia were associated with worry. Of women with up to three risk factors, fewer than half worried about CAD. Higher-risk women were unconcerned about CAD. This could undermine prevention efforts.

Authors
Biswas, MS; Calhoun, PS; Bosworth, HB; Bastian, LA
MLA Citation
Biswas, MS, Calhoun, PS, Bosworth, HB, and Bastian, LA. "Are women worrying about heart disease?." Womens Health Issues 12.4 (July 2002): 204-211.
PMID
12093584
Source
pubmed
Published In
Women's Health Issues
Volume
12
Issue
4
Publish Date
2002
Start Page
204
End Page
211

Terminal change in cognitive function: an updated review of longitudinal studies.

We provide an update to Siegler's (1975) review of the terminal change literature. Articles identified through MEDLINE, CANCERLIT, PUBMED, and PSYCINFO from 1975 to 2000 were examined. Lower levels of cognitive function are related to increased risk of mortality; however, the relationship between rate of cognitive change and mortality is less clear. Although there has been an increase in the number of studies since our last review, prior studies have been limited by a lack of medical data, consideration of dementia, small sample sizes, and poor cognitive measures. The emphasis on Alzheimer's disease and the growth of epidemiology of aging in the past 25 years have provided well-characterized population studies with serial cognitive measures that provide an opportunity to test the theory of terminal change.

Authors
Bosworth, HB; Siegler, IC
MLA Citation
Bosworth, HB, and Siegler, IC. "Terminal change in cognitive function: an updated review of longitudinal studies." Exp Aging Res 28.3 (July 2002): 299-315. (Review)
PMID
12079580
Source
pubmed
Published In
Experimental Aging Research
Volume
28
Issue
3
Publish Date
2002
Start Page
299
End Page
315
DOI
10.1080/03610730290080344

A tailored intervention to aid decision-making about hormone replacement therapy.

Authors
McBride, CM; Bastian, LA; Halabi, S; Fish, L; Lipkus, IM; Bosworth, HB; Rimer, BK; Siegler, IC
MLA Citation
McBride, CM, Bastian, LA, Halabi, S, Fish, L, Lipkus, IM, Bosworth, HB, Rimer, BK, and Siegler, IC. "A tailored intervention to aid decision-making about hormone replacement therapy." Am J Public Health 92.7 (July 2002): 1112-1114.
PMID
12084693
Source
pubmed
Published In
American journal of public health
Volume
92
Issue
7
Publish Date
2002
Start Page
1112
End Page
1114

Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder.

Caregiver burden and psychological distress were examined in a sample of 71 partners of Vietnam War combat veterans. Partners of patients (n = 51) diagnosed with posttraumatic stress disorder (PTSD) experienced more caregiver burden and had poorer psychological adjustment than did partners of veterans without PTSD (n = 20). Among PTSD caregivers, patient PTSD symptom severity and level of interpersonal violence were associated with increased caregiver burden. When accounting for patient PTSD symptom severity, hostility, presence of major depression, level of interpersonal violence, and health complaints, only PTSD severity was uniquely associated with caregiver burden. Caregiver sociodemographic factors including age, race, education, and the availability of social support, did not moderate the relationship between PTSD symptom severity and caregiver burden. Caregiver burden was strongly related to spouse psychological adjustment.

Authors
Calhoun, PS; Beckham, JC; Bosworth, HB
MLA Citation
Calhoun, PS, Beckham, JC, and Bosworth, HB. "Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder." J Trauma Stress 15.3 (June 2002): 205-212.
PMID
12092912
Source
pubmed
Published In
Journal of Traumatic Stress
Volume
15
Issue
3
Publish Date
2002
Start Page
205
End Page
212
DOI
10.1023/A:1015251210928

Behavioral medicine and aging.

A brief history of behavioral medicine and aging is followed by a series of perspectives that help to understand how age is used as a variable in this research, the relative importance of age to declines in cognitive functioning, and the impact of behavioral risk indicators on healthy survival. The authors discuss Alzheimer's disease and the role of age in clinical practice. Also discussed are potential problems in age-related research, ways to improve the knowledge base in behavioral medicine and aging, and thoughts about future challenges to enhance work in behavioral medicine and aging.

Authors
Siegler, IC; Bastian, LA; Steffens, DC; Bosworth, HB; Costa, PT
MLA Citation
Siegler, IC, Bastian, LA, Steffens, DC, Bosworth, HB, and Costa, PT. "Behavioral medicine and aging." J Consult Clin Psychol 70.3 (June 2002): 843-851. (Review)
PMID
12090387
Source
pubmed
Published In
Journal of Consulting and Clinical Psychology
Volume
70
Issue
3
Publish Date
2002
Start Page
843
End Page
851

Trends in stroke mortality: the impact of the Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "Trends in stroke mortality: the impact of the Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision." Stroke 33.6 (June 2002): 1722-.
PMID
12532958
Source
pubmed
Published In
Stroke
Volume
33
Issue
6
Publish Date
2002
Start Page
1722

Partners' ratings of combat veterans' anger.

Spouse reports may serve as an important source of collateral information in the assessment of posttraumatic stress disorder (PTSD) and associated behavioral problems. This study examined the concordance of anger reports among 94 combat veterans and their partners. Veterans' scores on subscales of the Multidimensional Anger Inventory were compared with scores on a parallel version completed by partners to assess veterans' anger symptomatology. The study examined whether the concordance between veteran and partner-reported anger is moderated by whether the veteran suffers from PTSD. There was moderate agreement between veterans and their partners on reports of anger and little evidence to suggest that PTSD diagnosis affected the convergence between partner and veteran scores.

Authors
Calhoun, PS; Beckham, JC; Feldman, ME; Barefoot, JC; Haney, T; Boswort, HB
MLA Citation
Calhoun, PS, Beckham, JC, Feldman, ME, Barefoot, JC, Haney, T, and Boswort, HB. "Partners' ratings of combat veterans' anger." J Trauma Stress 15.2 (April 2002): 133-136.
PMID
12013064
Source
pubmed
Published In
Journal of Traumatic Stress
Volume
15
Issue
2
Publish Date
2002
Start Page
133
End Page
136
DOI
10.1023/A:1014808008142

A model of psychosocial and cultural antecedents of blood pressure control.

Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades, yet only one fourth of all individuals have their blood pressure under control. Despite the potential impact of hypertension, interventions to improve control have had limited success. We present a model of how to understand antecedents of blood pressure control according to three interrelated categories: patient characteristics, social and cultural environment, and medical environment. This theoretical paper was conducted using a literature review and a model to explain psychosocial antecedents of blood pressure control is presented. We conclude that improved understanding of important antecedents of blood pressure control coupled with technological advances, such as tailored interventions, provide clinicians with a tool that may lead to improved blood pressure control. These interventions will require the involvement of clinicians and consideration of sociocultural factors to be successful.

Authors
Bosworth, HB; Oddone, EZ
MLA Citation
Bosworth, HB, and Oddone, EZ. "A model of psychosocial and cultural antecedents of blood pressure control." J Natl Med Assoc 94.4 (April 2002): 236-248.
PMID
11991336
Source
pubmed
Published In
Journal of the National Medical Association
Volume
94
Issue
4
Publish Date
2002
Start Page
236
End Page
248

No impact of literacy on glycemic control in type II diabetes mellitus.

Authors
Dolor, RJ; Kim, SH; Bosworth, HB; Edelman, D
MLA Citation
Dolor, RJ, Kim, SH, Bosworth, HB, and Edelman, D. "No impact of literacy on glycemic control in type II diabetes mellitus." JOURNAL OF GENERAL INTERNAL MEDICINE 17 (April 2002): 190-190.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
17
Publish Date
2002
Start Page
190
End Page
190

Psychosocial and clinical predictors of unipolar depression outcome in older adults.

BACKGROUND: This study examined psychosocial and clinical predictors of depression non-remittance among a sample of initially clinically depressed elders. METHODS: Incident and prevalent unipolar depression cases (n = 166) were enrolled into the MHCRC for the Study of Depression in Late Life and followed for 12 months while undergoing treatment using a standardized algorithm. The outcome was remission vs non-remission (<6 vs > 7 on the Montgomery-Asberg Depression Rating Scale (MADRS)) at one-year follow-up. Baseline predictor variables included psychosocial factors, such as four domains of social support, basic and instrumental activities of daily living (ADLs), and clinical factors, which included use of ECT, past history of depression, comorbidities, and antidepressant treatment. RESULTS: At one-year follow-up, 45% of the sample was in remission based upon MADRS scores. In bivariate analyses, non-remitted patients were more likely at baseline to use benzodiazepines, anxiolytic/sedatives, and/or MAO inhibitors than patients in remission, and have more depressive episodes. Among psychosocial factors, non-remitted patients had at baseline, more ADL and IADL problems and decreased subjective social support as compared to patients in remission. In logistic regression analyses more depression episodes, using anxiolytic/sedatives, more IADL problems and decreased subjective social support predicted poor depression outcome after one-year. CONCLUSIONS: While clinical and diagnostic variables were related to improvement, baseline psychosocial factors were also important.

Authors
Bosworth, HB; Hays, JC; George, LK; Steffens, DC
MLA Citation
Bosworth, HB, Hays, JC, George, LK, and Steffens, DC. "Psychosocial and clinical predictors of unipolar depression outcome in older adults." Int J Geriatr Psychiatry 17.3 (March 2002): 238-246.
PMID
11921152
Source
pubmed
Published In
International Journal of Geriatric Psychiatry
Volume
17
Issue
3
Publish Date
2002
Start Page
238
End Page
246

The next generation: The need to expand upon traditional risk factors for stroke - Editorial comment

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "The next generation: The need to expand upon traditional risk factors for stroke - Editorial comment." STROKE 33.1 (January 2002): 236-237.
Source
wos-lite
Published In
Stroke
Volume
33
Issue
1
Publish Date
2002
Start Page
236
End Page
237

The next generation: the need to expand upon traditional risk factors for stroke.

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "The next generation: the need to expand upon traditional risk factors for stroke." Stroke 33.1 (January 2002): 236-237.
PMID
11817349
Source
pubmed
Published In
Stroke
Volume
33
Issue
1
Publish Date
2002
Start Page
236
End Page
237

Outpatient care use among female veterans: differences between mental health and non-mental health users.

We examined the influence of mental health service use on outpatient health service use among female veterans. We conducted a retrospective and correlational study of treatment-seeking women and their pattern of health service use and the relationship between mental health and somatoform symptoms and service use. Data were obtained from a self-report measure designed to screen for mental and somatoform symptoms and from a federally maintained database of all outpatient contacts. Women who used mental health services were more likely to have a greater number of non-mental health visits than women who did not. The most commonly endorsed somatoform symptoms were feeling tired or having low energy and pain in extremities and joints. These symptoms were correlated with non-mental health service use, as were back pain, menstrual pain or problems, and trouble sleeping. We conclude that a history of somatoform symptoms might increase rates of health service use despite treatment for mental problems.

Authors
Forneris, CA; Bosworth, HB; Butterfield, MI
MLA Citation
Forneris, CA, Bosworth, HB, and Butterfield, MI. "Outpatient care use among female veterans: differences between mental health and non-mental health users." Mil Med 167.1 (January 2002): 10-13.
PMID
11799806
Source
pubmed
Published In
Military medicine
Volume
167
Issue
1
Publish Date
2002
Start Page
10
End Page
13

Subcortical white matter lesions and functional impairment in geriatric depression.

Geriatric depression is associated with significant functional impairment. There is also growing evidence linking vascular brain changes to depression in late life. We sought to examine the relationship between cerebrovascular disease and impairment in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in a group of older depressives. The sample consisted of 224 depressed adults aged 60 years and above enrolled in Duke's Mental Health Clinical Research Center. All subjects had unipolar major depression and were free of other major psychiatric and neurological illness, including dementia. In a structured interview, subjects reported their medical history and ability to perform both BADL and IADL. Geriatric psychiatrists assessed cognition using the Mini Mental State Examination (MMSE) and depression severity using the Montgomery Asberg Depression Rating Scale (MADRS). Subjects had a standardized magnetic resonance imaging (MRI) brain scan. MRI scans were processed using a semi-automated method to determine volumes of subcortical white matter lesions (WML) and subcortical gray matter lesions (GML). Logistic regression was used to examine effects of WML and GML controlling for demographic and clinical factors. Greater volume of WML was associated with impairment in both BADL and IADL, while GML was associated with IADL impairment. In logistic models, WML remained significantly associated with IADL after controlling for the effects of age, gender, depression severity, and medical comorbidity. We concluded that white matter lesions are independently associated with functional impairment. Further studies are needed to understand how these lesions affect function, e.g., through effects on cognition or motor skills.

Authors
Steffens, DC; Bosworth, HB; Provenzale, JM; MacFall, JR
MLA Citation
Steffens, DC, Bosworth, HB, Provenzale, JM, and MacFall, JR. "Subcortical white matter lesions and functional impairment in geriatric depression." Depress Anxiety 15.1 (2002): 23-28.
PMID
11816049
Source
pubmed
Published In
Depression and Anxiety
Volume
15
Issue
1
Publish Date
2002
Start Page
23
End Page
28

The relationship between hostility and behavioral risk factors for poor health in women veterans.

BACKGROUND: While previous research has generally supported a relationship between hostility and health risk behaviors, the majority of this research has been conducted in predominately male, highly educated, Caucasian samples. The current study was designed to further examine the relationship between hostility and health risk behaviors in a sample of women. METHODS: Measures of health risk behavior and scores from the Cook-Medley hostility scale were obtained from 409 women veterans. Linear and logistic regression analyses were used to examine the relationship between hostility and health behaviors including tobacco smoking, alcohol use, body-mass index, caffeine use, and level of physical activity, after sociodemographic factors were accounted for. RESULTS: In a cohort of women veterans using VA health care, ages 35-81, hostility was significantly associated with tobacco smoking (OR = 2.10; 95% CI = 1.34 to 3.30), caffeine use (OR = 2.12; 95% CI = 1.16 to 3.85), and the number of alcoholic beverages consumed by women who drink alcohol. Hostility was not associated with body mass index (OR = 1.15; 95% CI = 0.77 to 1.72) or a lack of physical exercise (OR = 0.89; 95% CI = 0.55 to 1.43). CONCLUSIONS: Results are generally consistent with previous research and support the relationship between hostility and health risk behaviors. Awareness that hostility contributes to risk behaviors and disease may help in the design of interventions aimed at risk reduction.

Authors
Calhoun, PS; Bosworth, HB; Siegler, IC; Bastian, LA
MLA Citation
Calhoun, PS, Bosworth, HB, Siegler, IC, and Bastian, LA. "The relationship between hostility and behavioral risk factors for poor health in women veterans." Prev Med 33.6 (December 2001): 552-557.
PMID
11716650
Source
pubmed
Published In
Preventive Medicine
Volume
33
Issue
6
Publish Date
2001
Start Page
552
End Page
557
DOI
10.1006/pmed.2001.0921

Racial differences in physician recommendation of hormone replacement therapy.

PURPOSE: Previous studies have suggested that black women may be less likely than white women to be offered and to take hormone replacement therapy (HRT). Thus, race and other factors associated with physician recommendation of HRT that may influence women's decisions about HRT were examined. METHODS: Data were from a baseline assessment of participants in a randomized controlled trial designed to evaluate the efficacy of a tailored decision-aid on HRT decision-making. We telephone interviewed 581 Durham women ages 45-54. The association of race and other factors with reported physician recommendation of HRT was tested using chi(2) and logistic regression analysis. RESULTS: Overall, 45% of women surveyed reported that their physician recommended HRT; black women were significantly less likely than white women to report being advised about HRT (35% vs. 48%, respectively, P < 0.005). Additional factors associated with being recommended HRT included older age, being postmenopausal, having had a hysterectomy, having thought about the benefits of HRT, and being satisfied with information about HRT. CONCLUSIONS: Black women are less likely than white women to receive physician recommendation of HRT. Racial differences in patient-provider communication about HRT exist and thus require greater diligence on the part of health care providers to minimize such a gap.

Authors
Weng, HH; McBride, CM; Bosworth, HB; Grambow, SC; Siegler, IC; Bastian, LA
MLA Citation
Weng, HH, McBride, CM, Bosworth, HB, Grambow, SC, Siegler, IC, and Bastian, LA. "Racial differences in physician recommendation of hormone replacement therapy." Prev Med 33.6 (December 2001): 668-673.
PMID
11716665
Source
pubmed
Published In
Preventive Medicine
Volume
33
Issue
6
Publish Date
2001
Start Page
668
End Page
673
DOI
10.1006/pmed.2001.0943

Does social support buffer functional decline in elderly patients with unipolar depression?

OBJECTIVE: This study tested whether social support protects against functional decline, either generally or selectively, in the most severely depressed elderly patients undergoing treatment for major depressive disorder. METHOD: In a prospective cohort study design, 113 patients with incident and prevalent unipolar depression were followed for 12 months while they were undergoing naturalistic treatment. Outcome measures included performance on basic and instrumental activities of daily living; predictor variables included Hamilton Depression Rating Scale scores and four domains of informal social support. The analysis employed multivariable ordinary least squares regression models. RESULTS: Improved scores on instrumental activities of daily living and stable scores on basic activities of daily living characterized the subjects. In adjusted analyses, instrumental social support provided marginal protection against worsening performance on instrumental activities of daily living, which were primarily a function of baseline depression severity. Large social networks, more frequent social interaction, and the perceived adequacy of social support played a modest buffering role against declines in performance on basic activities of daily living among the most depressed elderly patients. CONCLUSIONS: Instrumental support was generally protective against worsening performance on instrumental abilities of daily living among elderly patients with recurrent unipolar depression. Subjective and structural dimensions of social support protected the most severely depressed elderly patients against the loss of basic maintenance abilities.

Authors
Hays, JC; Steffens, DC; Flint, EP; Bosworth, HB; George, LK
MLA Citation
Hays, JC, Steffens, DC, Flint, EP, Bosworth, HB, and George, LK. "Does social support buffer functional decline in elderly patients with unipolar depression?." Am J Psychiatry 158.11 (November 2001): 1850-1855.
PMID
11691691
Source
pubmed
Published In
American Journal of Psychiatry
Volume
158
Issue
11
Publish Date
2001
Start Page
1850
End Page
1855
DOI
10.1176/appi.ajp.158.11.1850

Recent victimization in women and men with severe mental illness: prevalence and correlates.

The problem of violence against individuals with severe mental illness (SMI) has received relatively, little notice, despite several studies suggesting an exceptionally high prevalence of victimization in this population. This paper describes the results of an investigation of the prevalence and correlates of past year physical and sexual assault among a large sample of women and men with SMI drawn from inpatient and outpatient settings across 4 states. Results confirmed preliminary findings of a high prevalence of victimization in this population (with sexual abuse more prevalent for women and physical abuse more prevalent for men), and indicated the existence of a range of correlates of recent victimization, including demographic factors and living circumstances, history of childhood abuse, and psychiatric illness severity and substance abuse. The research and clinical implications of these findings are discussed.

Authors
Goodman, LA; Salyers, MP; Mueser, KT; Rosenberg, SD; Swartz, M; Essock, SM; Osher, FC; Butterfield, MI; Swanson, J
MLA Citation
Goodman, LA, Salyers, MP, Mueser, KT, Rosenberg, SD, Swartz, M, Essock, SM, Osher, FC, Butterfield, MI, and Swanson, J. "Recent victimization in women and men with severe mental illness: prevalence and correlates." Journal of traumatic stress 14.4 (October 2001): 615-632.
PMID
11776413
Source
epmc
Published In
Journal of Traumatic Stress
Volume
14
Issue
4
Publish Date
2001
Start Page
615
End Page
632
DOI
10.1023/a:1013026318450

Time to recovery from geriatric depression: Psychosocial and clinical factors

Authors
Bosworth, HB; McQuoid, D; George, LK; Steffens, DC
MLA Citation
Bosworth, HB, McQuoid, D, George, LK, and Steffens, DC. "Time to recovery from geriatric depression: Psychosocial and clinical factors." GERONTOLOGIST 41 (October 2001): 72-72.
Source
wos-lite
Published In
The Gerontologist
Volume
41
Publish Date
2001
Start Page
72
End Page
72

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Authors
Bosworth, HB; Bastian, LA; Kuchibhatla, MN; Steffens, DC; McBride, CM; Skinner, CS; Rimer, BK; Siegler, IC
MLA Citation
Bosworth, HB, Bastian, LA, Kuchibhatla, MN, Steffens, DC, McBride, CM, Skinner, CS, Rimer, BK, and Siegler, IC. "Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife." Psychosom Med 63.4 (July 2001): 603-608.
PMID
11485114
Source
pubmed
Published In
Psychosomatic Medicine
Volume
63
Issue
4
Publish Date
2001
Start Page
603
End Page
608

Effect of race and poverty on the process and outcome of inpatient rehabilitation among stroke patients.

Authors
Horner, RD; Swanson, JW; Bosworth, HB; Matchar, DB
MLA Citation
Horner, RD, Swanson, JW, Bosworth, HB, and Matchar, DB. "Effect of race and poverty on the process and outcome of inpatient rehabilitation among stroke patients." AMERICAN JOURNAL OF EPIDEMIOLOGY 153.11 (June 1, 2001): S268-S268.
Source
wos-lite
Published In
American Journal of Epidemiology
Volume
153
Issue
11
Publish Date
2001
Start Page
S268
End Page
S268

Patterns of cognitive impairment in alcoholics on neuropsychological screening

Authors
Zinn, S; Edwards, CL; Bosworth, HB; Swartzwelder, HS; Logue, PE
MLA Citation
Zinn, S, Edwards, CL, Bosworth, HB, Swartzwelder, HS, and Logue, PE. "Patterns of cognitive impairment in alcoholics on neuropsychological screening." CLINICAL NEUROPSYCHOLOGIST 15.2 (May 2001): 283-283.
Source
wos-lite
Published In
Clinical Neuropsychologist
Volume
15
Issue
2
Publish Date
2001
Start Page
283
End Page
283

Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality.

OBJECTIVES: Social isolation has been linked to poor survival in patients with coronary artery disease (CAD). Few studies have closely examined the psychosocial characteristics of CAD patients who lack social contact. METHODS: Social isolation was examined as a predictor of mortality in 430 patients with significant CAD. More isolated patients were compared with their less isolated counterparts on factors that might help explain the association between isolation and survival. RESULTS: The mortality rate was higher among isolated individuals. Those with three or fewer people in their social support network had a relative risk of 2.43 (p = .001) for cardiac mortality and 2.11 (p = .001) for all-cause mortality, controlling for age and disease severity. Adjustments for income, hostility, and smoking status did not alter the risk due to social isolation. With the exception of lower income, higher hostility ratings, and higher smoking rates, isolated patients did not differ from nonisolated patients on demographic indicators, disease severity, physical functioning, or psychological distress. Isolated patients reported less social support and were less pleased with the way they got along with network members, but they did not report less satisfaction with the amount of social contact received. CONCLUSIONS: Patients with small social networks had an elevated risk of mortality, but this greater risk was not attributable to confounding with disease severity, demographics, or psychological distress. These findings have implications for mechanisms linking social isolation to mortality and for the application of psychosocial interventions.

Authors
Brummett, BH; Barefoot, JC; Siegler, IC; Clapp-Channing, NE; Lytle, BL; Bosworth, HB; Williams, RB; Mark, DB
MLA Citation
Brummett, BH, Barefoot, JC, Siegler, IC, Clapp-Channing, NE, Lytle, BL, Bosworth, HB, Williams, RB, and Mark, DB. "Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality." Psychosom Med 63.2 (March 2001): 267-272.
PMID
11292274
Source
pubmed
Published In
Psychosomatic Medicine
Volume
63
Issue
2
Publish Date
2001
Start Page
267
End Page
272

Personality and coping with a common stressor: cardiac catheterization.

The association between coping and personality was examined in a sample of 204 cardiac catheterization patients who were asked to evaluate the use of specific coping strategies used to deal with their cardiac catheterization. Personality, as measured by the NEO Five-Factor Inventory (FFI), was moderately correlated with coping measures. In multivariate analyses, after considering confounding factors, Neuroticism was positively and Extraversion was negatively related to avoidance coping and Neuroticism was negatively associated with counting one's blessings as a coping strategy. Personality was not related to either problem solving or seeking social support coping strategies for individuals experiencing a cardiac catheterization. However, important covariates were associated with coping strategies. Not being married was negatively correlated with use of seeking social support and not having a confidant was negatively related with seeking social support and positively with avoidance. These results suggest that there are specific relationships between personality and coping, but these relationships are, for the most part, moderate in persons coping with a cardiac catheterization, and that coping processes are associated with individual differences in available social resources.

Authors
Bosworth, HB; Feaganes, JR; Vitaliano, PP; Mark, DB; Siegler, IC
MLA Citation
Bosworth, HB, Feaganes, JR, Vitaliano, PP, Mark, DB, and Siegler, IC. "Personality and coping with a common stressor: cardiac catheterization." J Behav Med 24.1 (February 2001): 17-31.
PMID
11296468
Source
pubmed
Published In
Journal of Behavioral Medicine
Volume
24
Issue
1
Publish Date
2001
Start Page
17
End Page
31

Health-related quality of life after stroke: A comprehensive review

Authors
Bosworth, HB
MLA Citation
Bosworth, HB. "Health-related quality of life after stroke: A comprehensive review." Stroke 32.4 (2001): 972--.
Source
scival
Published In
Stroke
Volume
32
Issue
4
Publish Date
2001
Start Page
972-

Reliability and validity of the SF-12 health survey among people with severe mental illness.

OBJECTIVE: The objective of this work was to assess the reliability and validity of the Medical Outcomes Study Short-Form 12-Item Health Survey (SF-12) in a large sample of people with severe mental illness (SMI). METHODS: We examined the internal factor structure of the SF-12, compared component scores for this sample with normative levels, examined test-retest reliability, and examined convergent and divergent validity by comparing SF-12 scores to other indexes of physical and mental health. RESULTS: The SF-12 distinguished this sample of people with SMI from the general population, was stable over a 1-week interval, consisted of 2 fairly distinct factors, and was related to physical and mental health indexes in expected ways. CONCLUSIONS: The SF-12 appears to be a psychometrically sound instrument for measuring health-related quality of life for people with SMI.

Authors
Salyers, MP; Bosworth, HB; Swanson, JW; Lamb-Pagone, J; Osher, FC
MLA Citation
Salyers, MP, Bosworth, HB, Swanson, JW, Lamb-Pagone, J, and Osher, FC. "Reliability and validity of the SF-12 health survey among people with severe mental illness." Med Care 38.11 (November 2000): 1141-1150.
PMID
11078054
Source
pubmed
Published In
Medical Care
Volume
38
Issue
11
Publish Date
2000
Start Page
1141
End Page
1150

Depression and other determinants of values placed on current health state by stroke patients: evidence from the VA Acute Stroke (VASt) study.

BACKGROUND AND PURPOSE: This prospective study examined the determinants of the utility (value) placed on health status among a sample of patients with acute ischemic and intracerebral hemorrhagic stroke. METHODS: Data were from the VA Acute Stroke (VASt) study, a nationwide prospective cohort of 1073 acute stroke patients admitted at any of 9 Department of Veterans Affairs Medical Center sites between April 1, 1995, and March 31, 1997. The primary outcome was the patient's health status utility as measured by the time-tradeoff method. Data were obtained by telephone interviews at 1, 6, and 12 months and by medical record review. General linear mixed modeling was used to assess the effects of social, psychological, and physical factors on patients' valuations of their current health state. The analysis was confined to the 327 patients who were able to provide self-reports at >/=2 time points. RESULTS: Patients' valuations of their health state status over the initial 12 months after stroke were very stable over time, with only a slight improvement at 6 months, followed by a slight decline at 12 months. In adjusted analyses, living alone, being institutionalized, decreased physical function, and depression were independently associated with lower levels of patient health status utility over time. CONCLUSIONS: Stroke patient health status utilities are relatively stable during the initial year after stroke. In addition to physical function, psychological health and social environment are important determinants of patient health status utility. These factors need to be considered when conducting stroke decision analyses if more accurate conclusions are to be drawn regarding preferred patterns of care.

Authors
Bosworth, HB; Horner, RD; Edwards, LJ; Matchar, DB
MLA Citation
Bosworth, HB, Horner, RD, Edwards, LJ, and Matchar, DB. "Depression and other determinants of values placed on current health state by stroke patients: evidence from the VA Acute Stroke (VASt) study." Stroke 31.11 (November 2000): 2603-2609.
PMID
11062282
Source
pubmed
Published In
Stroke
Volume
31
Issue
11
Publish Date
2000
Start Page
2603
End Page
2609

Drug use and validity of substance use self-reports in veterans seeking help for posttraumatic stress disorder.

The present study assessed drug use and the validity of self-reports of substance use among help-seeking veterans referred to a specialty clinic for the assessment of posttraumatic stress disorder (PTSD). Patients (n = 341) were asked to provide a urine sample for use in drug screening as part of an evaluation of PTSD. Self-reports of substance use were compared with same-day supervised urine samples for 317 patients who volunteered to participate in a drug screening. Results suggested that self-reports were generally quite valid. Only 8% of the cases involved patients not reporting substance use detected by urine screens. A total of 42% of the participants were identified as using drugs of abuse (excluding alcohol) through self-report and urine drug screens. Among participants using drugs, PTSD diagnosis was significantly associated with greater marijuana and depressant use as compared with stimulant (cocaine and amphetamines) use.

Authors
Calhoun, PS; Sampson, WS; Bosworth, HB; Feldman, ME; Kirby, AC; Hertzberg, MA; Wampler, TP; Tate-Williams, F; Moore, SD; Beckham, JC
MLA Citation
Calhoun, PS, Sampson, WS, Bosworth, HB, Feldman, ME, Kirby, AC, Hertzberg, MA, Wampler, TP, Tate-Williams, F, Moore, SD, and Beckham, JC. "Drug use and validity of substance use self-reports in veterans seeking help for posttraumatic stress disorder." J Consult Clin Psychol 68.5 (October 2000): 923-927.
PMID
11068979
Source
pubmed
Published In
Journal of Consulting and Clinical Psychology
Volume
68
Issue
5
Publish Date
2000
Start Page
923
End Page
927

The relationship between self-rated health and health care service use among women veterans in a primary care clinic.

This study examined whether self-rated health predicted health service use among women in an equal access primary care clinic setting. Women veterans (n = 139), 23-76 years of age were administered the PRIME-MD questionnaire at their outpatient clinic (OPC) visit which included a self-rated health item and assessment of symptoms. Number of prospective OPC visits was the outcome variable. Women who had poor/fair health were significantly more likely (OR = 3.25) to have more (>12) OPC visits than women who reported excellent/very good health. We conclude that poor perception of one's health is an important predictor of health care use among women veterans.

Authors
Bosworth, HB; Butterfield, MI; Stechuchak, KM; Bastian, LA
MLA Citation
Bosworth, HB, Butterfield, MI, Stechuchak, KM, and Bastian, LA. "The relationship between self-rated health and health care service use among women veterans in a primary care clinic." Womens Health Issues 10.5 (September 2000): 278-285.
PMID
10980445
Source
pubmed
Published In
Women's Health Issues
Volume
10
Issue
5
Publish Date
2000
Start Page
278
End Page
285

Relationships among breast cancer perceived absolute risk, comparative risk, and worries.

When trying to predict breast cancer screening, it may be important to understand the relationships between perceived breast cancer risks and worries about getting breast cancer. This study examines the extent to which women's worries about breast cancer correlate with perceptions of both absolute (assessment of own) and comparative (self versus other) 10-year and lifetime risks. As part of a larger randomized intervention trial concerning hormone replacement therapy, 581 women participated in a telephone baseline survey to assess their perceptions of breast cancer risks and worries. Worries about getting breast cancer in the next 10 years and in one's lifetime were related positively to both absolute and comparative 10-year and lifetime risks. The magnitude of these relationships did not differ by time frame. Worry about breast cancer is a function of both how a woman views her own risk and how she compares her risk with that of other women. Some practitioners may encourage women to get screened for breast cancer by using emotional appeals, such as heightening women's worries about breast cancer by using risk information. Our data suggest that they should give careful consideration how best to combine, if at all, information about absolute and comparative risks. For example, if the motivation to screen is based on a sequential assessment of risk beginning with comparative and then absolute risk, creating communications that heighten perceived risk on both of these risk dimensions may be needed to evoke sufficient worry to initiate breast cancer screening.

Authors
Lipkus, IM; Kuchibhatla, M; McBride, CM; Bosworth, HB; Pollak, KI; Siegler, IC; Rimer, BK
MLA Citation
Lipkus, IM, Kuchibhatla, M, McBride, CM, Bosworth, HB, Pollak, KI, Siegler, IC, and Rimer, BK. "Relationships among breast cancer perceived absolute risk, comparative risk, and worries." Cancer Epidemiol Biomarkers Prev 9.9 (September 2000): 973-975.
PMID
11008917
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
9
Issue
9
Publish Date
2000
Start Page
973
End Page
975

Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic.

Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for mental health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use.

Authors
Bosworth, HB; Parsey, KS; Butterfield, MI; McIntyre, LM; Oddone, EZ; Stechuchak, KM; Bastian, LA
MLA Citation
Bosworth, HB, Parsey, KS, Butterfield, MI, McIntyre, LM, Oddone, EZ, Stechuchak, KM, and Bastian, LA. "Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic." J Natl Med Assoc 92.5 (May 2000): 231-236.
PMID
10881472
Source
pubmed
Published In
Journal of the National Medical Association
Volume
92
Issue
5
Publish Date
2000
Start Page
231
End Page
236

Hostility in marital dyads: associations with depressive symptoms.

We examined the relations of hostility (of self and spouse) with self-ratings of depressive symptoms in 898 spouse pairs. Self-ratings of hostility were initially examined as predictors of depression. Next, spouse self-ratings of hostility were added to the model. Finally, the interaction of self x spouse hostility was investigated. These relations were explored for three components of hostility (Cynicism, Aggressive Responding, and Hostile Affect). Age and education were controlled in all models and effects were examined separately for women and men. Self-ratings of Hostile Affect were positively related to depressive symptoms for both women and men. Self-ratings of Cynicism were also significantly related to depression, but only for men. All three components of spouse's hostility were positively related to one's own symptoms of depression for women. For men, however, spouse's hostility was not related to symptoms of depression. These findings highlight the need to study psychosocial risk factors in social units and have potential implications for intervention.

Authors
Brummett, BH; Barefoot, JC; Feaganes, JR; Yen, S; Bosworth, HB; Williams, RB; Siegler, IC
MLA Citation
Brummett, BH, Barefoot, JC, Feaganes, JR, Yen, S, Bosworth, HB, Williams, RB, and Siegler, IC. "Hostility in marital dyads: associations with depressive symptoms." J Behav Med 23.1 (February 2000): 95-105.
PMID
10749013
Source
pubmed
Published In
Journal of Behavioral Medicine
Volume
23
Issue
1
Publish Date
2000
Start Page
95
End Page
105

Relation between informant-rated personality and clinician-rated depression in patients with memory disorders.

OBJECTIVE: The goal of this study was to examine the convergent validity of informant-rated changes in depressive and related personality traits with clinician-assessed depression in memory-disordered patients. BACKGROUND: Depressive symptoms are frequent complications in persons with dementias such as Alzheimer disease, and caregiver informants consistently report changes in depression and related neurotic traits on the NEO Personality Inventory (NEO-PI) in dementia patients. METHODS: In 78 patients undergoing evaluation of memory complaints at an Alzheimer disease clinic, depression was characterized by clinical diagnosis, a clinician-rated scale, and informant ratings of premorbid versus current depression, anxiety, vulnerability, and neuroticism on the NEO-PI. RESULTS: The diagnostic groups differed in meaningful patterns on the NEO-PI measures. Those with a diagnosis of major depression differed from never-depressed patients in all personality areas, although those with depressed mood differed only on NEO-PI depression. The clinician-rated depression scale correlated modestly with current personality and change from baseline personality. CONCLUSIONS: The NEO-PI provides a useful measure of informants' perspectives on depressive personality changes in patients with memory disorders but does not correspond fully with a clinical syndrome of depression.

Authors
Clark, LM; Bosworth, HB; Welsh-Bohmer, KA; Dawson, DV; Siegler, IC
MLA Citation
Clark, LM, Bosworth, HB, Welsh-Bohmer, KA, Dawson, DV, and Siegler, IC. "Relation between informant-rated personality and clinician-rated depression in patients with memory disorders." Neuropsychiatry Neuropsychol Behav Neurol 13.1 (January 2000): 39-47.
PMID
10645735
Source
pubmed
Published In
Neuropsychiatry, neuropsychology, and behavioral neurology
Volume
13
Issue
1
Publish Date
2000
Start Page
39
End Page
47

Social support and quality of life in patients with coronary artery disease.

The relationship between perceived social support and domain-specific health-related quality of life (HRQOL) was examined in a sample of cardiac catheterization patients after considering age, gender, race, education, and coronary artery disease (CAD) severity. Data was collected on 4,278 cardiac catheterization patients (63% males) and included 1,215 patients with non-significant CAD and 3,063 patients who had significant CAD ( > or = 75% stenosis of at least one major coronary artery). Among the patients with significant CAD, 2,721 were classified as low disease severity and 342 were considered high disease severity. Regression models indicated that a lack of social support was associated with significantly lower levels of HRQOL across all eight SF-36 HRQOL domains after considering disease severity and other demographic factors. The models also indicated that social support and other relevant variables interacted across various HRQOL domains. Physical function and physical role function were lower with age, whereas mental health, emotional role function, and vitality were higher with age. Females reported lower HRQOL than males across all domains. Minority patients reported lower levels of HRQOL than white patients across four domains. Increased disease severity was related to lower levels among four of the eight HRQOL domains. The observed interactions of social support with minority status, disease severity, and education suggest that a subset of individuals may suffer lower levels of HRQOL. These individuals may subsequently require the greatest degree of care and potentially benefit most from intervention.

Authors
Bosworth, HB; Siegler, IC; Olsen, MK; Brummett, BH; Barefoot, JC; Williams, RB; Clapp-Channing, NE; Mark, DB
MLA Citation
Bosworth, HB, Siegler, IC, Olsen, MK, Brummett, BH, Barefoot, JC, Williams, RB, Clapp-Channing, NE, and Mark, DB. "Social support and quality of life in patients with coronary artery disease." Qual Life Res 9.7 (2000): 829-839.
PMID
11297025
Source
pubmed
Published In
Quality of Life Research
Volume
9
Issue
7
Publish Date
2000
Start Page
829
End Page
839

The relationship of social support, social networks and negative events with depression in patients with coronary artery disease

This study examined the relationship of social relationships and negative life events with major depression among 335 inpatients with coronary artery disease (CAD) who were free of neurological illnesses. Depression was assessed using the Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression sub-scale, two scales for measuring instrumental and self-maintenance activities of daily living, a measure of negative events and four dimensions of social support. Twenty-seven subjects met DSM-IV criteria for major depression. Examination of the bivariate relationships indicated that being younger, having at least one problem with an ADL and/or one IADL, being non-white, experiencing a greater number of negative events, lack of perceived social support and a lack of social interactions were significantly related to an increased likelihood of being depressed. In multivariate analyses depressed subjects were significantly more likely to report a greater number of negative events than non-depressed individuals after adjusting for sociodemographic and ADL measures. A lack of perceived social support and increased number of negative events increased the likelihood of reporting major depressive symptoms among CAD patients. Understanding the causes of depression in CAD patients may have clinical utility in that reduction in depression may lead to a decreased risk of future CAD events.

Authors
Bosworth, HB; Steffens, DC; Kuchibhatla, MN; Jiang, WJ; Arias, RM; O'Connor, CM; Krishnan, KRR
MLA Citation
Bosworth, HB, Steffens, DC, Kuchibhatla, MN, Jiang, WJ, Arias, RM, O'Connor, CM, and Krishnan, KRR. "The relationship of social support, social networks and negative events with depression in patients with coronary artery disease." Aging and Mental Health 4.3 (2000): 253-258.
Source
scival
Published In
Aging and Mental Health
Volume
4
Issue
3
Publish Date
2000
Start Page
253
End Page
258

The relationship between depressive symptoms and climacteric symptoms in women at mid-life

Authors
Bosworth, HB; Bastian, LA; Kuchitbhatta, MN; McBride, CM; Skinner, CS; Rimer, BK; Siegler, IC
MLA Citation
Bosworth, HB, Bastian, LA, Kuchitbhatta, MN, McBride, CM, Skinner, CS, Rimer, BK, and Siegler, IC. "The relationship between depressive symptoms and climacteric symptoms in women at mid-life." PSYCHOSOMATIC MEDICINE 62.1 (2000): 115-115.
Source
wos-lite
Published In
Psychosomatic Medicine
Volume
62
Issue
1
Publish Date
2000
Start Page
115
End Page
115

The association between self-rated health and mortality in a well-characterized sample of coronary artery disease patients.

BACKGROUND: The relationship between self-rated health and mortality after adjustment for sociodemographic variables, physician-rated comorbidities, disease severity, health-related quality of life (HRQOL), and psychosocial measures (depression, social support, and functional ability) was examined in the Mediators of Social Support (MOSS) study. SUBJECTS: The sample consisted of 2,885 individuals (mean age, 62.5 years) who had significant heart disease based upon heart catheterization. RESULTS. Using Cox proportional survival analysis, individuals who rated their health as "fair" or "poor" had a significantly greater likelihood of all-cause mortality (OR = 2.13; CI = 1.40-3.23; OR = 4.92; CI = 3.24-7.46, respectively) across follow-up (mean, 3.5 years) than those who rated their health as "very good" after considering sociodemographic factors. After adjustment for comorbidities, disease severity, HRQOL, psychosocial factors, and demographic variables, only those who rated their health as poor had a significant greater risk of mortality (OR = 2.96, CI = 1.80-4.85). A similar pattern was observed for coronary artery disease (CAD)-related mortality; increased adjustment of variables weakened the relationship between self-rated health and mortality. Individuals who rated their health as poor had a significantly greater risk of CAD-related mortality than did those who rated their health as very good (poor vs. very good OR = 3.58, CI = 2.13-6.02) after adjustment for all available mortality risk factors. CONCLUSIONS: This study indicates that it is important to include self-rated health when studying risk factors for mortality. Not adjusting for relevant factors may provide an overestimation of the effects of self-rated health on mortality in a sample of CAD patients.

Authors
Bosworth, HB; Siegler, IC; Brummett, BH; Barefoot, JC; Williams, RB; Clapp-Channing, NE; Mark, DB
MLA Citation
Bosworth, HB, Siegler, IC, Brummett, BH, Barefoot, JC, Williams, RB, Clapp-Channing, NE, and Mark, DB. "The association between self-rated health and mortality in a well-characterized sample of coronary artery disease patients." Med Care 37.12 (December 1999): 1226-1236.
PMID
10599604
Source
pubmed
Published In
Medical Care
Volume
37
Issue
12
Publish Date
1999
Start Page
1226
End Page
1236

The relationship between self-rated health and health status among coronary artery patients.

OBJECTIVES: This study examined the descriptive relationship of self-rated health (SRH) with various psychosocial measures, sociodemographic variables, coronary artery disease (CAD) diagnostic/clinical measures, and medically abstracted comorbidities. METHODS: The sample was 2,855 individuals from the Mediators of Social Support (MOSS) study who had at least 75% narrowing in more than one vessel, as indicated by a cardiac catheterization. RESULTS: After adjusting for sociodemographic factors, individuals who rated their health as poor/fair had significantly worse performance on all psychosocial measures and were more likely to be female, non-White, and of a lower socioeconomic status than those who rated their health as being good or better. There were few differences on SRH across various diagnostic/clinical measures of health. DISCUSSION: A single item measure of SRH may be useful; the generalizability of the item must be considered. In this sample of CAD patients, SRH was related more to psychosocial factors than to clinical and disease indicators.

Authors
Bosworth, HB; Siegler, IC; Brummett, BH; Barefoot, JC; Williams, RB; Vitaliano, PP; Clapp-Channing, N; Lytle, BL; Mark, DB
MLA Citation
Bosworth, HB, Siegler, IC, Brummett, BH, Barefoot, JC, Williams, RB, Vitaliano, PP, Clapp-Channing, N, Lytle, BL, and Mark, DB. "The relationship between self-rated health and health status among coronary artery patients." J Aging Health 11.4 (November 1999): 565-584.
PMID
10848078
Source
pubmed
Published In
Journal of Aging and Health
Volume
11
Issue
4
Publish Date
1999
Start Page
565
End Page
584
DOI
10.1177/089826439901100405

Cognitive and sociodemographic risk factors for mortality in the Seattle Longitudinal Study.

The relationship between cognitive function and survivorship was examined in a community-dwelling sample. Survival analysis was used to examine how level and change in intellectual functioning, verbal memory, perceptual speed, and psychomotor speed were related to mortality in a sample of 601 individuals who subsequently died (decedents; n = 342 men; n = 259 women; M = 73.81 years of age) and a control group of 609 survivors (n = 296 men; n = 313 women; M = 71.96). The sample of survivors was selected to be of similar age and to have a similar level of education as the decedents. Individuals in the lowest 25th percentile of performance (crystallized abilities, visualization abilities, verbal memory, and perceptual and psychomotor speed) had a significant risk for subsequent mortality compared to individuals in the highest 25th percentile. However, after adjusting for demographic variables and psychomotor speed, only perceptual speed remained a significant risk factor for mortality. Significant 7-year declines (lowest 25th percentile) in measurements of Verbal Meaning, Spatial Ability, Reasoning Ability, and Psychomotor Speed were risk factors for subsequent mortality relative to those who had the least amount of decline. The relationship between mortality and cognitive function tended to be a specific rather than a pervasive phenomenon, even after adjusting for sociodemographic factors and psychomotor speed. Decrease in cognitive performance tended to be a better predictor of subsequent mortality than was the level of cognitive performance.

Authors
Bosworth, HB; Schaie, KW; Willis, SL
MLA Citation
Bosworth, HB, Schaie, KW, and Willis, SL. "Cognitive and sociodemographic risk factors for mortality in the Seattle Longitudinal Study." J Gerontol B Psychol Sci Soc Sci 54.5 (September 1999): P273-P282.
PMID
10542820
Source
pubmed
Published In
Journals of Gerontology: Series B
Volume
54
Issue
5
Publish Date
1999
Start Page
P273
End Page
P282

Survival effects in cognitive function, cognitive style, and sociodemographic variables in the Seattle Longitudinal Study.

Survival effects in cognitive performance were examined in the Seattle Longitudinal Study (SLS) for a sample of 605 individuals who subsequently died (decedents) (n = 343 males; n = 262 females; M = 73.73 years of age) and a control group of 613 survivors (n = 299 males; n = 314 females; M = 71.91 years of age). A sample of survivors of similar age and have a similar level of education as the decedents was selected. Differences in cognitive functioning and cognitive style in level and change over time between decedents and survivors were studied. Decedents had lower levels of crystallized abilities (Verbal Meaning and Numerical Ability), visualization abilities (Spatial Orientation), verbal memory (Delayed Word Recall), perceptual speed (Identical Pictures), and Psychomotor Speed at last measurement. Decedents also had greater declines on Psychomotor Speed and Verbal Meaning at 7 and 14 years before the conclusion of the study. Survival effects were found to be ability-specific, appeared primarily in older adults, were more evident for males, and were observed up to 14 years before last measurement for specific abilities. Age-related changes in fluid ability appeared to be normative, whereas changes in crystallized abilities and perceptual speed may signify impending mortality.

Authors
Bosworth, HB; Schaie, KW
MLA Citation
Bosworth, HB, and Schaie, KW. "Survival effects in cognitive function, cognitive style, and sociodemographic variables in the Seattle Longitudinal Study." Exp Aging Res 25.2 (April 1999): 121-139.
PMID
10223172
Source
pubmed
Published In
Experimental Aging Research
Volume
25
Issue
2
Publish Date
1999
Start Page
121
End Page
139
DOI
10.1080/036107399244057

Age and distance to death in the Seattle Longitudinal Study

A series of hierarchical regression models was used to determine if time to death was a significant independent variable for level and seven-year change in intellectual performance for 1,214 community-dwelling adults. Distance to death explained a significant amount of the variance of intellectual performance at individuals' last measurement but not of the decline in performance after controlling for age, education, gender, and survivorship. The inclusion of time to death improved the proportion of unique variance explained by about 1% to 3% and between 4% and 10.4% of the total variance explained. Decedents had lower levels of verbal meaning, spatial ability, reasoning ability, and psychomotor speed at last measurements and greater amounts of seven-year decline on verbal meaning and psychomotor speed. The inclusion of distance to death may help improve the explanation of variability in performance associated with increased age.

Authors
Bosworth, HB; Schaie, KW; Willis, SL; Siegler, IC
MLA Citation
Bosworth, HB, Schaie, KW, Willis, SL, and Siegler, IC. "Age and distance to death in the Seattle Longitudinal Study." Research on Aging 21.6 (1999): 723-738.
Source
scival
Published In
Research on Aging
Volume
21
Issue
6
Publish Date
1999
Start Page
723
End Page
738
DOI
10.1177/0164027599216001

Attitudes and knowledge associated with being undecided about hormone replacement therapy: Results from a community sample

Authors
Bastian, LA; McBride, CM; Halabi, S; Fish, LJ; Skinner, CS; Kaplan, EB; Bosworth, HB; Rimer, BK; Siegler, IC
MLA Citation
Bastian, LA, McBride, CM, Halabi, S, Fish, LJ, Skinner, CS, Kaplan, EB, Bosworth, HB, Rimer, BK, and Siegler, IC. "Attitudes and knowledge associated with being undecided about hormone replacement therapy: Results from a community sample." WOMENS HEALTH ISSUES 9.6 (1999): 330-337.
Source
wos-lite
Published In
Women's Health Issues
Volume
9
Issue
6
Publish Date
1999
Start Page
330
End Page
337

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study.

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.

Authors
Brummett, BH; Babyak, MA; Barefoot, JC; Bosworth, HB; Clapp-Channing, NE; Siegler, IC; Williams, RB; Mark, DB
MLA Citation
Brummett, BH, Babyak, MA, Barefoot, JC, Bosworth, HB, Clapp-Channing, NE, Siegler, IC, Williams, RB, and Mark, DB. "Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study." Psychosom Med 60.6 (November 1998): 707-713.
PMID
9847029
Source
pubmed
Published In
Psychosomatic Medicine
Volume
60
Issue
6
Publish Date
1998
Start Page
707
End Page
713

The importance of the relationship between social networks and quality of life.

Authors
Bosworth, HB; Hoff, JA; Horner, RD; Matcher, DB; Team, VS
MLA Citation
Bosworth, HB, Hoff, JA, Horner, RD, Matcher, DB, and Team, VS. "The importance of the relationship between social networks and quality of life." AMERICAN JOURNAL OF EPIDEMIOLOGY 147.11 (June 1, 1998): S47-S47.
Source
wos-lite
Published In
American Journal of Epidemiology
Volume
147
Issue
11
Publish Date
1998
Start Page
S47
End Page
S47

Benefits and drawbacks to hormone replacement therapy among nursing home patients.

Authors
Bosworth, HB; Bastian, LA; Siegler, IC
MLA Citation
Bosworth, HB, Bastian, LA, and Siegler, IC. "Benefits and drawbacks to hormone replacement therapy among nursing home patients." Womens Health Issues 8.1 (January 1998): 53-59.
PMID
9504039
Source
pubmed
Published In
Women's Health Issues
Volume
8
Issue
1
Publish Date
1998
Start Page
53
End Page
59

The relationship of social environment, social networks, and health outcomes in the Seattle Longitudinal Study: two analytical approaches.

This study examined the relation of social networks and perceived social environment to health outcomes and cost utilization over a 1-year period in a community sample of 387 (173 males, 214 females). Two analytical strategies, a variable-oriented approach and a subject-oriented approach, were used to complement each other: structural equation modeling assessed the direct relationship between social relationships and health, while cluster analysis examined how social relationship patterns were related to health outcomes. Lower levels of perceived social environment were associated with an increased number of hospital visits. For unmarried individuals, increased age was associated with greater medical usage and estimated total health care cost, while low perceived social environment was related to a greater number of doctor visits. Among married individuals, women had more frequent doctor visits, medication usage, estimated outpatient costs, and primary care visits. Married individuals with low levels of social networks had increased total health care costs, outpatient costs, and primary care visits. Cluster analysis was used to group individuals by characteristics of perceived social environment and social networks. Members of the cluster groups with greater health problems were more likely to be isolated, had the least social contact, and had lower levels of education and income. Including subject-oriented approaches is useful in complementing more popular regression methods for data analysis.

Authors
Bosworth, HB; Schaie, KW
MLA Citation
Bosworth, HB, and Schaie, KW. "The relationship of social environment, social networks, and health outcomes in the Seattle Longitudinal Study: two analytical approaches." J Gerontol B Psychol Sci Soc Sci 52.5 (September 1997): P197-P205.
PMID
9310088
Source
pubmed
Published In
Journals of Gerontology: Series B
Volume
52
Issue
5
Publish Date
1997
Start Page
P197
End Page
P205

The relationship of social environment, social networks, and health outcomes in the Seattle longitudinal study: Two analytical approaches

This study examined the relation of social networks and perceived social environment to health outcomes and cost utilization over a 1-year period in a community sample of 387 (173 males, 214 females). Two analytical strategies, a variable-oriented approach and a subject-oriented approach, were used to complement each other: structural equation modeling assessed the direct relationship between social relationships and health, while cluster analysis examined how social relationship patterns were related to health outcomes. Lower levels of perceived social environment were associated with an increased number of hospital visits. For unmarried individuals, increased age was associated with greater medical usage and estimated total health care cost, while low perceived social environment was related to a greater number of doctor visits. Among married individuals, women had more frequent doctor visits, medication usage, estimated outpatient costs, and primary care visits. Married individuals with low levels of social networks had increased total health care costs, outpatient costs, and primary care visits. Cluster analysis was used to group individuals by characteristics of perceived social environment and social networks. Members of the cluster groups with greater health problems were more likely to be isolated, had the least social contact, and had lower levels of education and income. Including subject-oriented approaches is useful in complementing more popular regression methods for data analysis.

Authors
Bosworth, HB; Schaie, KW
MLA Citation
Bosworth, HB, and Schaie, KW. "The relationship of social environment, social networks, and health outcomes in the Seattle longitudinal study: Two analytical approaches." Journals of Gerontology - Series B Psychological Sciences and Social Sciences 52.5 (January 1, 1997).
Source
scopus
Published In
Journals of Gerontology: Series B
Volume
52
Issue
5
Publish Date
1997

A measurement model of cortisol reactivity of healthy older adults

Research on the physiological adaptation process has found that stress is associated with the rate of cortisol secretion, the main hormone that reflects stress. However, considerable variation among subjects has been reported. Using a sample of older adults (N = 46), we tested the hypothesis that cortisol reactivity is composed of (1) a situation-related component representing hypothalamic influence on cortisol secretion observed on three different occasions, and (2) a stable component representing a general trait responsible for cortisol responses observed from occasion to occasion. LISREL VIII was used to test this hypothesis. Results indicated that a homogeneous reliability model was not supported by the data. A congeneric measurement model represented a better fit to the data. Results suggest that subjects have consistent patterns of response during separate experimental occasions. However, results do not suggest a consistent pattern of response over time. The main implication of these results is that salivary cortisol measures are sensitive to experimental stress situations. As such, this noninvasive method may be useful in examining adaptive responses to stress.

Authors
Préville, M; Susman, E; Zarit, SH; Smyer, M; Bosworth, HB; Reid, JD
MLA Citation
Préville, M, Susman, E, Zarit, SH, Smyer, M, Bosworth, HB, and Reid, JD. "A measurement model of cortisol reactivity of healthy older adults." Journals of Gerontology - Series B Psychological Sciences and Social Sciences 51.2 (March 1, 1996).
Source
scopus
Published In
Journals of Gerontology: Series B
Volume
51
Issue
2
Publish Date
1996

A measurement model of cortisol reactivity of healthy older adults.

Research on the physiological adaptation process has found that stress is associated with the rate of cortisol secretion, the main hormone that reflects stress. However, considerable variation among subjects has been reported. Using a sample of older adults (N=46), we tested the hypothesis that cortisol reactivity is composed of (1) a situation-related component representing hypothalamic influence on cortisol secretion observed on three different occasions, and (2) a stable component representing a general trait responsible for cortisol responses observed from occasion to occasion. LISREL VIII was used to test this hypothesis. Results indicated that a homogeneous reliability model was not supported by the data. A congeneric measurement model represented a better fit to the data. Results suggest that subjects have consistent patterns of response during separate experimental occasions. However, results do not suggest a consistent pattern of response over time. The main implication of these results is that salivary cortisol measures are sensitive to experimental stress situations. As such, this noninvasive method may be useful in examining adaptive responses to stress.

Authors
Préville, M; Susman, E; Zarit, SH; Smyer, M; Bosworth, HB; Reid, JD
MLA Citation
Préville, M, Susman, E, Zarit, SH, Smyer, M, Bosworth, HB, and Reid, JD. "A measurement model of cortisol reactivity of healthy older adults." J Gerontol B Psychol Sci Soc Sci 51.2 (March 1996): P64-P69.
PMID
8785688
Source
pubmed
Published In
Journals of Gerontology: Series B
Volume
51
Issue
2
Publish Date
1996
Start Page
P64
End Page
P69
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