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Zullig, Leah L

Overview:

Leah L. Zullig, PhD, MPH is a health services researcher, Assistant Professor in the Duke Department of Medicine, investigator at the Durham Veterans Affairs Medical Center, and Adjunct Assistant Professor of Health Policy and Management at the University of North Carolina at Chapel Hill. Her research is supported by a VA HSR&D Career Development Award, focused on improving colorectal cancer survivors’ care quality through a self-management intervention bridging cancer surveillance and chronic disease management. Dr. Zullig’s overarching research interests address the reduction of healthcare disparities, developing cancer care quality monitoring systems, and promoting patient chronic disease self-management. She has authored over 70 peer-reviewed publications.

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, and Health Services Research


Positions:

Assistant Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2013

Ph.D. — University of North Carolina at Chapel Hill

Fellow

Washington University

Grants:

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
AwardedBy
National Institutes of Health
Role
Faculty Member
Start Date
September 01, 2017
End Date
August 31, 2022

PhRMA Editorial

Administered By
Population Health Sciences
AwardedBy
PhRMA Foundation
Role
Investigator
Start Date
July 01, 2017
End Date
December 31, 2017

Publications:

Improving Medication Adherence in Coronary Heart Disease.

The purpose of this review was to synthesize research findings from recently published randomized controlled trials (RCTs) targeting any phase of medication adherence, from initiation to discontinuation, among patients with coronary heart disease (CHD).We identified successful strategies and promising practices for improving medication adherence among patients diagnosed with CHD. Consistent intervention strategies included the following: (1) facilitating patient-provider communication, (2) using mHealth technologies with emphasis on two-way communication, (3) providing patient education in tandem with lifestyle and behavioral counseling, and (4) providing psychosocial support. Regarding medication adherence phases, all studies examined implementation (i.e., taking medications as prescribed over time) and one also addressed treatment initiation (i.e., beginning a new medication). None identified addressed discontinuation. Studies varied by use of objective, self-report, and a combination of outcome measures with a greater number reporting only subjective measures of adherence. Key findings remained mixed in supporting specific intervention designs or delivery formats. This review addresses available data of promising practices for improving CHD medication adherence. Future studies are needed to examine intervention effectiveness, scalability, and durability of observed outcome effects.

Authors
Zullig, LL; Ramos, K; Bosworth, HB
MLA Citation
Zullig, LL, Ramos, K, and Bosworth, HB. "Improving Medication Adherence in Coronary Heart Disease." Current cardiology reports 19.11 (September 22, 2017): 113-. (Review)
PMID
28940020
Source
epmc
Published In
Current Cardiology Reports
Volume
19
Issue
11
Publish Date
2017
Start Page
113
DOI
10.1007/s11886-017-0918-y

Changes in the Delivery of Veterans Affairs Cancer Care: Ensuring Delivery of Coordinated, Quality Cancer Care in a Time of Uncertainty.

Authors
Zullig, LL; Goldstein, KM; Bosworth, HB
MLA Citation
Zullig, LL, Goldstein, KM, and Bosworth, HB. "Changes in the Delivery of Veterans Affairs Cancer Care: Ensuring Delivery of Coordinated, Quality Cancer Care in a Time of Uncertainty." Journal of oncology practice (September 11, 2017): JOP2017021527-.
PMID
28892409
Source
epmc
Published In
Journal of Oncology Practice
Publish Date
2017
Start Page
JOP2017021527
DOI
10.1200/jop.2017.021527

Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers.

In the past decade, there has been an increase in the development and use of oral anti-cancer medications (OAMs), especially for breast cancer-the most prevalent cancer in women. However, adherence rates for OAMs are often suboptimal, leading to lower survival rate, increased risk of recurrence, and higher healthcare costs. Our goal was to identify potentially modifiable psychosocial facilitators and barriers that may be targeted to increase OAM adherence for breast cancer patients.We systematically searched PubMed for studies published in the U.S. by June 15, 2016 that addressed the following: (1) OAMs for breast cancer; (2) medication adherence; and (3) at least one psychosocial aspect of adherence.Of the 1752 papers screened, 21 articles were included and analyzed. The most commonly reported motivators for adherence are patient-provider relationships (n = 11 studied, 82% reported significant association) and positive views and beliefs of medication (n = 9 studied, 89% reported significant association). We also identified consistent evidence of the impact of depression and emotions, perception of illness, concern of side effects, self-efficacy in medication management and decision making, knowledge of medication, and social support on OAM adherence.Compared to traditional demographic, system, and clinical-related factors that have been well documented in the literature but are not easily changed, these cognitive, psychological, and interpersonal factors are more amendable via intervention and therefore could generate greater benefit in improving patient compliance and health outcomes. As OAMs shift treatment administration responsibility onto patients, continuous provider communication and education on illness and regimen are the keys to supporting patients' medication behavior.

Authors
Lin, C; Clark, R; Tu, P; Bosworth, HB; Zullig, LL
MLA Citation
Lin, C, Clark, R, Tu, P, Bosworth, HB, and Zullig, LL. "Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers." Breast cancer research and treatment 165.2 (September 2017): 247-260. (Review)
PMID
28573448
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
165
Issue
2
Publish Date
2017
Start Page
247
End Page
260
DOI
10.1007/s10549-017-4317-2

Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study.

While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.

Authors
Zullig, LL; Diamantidis, CJ; Bosworth, HB; Bhapkar, MV; Barnhart, H; Oakes, MM; Pendergast, JF; Miller, JJ; Patel, UD
MLA Citation
Zullig, LL, Diamantidis, CJ, Bosworth, HB, Bhapkar, MV, Barnhart, H, Oakes, MM, Pendergast, JF, Miller, JJ, and Patel, UD. "Racial differences in nocturnal dipping status in diabetic kidney disease: Results from the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study." Journal of clinical hypertension (Greenwich, Conn.) (August 20, 2017).
PMID
28834119
Source
epmc
Published In
Journal of Clinical Hypertension
Publish Date
2017
DOI
10.1111/jch.13088

Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.

Authors
Berkowitz, C; Allen, DH; Tenhover, J; Zullig, LL; Ragsdale, J; Fischer, JE; Pollak, KI; Koontz, BF
MLA Citation
Berkowitz, C, Allen, DH, Tenhover, J, Zullig, LL, Ragsdale, J, Fischer, JE, Pollak, KI, and Koontz, BF. "Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care." Journal of cancer education : the official journal of the American Association for Cancer Education (July 14, 2017).
PMID
28707205
Source
epmc
Published In
Journal of Cancer Education
Publish Date
2017
DOI
10.1007/s13187-017-1250-3

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) 26.7 (July 2017): 806-814.
PMID
28192012
Source
epmc
Published In
Journal of Women's Health
Volume
26
Issue
7
Publish Date
2017
Start Page
806
End Page
814
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 100.7 (July 2017): 1410-1414.
PMID
28214168
Source
epmc
Published In
Patient Education and Counseling
Volume
100
Issue
7
Publish Date
2017
Start Page
1410
End Page
1414
DOI
10.1016/j.pec.2017.02.001

Trajectory of systolic blood pressure in a low-income, racial-ethnic minority cohort with diabetes and baseline uncontrolled hypertension.

In two primary care clinics in Texas serving low-income patients, systolic blood pressure (SBP) trajectory was examined during 2 years in patients with diabetes mellitus (mean SBP ≥140 mm Hg: 152 mm Hg±11.2 in the baseline year). Among 860 eligible patients, 62.0% were women, 78.8% were Hispanic, and 41.2% were uninsured. Overall, SBP dropped 0.56 mm Hg per month or 13.4 mm Hg by 24 months. For patients with mean glycated hemoglobin ≥9% in year 1, SBP declined 4.8 mm Hg less by 24 months vs those with glycated hemoglobin <7% (P=.03). Compared with white women, SPB declined 7.2 mm Hg less by 24 months in Hispanic women (P=.03) and 9.6 mm Hg less by 24 months in black men (P=.04). SBP also declined 9.1 mm Hg less by 24 months for patients taking four or more blood pressure drug classes at baseline vs one drug class. In this low-income cohort, clinically complex patients and racial-ethnic minorities had clinically significantly smaller declines in SBP.

Authors
Zullig, LL; Liang, Y; Vale Arismendez, S; Trevino, A; Bosworth, HB; Turner, BJ
MLA Citation
Zullig, LL, Liang, Y, Vale Arismendez, S, Trevino, A, Bosworth, HB, and Turner, BJ. "Trajectory of systolic blood pressure in a low-income, racial-ethnic minority cohort with diabetes and baseline uncontrolled hypertension." Journal of clinical hypertension (Greenwich, Conn.) 19.7 (July 2017): 722-730.
PMID
28371157
Source
epmc
Published In
Journal of Clinical Hypertension
Volume
19
Issue
7
Publish Date
2017
Start Page
722
End Page
730
DOI
10.1111/jch.12984

Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update.

Nearly 50,000 incident cancer cases are reported in Veterans Affairs (VA) Central Cancer Registry (VACCR) annually. This article provides an updated report of cancer incidence recorded in VACCR.Data were obtained from VACCR for incident cancers diagnosed in the VA health care system, focusing on 2010 data. Cancer incidence among VA patients is described by anatomical site, sex, race, stage, and geographic location, and was compared to the general U.S. cancer population.In 2010, among 46,170 invasive cancers, 97% were diagnosed among men. Approximately 80% of newly diagnosed patients were white, 19% black, and less than 2% were other minority races. Median age at diagnosis was 65 years. The three most frequently diagnosed cancers among VA were prostate (29%), lung/bronchus (18%), and colon/rectum (8%). Melanoma and kidney/renal pelvis tied for fourth (4%), and urinary bladder tied for sixth with liver and intrahepatic bile duct (3.4%). Approximately 23% of prostate, 21% of lung/bronchus, and 31% of colon/rectum cancers were diagnosed with Stage I disease. The overall invasive cancer incidence rate among VA users was 505.8 per 100,000 person-years.Although the composition of the VA population is shifting and includes a larger number of women, registry data indicate that incident cancers in VA in 2010 were most similar to those observed among U.S. men. Consistent reporting of VACCR data is important to provide accurate estimates of VA cancer incidence. This information can be used to plan efforts to improve quality of cancer care and access to services.

Authors
Zullig, LL; Sims, KJ; McNeil, R; Williams, CD; Jackson, GL; Provenzale, D; Kelley, MJ
MLA Citation
Zullig, LL, Sims, KJ, McNeil, R, Williams, CD, Jackson, GL, Provenzale, D, and Kelley, MJ. "Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update." Military medicine 182.7 (July 2017): e1883-e1891.
PMID
28810986
Source
epmc
Published In
Military medicine
Volume
182
Issue
7
Publish Date
2017
Start Page
e1883
End Page
e1891
DOI
10.7205/milmed-d-16-00371

The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients.

Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs).To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAPs.This was a retrospective study of prescription anticancer medication costs and PAP coverage. The study used data from an academic cancer center's specialty pharmacy. Medication, cost, and coverage data were collected from the specialty pharmacy database for prescriptions filled from January 2013 to November 2015. Prescriptions with missing copayments, insurance, or financial assistance amounts were excluded. Descriptive statistics summarized prescription characteristics.Of 9,388 anticancer medication prescriptions filled, 8,212 (87%) had complete cost data and were included. The 5 most common medications prescribed were capecitabine (20%), temozolomide (13%), enzalutamide (10%), letrozole (6%), and tamoxifen (4%). Most prescriptions were covered by commercial insurance or Part D (41.6%, n = 3,418). The median copayment was $20 per prescription (interquartile range [IQR] = $10.00-$80.30). When considering all prescriptions that received PAP assistance, the median amount of financial assistance provided by PAPs per prescription was $411.0 (IQR = $302.80-$523.40), amounting to 15% of the median prescription cash price. When considering all prescriptions, the median amount of financial assistance provided by PAPs per prescription was $0, and the mean was $79.30 (SD = $389.90).A minority of prescriptions received financial assistance from PAPs. The proportion of financial assistance was small relative to the price billed to insurance. PAPs play a modest role in reducing anticancer prescription-related costs.Support of this project by The Duke Biostatistics Core was made possible by Grant Number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Zullig is supported by a VA Health Services Research and Development (HSR&D) Career Development Award (CDA 13-025). Zullig also reports a financial relationship with Novartis. Zafar reports financial relationships with Novartis, Genentech-Roche, and Vivor. Vlastelica, Shankaran, and Wolf have nothing to disclose. The views in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, Duke University, NCATS, or NIH. This abstract was previously presented at the 2016 ASCO Annual Meeting; Chicago, Illinois; June 3-7, 2016. Study concept and design were contributed by Zafar, Zullig, and Vlastelica, with assistance from Shankaran. Vlastelica and Wolf took the lead in data collection, along with Zafar, and data interpretation was performed by Zullig, Zafar, and Wolf, along with Vlastelica and Shankaran. The manuscript was written and revised by Zullig and Zafar, along with the other authors.

Authors
Zullig, LL; Wolf, S; Vlastelica, L; Shankaran, V; Zafar, SY
MLA Citation
Zullig, LL, Wolf, S, Vlastelica, L, Shankaran, V, and Zafar, SY. "The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients." Journal of managed care & specialty pharmacy 23.4 (April 2017): 407-411.
PMID
28345445
Source
epmc
Published In
Journal of managed care & specialty pharmacy
Volume
23
Issue
4
Publish Date
2017
Start Page
407
End Page
411
DOI
10.18553/jmcp.2017.23.4.407

Next steps to improve disparities in lung cancer treatment clinical trial enrollment.

Authors
Zullig, LL; Carpenter, WR; Williams, CD
MLA Citation
Zullig, LL, Carpenter, WR, and Williams, CD. "Next steps to improve disparities in lung cancer treatment clinical trial enrollment." Annals of translational medicine 5.5 (March 2017): 118-.
PMID
28361083
Source
epmc
Published In
Annals of translational medicine
Volume
5
Issue
5
Publish Date
2017
Start Page
118
DOI
10.21037/atm.2017.01.25

ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol.

Medication adherence is fundamental to achieving optimal patient outcomes. Reporting research on medication adherence suffers from some issues-including conceptualisation, measurement and data analysis-that thwart its advancement. Using the ABC taxonomy for medication adherence as the conceptual basis, a steering committee of members of the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) launched an initiative to develop ESPACOMP Medication Adherence Reporting Guidelines (EMERGE). This paper is a protocol for a Delphi study that aims to build consensus among a group of topic experts regarding an item list that will support developing EMERGE.This study uses a reactive-Delphi design where a group of topic experts will be asked to rate the relevance and clarity of an initial list of items, in addition to suggesting further items and/or modifications of the initial items. The initial item list, generated by the EMERGE steering committee through a structured process, consists of 26 items distributed in 2 sections: 4 items representing the taxonomy-based minimum reporting criteria, and 22 items organised according to the common reporting sections. A purposive sample of experts will be selected from relevant disciplines and diverse geographical locations. Consensus will be achieved through predefined decision rules to keep, delete or modify the items. An iterative process of online survey rounds will be carried out until consensus is reached.An ethics approval was not required for the study according to the Swiss federal act on research involving human beings. The participating experts will be asked to give an informed consent. The results of this Delphi study will feed into EMERGE, which will be disseminated through peer-reviewed publications and presentations at conferences. Additionally, the steering committee will encourage their endorsement by registering the guidelines at the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network and other relevant organisations.

Authors
Helmy, R; Zullig, LL; Dunbar-Jacob, J; Hughes, DA; Vrijens, B; Wilson, IB; De Geest, S
MLA Citation
Helmy, R, Zullig, LL, Dunbar-Jacob, J, Hughes, DA, Vrijens, B, Wilson, IB, and De Geest, S. "ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol." BMJ open 7.2 (February 10, 2017): e013496-.
PMID
28188154
Source
epmc
Published In
BMJ Open
Volume
7
Issue
2
Publish Date
2017
Start Page
e013496
DOI
10.1136/bmjopen-2016-013496

ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol

Authors
Helmy, R; Zullig, LL; Dunbar-Jacob, J; Hughes, DA; Vrijens, B; Wilson, IB; De Geest, S
MLA Citation
Helmy, R, Zullig, LL, Dunbar-Jacob, J, Hughes, DA, Vrijens, B, Wilson, IB, and De Geest, S. "ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol." BMJ OPEN 7.2 (February 2017).
Source
wos-lite
Published In
BMJ Open
Volume
7
Issue
2
Publish Date
2017
DOI
10.1136/bmjopen-2016-013496

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

Coming full circle in the measurement of medication adherence: opportunities and implications for health care.

There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.

Authors
Whalley Buono, E; Vrijens, B; Bosworth, HB; Liu, LZ; Zullig, LL; Granger, BB
MLA Citation
Whalley Buono, E, Vrijens, B, Bosworth, HB, Liu, LZ, Zullig, LL, and Granger, BB. "Coming full circle in the measurement of medication adherence: opportunities and implications for health care." Patient preference and adherence 11 (January 2017): 1009-1017.
PMID
28652710
Source
epmc
Published In
Patient Preference and Adherence
Volume
11
Publish Date
2017
Start Page
1009
End Page
1017
DOI
10.2147/ppa.s127131

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

Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients.

Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV and the relationship between the two.We used SEER-Medicare data to evaluate the health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between (1) race and CINV-related utilization and (2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI).The study included 1130 women. Black women were 11 % less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p = 0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR = 0.63, 95 %CI = 0.40-0.99; p = 0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p = 0.07). Among white women, NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95 % CI = 1.07-1.69, p = 0.01), likely resulting from unmeasured confounders.Black women were less likely to use NK1s- and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.

Authors
Check, DK; Reeder-Hayes, KE; Zullig, LL; Weinberger, M; Basch, EM; Dusetzina, SB
MLA Citation
Check, DK, Reeder-Hayes, KE, Zullig, LL, Weinberger, M, Basch, EM, and Dusetzina, SB. "Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 24.12 (December 2016): 4839-4847.
PMID
27465051
Source
epmc
Published In
Supportive Care in Cancer
Volume
24
Issue
12
Publish Date
2016
Start Page
4839
End Page
4847
DOI
10.1007/s00520-016-3338-4

Validation and Quality Assessment of the Kilimanjaro Cancer Registry.

Global cancer burden has increasingly shifted to low- and middle-income countries and is particularly pronounced in Africa. There remains a lack of comprehensive cancer information as a result of limited cancer registry development. In Moshi, Tanzania, a regional cancer registry exists at Kilimanjaro Christian Medical Center. Data quality is unknown. Our objective was to evaluate the completeness and quality of the Kilimanjaro Cancer Registry (KCR).In October 2015, we conducted a retrospective review of KCR by validating the internal consistency of registry records with medical and pathology records. We randomly sampled approximately 100 total registry cases. Four reviewers not associated with the KCR manually collected data elements from medical records and compared them with KCR data.All 100 reviewed registry cases had complete cancer site and morphology included in the registry. Six had a recorded stage. For the majority (n = 92), the basis of diagnosis was pathology. Pathology reports were found in the medical record for 40% of patients; for the remainder, these were stored separately in the pathology department. Of sampled registry cases, the KCR and medical records were 98% and 94% concordant for primary cancer site and morphology, respectively. For 28%, recorded diagnosis dates were within 14 days of what was found in the medical record, and for 32%, they were within 30 days.The KCR has a high level of concordance for classification and coding when data are retrieved for validation. This parameter is one of the most important for measuring data quality in a regional cancer registry.

Authors
Zullig, LL; Schroeder, K; Nyindo, P; Namwai, T; Silayo, E; Msomba, A; Munishi, MO; Karia, F; Muiruri, C; Bartlett, J; Maro, V; Zafar, SY
MLA Citation
Zullig, LL, Schroeder, K, Nyindo, P, Namwai, T, Silayo, E, Msomba, A, Munishi, MO, Karia, F, Muiruri, C, Bartlett, J, Maro, V, and Zafar, SY. "Validation and Quality Assessment of the Kilimanjaro Cancer Registry." Journal of global oncology 2.6 (December 2016): 381-386.
Website
http://hdl.handle.net/10161/15102
PMID
28717724
Source
epmc
Published In
Journal of Global Oncology
Volume
2
Issue
6
Publish Date
2016
Start Page
381
End Page
386
DOI
10.1200/jgo.2015.002873

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-. (Review)
PMID
27696318
Source
epmc
Published In
Current Atherosclerosis Reports
Volume
18
Issue
11
Publish Date
2016
Start Page
63
DOI
10.1007/s11883-016-0619-9

Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening.

Colorectal cancer (CRC) remains a common cancer and significant public health burden. CRC-related mortality is declining, partly due to the early detection of CRC through robust screening. NCCN has established the NCCN Guidelines for CRC Screening to help healthcare providers make appropriate screening recommendations according to the patient's risk of developing CRC. This review describes the evolution of CRC screening guidelines for average-risk individuals, discusses the role of NCCN Guidelines for CRC Screening in cancer prevention, and comments on the current and emerging use of biomarkers for CRC screening.

Authors
Williams, CD; Grady, WM; Zullig, LL
MLA Citation
Williams, CD, Grady, WM, and Zullig, LL. "Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening." Journal of the National Comprehensive Cancer Network : JNCCN 14.11 (November 2016): 1479-1485. (Review)
PMID
27799515
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
11
Publish Date
2016
Start Page
1479
End Page
1485
DOI
10.6004/jnccn.2016.0154

Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress.

Cancer patients may experience financial distress as a side effect of their care. Little is known about which patients are at greatest risk for altering their care or lifestyle due to treatment-related financial distress.We conducted a cross-sectional survey study to determine which patients are at greatest risk for altering their care or lifestyle due to treatment-related financial distress. Eligible patients were adults receiving cancer treatment enrolled between June 2010 and May 2011. We grouped coping strategies as lifestyle altering or care altering. We assessed coping strategies and relationships between covariates using descriptive statistics and analysis of variance.Among 174 participants, 89% used at least one lifestyle-altering coping strategy, while 39% used a care-altering strategy. Care-altering coping strategies adopted by patients included the following: not filling a prescription (28%) and taking less medication than prescribed (23%). Lifestyle-altering strategies included the following: spending less on leisure activities (77%), spending less on basics like food and clothing (57%), borrowing money (54%), and spending savings (50%). Younger patients were more likely than older patients to use coping strategies (p < 0.001). Lower-income patients adopted care-altering strategies more than higher-income patients (p = 0.03). Participants with more education and shorter duration of chemotherapy used lifestyle-altering strategies more than their counterparts (both p < 0.05).As a means of coping with treatment-related financial distress, patients were more likely to use lifestyle-altering approaches, but more than one-third adopted potentially harmful care-altering strategies. Younger age, lower income, higher education, and shorter duration of chemotherapy were characteristics associated with greater use of coping strategies. Copyright © 2015 John Wiley & Sons, Ltd.

Authors
Nipp, RD; Zullig, LL; Samsa, G; Peppercorn, JM; Schrag, D; Taylor, DH; Abernethy, AP; Zafar, SY
MLA Citation
Nipp, RD, Zullig, LL, Samsa, G, Peppercorn, JM, Schrag, D, Taylor, DH, Abernethy, AP, and Zafar, SY. "Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress." Psycho-oncology 25.6 (June 2016): 719-725.
PMID
26149817
Source
epmc
Published In
Psycho-Oncology
Volume
25
Issue
6
Publish Date
2016
Start Page
719
End Page
725
DOI
10.1002/pon.3911

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

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

Feasibility and Smokers' Evaluation of Self-Generated Text Messages to Promote Quitting.

Cigarette smoking is a leading cause of preventable mortality. Mobile technologies, including text messaging, provide opportunities to promote quitting. Many text messaging-based cessation interventions contain content created by experts. However, smokers may be best persuaded by receipt of text messages they created based on their reasons for quitting, assisted or not by a motivational facilitator. This study assessed the feasibility and participants' evaluation of two ways to self-generate smoking cessation messages delivered via cell-phone.We enrolled smokers (N = 24) and randomized them to: (1) behavioral counseling assistance plus self-generated messages, or (2) self-generated messages only. Both groups wrote: (1) their reasons for wanting to quit and then (2) text messages related to their reason(s) for quitting, Messages were delivered as text messages as well as with a link to verbatim self-recorded audio message for 10 days. At follow-up, participants evaluated the intervention.Participants composed and recorded messages and evaluated them and the intervention favorably. The counseling+message group wrote an average of 7.66 (SD = 4.86) text messages while the message-only wrote an average of 6.66 (SD = 2.93) messages. Most participants felt that the messages were of appropriate length, including the frequency and timing of message delivery.It is feasible for smokers to self-generate motivational text and audio messages concerning reasons for quitting, even among smokers without an immediate desire to quit. Participants evaluated the messages and intervention favorably. Future research should test self-generated messages in larger trials of self- versus expert-generated message.This study assessed the feasibility and participants' evaluation of two ways to self-generate smoking cessation messages delivered via cell-phone. It is feasible for smokers to self-generate motivational text and audio messages concerning reasons for quitting, even among smokers without an immediate desire to quit. Participants evaluated the messages and intervention favorable. Future research should test self-generated messages in larger trials of self- versus expert-generated messages.

Authors
Shaw, RJ; Pollak, K; Zullig, LL; Bennett, G; Hawkins, K; Lipkus, I
MLA Citation
Shaw, RJ, Pollak, K, Zullig, LL, Bennett, G, Hawkins, K, and Lipkus, I. "Feasibility and Smokers' Evaluation of Self-Generated Text Messages to Promote Quitting." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18.5 (May 2016): 1206-1209.
PMID
26647104
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
18
Issue
5
Publish Date
2016
Start Page
1206
End Page
1209
DOI
10.1093/ntr/ntv268

FACTORS ASSOCIATED WITH SUSTAINED UNCONTROLLED HYPERTENSION IN A LOW-INCOME, LARGELY HISPANIC PRIMARY CARE COHORT WITH DIABETES

Authors
Zullig, LL; Liang, Y; Vale, S; Bosworth, H; Turner, BJ
MLA Citation
Zullig, LL, Liang, Y, Vale, S, Bosworth, H, and Turner, BJ. "FACTORS ASSOCIATED WITH SUSTAINED UNCONTROLLED HYPERTENSION IN A LOW-INCOME, LARGELY HISPANIC PRIMARY CARE COHORT WITH DIABETES." May 2016.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
31
Publish Date
2016
Start Page
S223
End Page
S224

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer.

Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. We used 2006-2012 SEER-Medicare data to evaluate the use of neurokinin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). The study included 1130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95 % CI 0.51-0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95 % CI 0.35-0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. We found racial disparities in women's use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.

Authors
Check, DK; Reeder-Hayes, KE; Basch, EM; Zullig, LL; Weinberger, M; Dusetzina, SB
MLA Citation
Check, DK, Reeder-Hayes, KE, Basch, EM, Zullig, LL, Weinberger, M, and Dusetzina, SB. "Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer." Breast cancer research and treatment 156.2 (April 2016): 351-359.
PMID
26968396
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
156
Issue
2
Publish Date
2016
Start Page
351
End Page
359
DOI
10.1007/s10549-016-3747-6

How Context Matters: A Dissemination and Implementation Primer for Global Oncologists.

Authors
Koczwara, B; Birken, SA; Perry, CK; Cragun, D; Zullig, LL; Ginossar, T; Nodora, J; Chawla, N; Ramanadhan, S; Kerner, J; Brownson, RC
MLA Citation
Koczwara, B, Birken, SA, Perry, CK, Cragun, D, Zullig, LL, Ginossar, T, Nodora, J, Chawla, N, Ramanadhan, S, Kerner, J, and Brownson, RC. "How Context Matters: A Dissemination and Implementation Primer for Global Oncologists." Journal of global oncology 2.2 (April 2016): 51-55.
PMID
28717683
Source
epmc
Published In
Journal of Global Oncology
Volume
2
Issue
2
Publish Date
2016
Start Page
51
End Page
55
DOI
10.1200/jgo.2015.001438

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among breast cancer patients

Authors
Check, D; Reeder-Hayes, KE; Basch, EM; Zullig, LL; Weinberger, M; Dusetzina, S
MLA Citation
Check, D, Reeder-Hayes, KE, Basch, EM, Zullig, LL, Weinberger, M, and Dusetzina, S. "Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among breast cancer patients." March 1, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
7
Publish Date
2016

Validation and quality assessment of the Kilimanjaro Cancer Registry

Authors
Zullig, LL; Muiruri, C; Nyindo, P; Namwai, T; Karia, F; Oresto, M; Silayo, E; Msomba, A; Bartlett, J; Zafar, Y
MLA Citation
Zullig, LL, Muiruri, C, Nyindo, P, Namwai, T, Karia, F, Oresto, M, Silayo, E, Msomba, A, Bartlett, J, and Zafar, Y. "Validation and quality assessment of the Kilimanjaro Cancer Registry." March 1, 2016.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
34
Issue
7
Publish Date
2016

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.

Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes.Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models.We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process.From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors.This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.

Authors
Zullig, LL; Whitson, HE; Hastings, SN; Beadles, C; Kravchenko, J; Akushevich, I; Maciejewski, ML
MLA Citation
Zullig, LL, Whitson, HE, Hastings, SN, Beadles, C, Kravchenko, J, Akushevich, I, and Maciejewski, ML. "A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development." Journal of General Internal Medicine 31.3 (March 2016): 329-337. (Review)
Website
http://hdl.handle.net/10161/14815
PMID
26423992
Source
epmc
Published In
Journal of General Internal Medicine
Volume
31
Issue
3
Publish Date
2016
Start Page
329
End Page
337
DOI
10.1007/s11606-015-3512-2

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

Enrollment and Racial Disparities in Cancer Treatment Clinical Trials in North Carolina.

Clinical trials provide access to innovative, high-quality cancer treatment. Simultaneously, broad access helps to ensure that trials include heterogeneous patient populations, which improves the generalizability of findings and the development of interventions that are effective for diverse populations. We provide updated data describing enrollment into cancer treatment trials in North Carolina.For the period 1996-2009, person-level data regarding cancer clinical trial enrollment and cancer incidence were obtained from the North Carolina Central Cancer Registry and the National Cancer Institute (NCI). Enrollment rates were estimated as the ratio of trial enrollment to cancer incidence for race, sex, and year for each county, Area Health Education Center region, and the state overall. Enrollment rates for common cancers are presented.From 1996 to 2009, North Carolina NCI treatment trial enrollment rates were 2.4% and 2.2% for white patients and minority patients, respectively. From 2007 to 2009, rates were 3.8% for white women, 3.5% for minority women, 1.3% for white men, and 1.0% for minority men; there was greater enrollment among more urban populations (2.4%) than among the most rural populations (1.5%).This study is limited to NCI-sponsored treatment trials in North Carolina. Policies governing collection of original data necessitate a delay in data availability.Effort is needed to ensure trial access and enrollment among all North Carolina populations. Specifically, we identified racial and sex disparities, particularly for certain cancers (eg, breast cancer). Programs in North Carolina and across the nation can use the methods we employed to assess their success in broadening clinical trial enrollment to include diverse populations.

Authors
Zullig, LL; Fortune-Britt, AG; Rao, S; Tyree, SD; Godley, PA; Carpenter, WR
MLA Citation
Zullig, LL, Fortune-Britt, AG, Rao, S, Tyree, SD, Godley, PA, and Carpenter, WR. "Enrollment and Racial Disparities in Cancer Treatment Clinical Trials in North Carolina." North Carolina medical journal 77.1 (January 2016): 52-58.
PMID
26763244
Source
epmc
Published In
North Carolina Medical Journal
Volume
77
Issue
1
Publish Date
2016
Start Page
52
End Page
58
DOI
10.18043/ncm.77.1.52

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

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

What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?

A number of observational studies and clinical trials have shown that physical activity after a diagnosis of prostate cancer is associated with a decrease in disease progression and an increase in survival, and that specific exercises reduce morbidity from prostate cancer treatments. However, providers need more guidance on what types of physical activity to recommend to patients across different disease states and treatments in prostate cancer, and when and how to initiate the discussion. In addition to evaluating important studies showing benefits of physical activity in patients with prostate cancer, this review suggests some evidence-based methods for incorporating physical activity interventions into clinical practice.

Authors
Ramalingam, S; Pollak, KI; Zullig, LL; Harrison, MR
MLA Citation
Ramalingam, S, Pollak, KI, Zullig, LL, and Harrison, MR. "What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?." Oncology (Williston Park, N.Y.) 29.9 (September 1, 2015). (Review)
Source
scopus
Published In
Oncology
Volume
29
Issue
9
Publish Date
2015

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

What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?

A number of observational studies and clinical trials have shown that physical activity after a diagnosis of prostate cancer is associated with a decrease in disease progression and an increase in survival, and that specific exercises reduce morbidity from prostate cancer treatments. However, providers need more guidance on what types of physical activity to recommend to patients across different disease states and treatments in prostate cancer, and when and how to initiate the discussion. In addition to evaluating important studies showing benefits of physical activity in patients with prostate cancer, this review suggests some evidence-based methods for incorporating physical activity interventions into clinical practice.

Authors
Ramalingam, S; Pollak, KI; Zullig, LL; Harrison, MR
MLA Citation
Ramalingam, S, Pollak, KI, Zullig, LL, and Harrison, MR. "What Should We Tell Patients About Physical Activity After a Prostate Cancer Diagnosis?." Oncology (Williston Park, N.Y.) 29.9 (September 2015): 680-694. (Review)
PMID
26384805
Source
epmc
Published In
Oncology
Volume
29
Issue
9
Publish Date
2015
Start Page
680
End Page
694

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 (August 7, 2015): 1435-1441.
Source
scopus
Published In
Clinical Rheumatology
Volume
34
Issue
8
Publish Date
2015
Start Page
1435
End Page
1441
DOI
10.1007/s10067-014-2707-y

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

Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system.

The current study was performed to determine whether patient characteristics, including race/ethnicity, were associated with patient-reported care coordination for patients with colorectal cancer (CRC) who were treated in the Veterans Affairs (VA) health care system, with the goal of better understanding potential goals of quality improvement efforts aimed at improving coordination.The nationwide Cancer Care Assessment and Responsive Evaluation Studies survey involved VA patients with CRC who were diagnosed in 2008 (response rate, 67%). The survey included a 4-item scale of patient-reported frequency ("never," "sometimes," "usually," and "always") of care coordination activities (scale score range, 1-4). Among 913 patients with CRC who provided information regarding care coordination, demographics, and symptoms, multivariable logistic regression was used to examine odds of patients reporting optimal care coordination.VA patients with CRC were found to report high levels of care coordination (mean scale score, 3.50 [standard deviation, 0.61]). Approximately 85% of patients reported a high level of coordination, including the 43% reporting optimal/highest-level coordination. There was no difference observed in the odds of reporting optimal coordination by race/ethnicity. Patients with early-stage disease (odds ratio [OR], 0.60; 95% confidence interval [95% CI], 0.45-0.81), greater pain (OR, 0.97 for a 1-point increase in pain scale; 95% CI, 0.96-0.99), and greater levels of depression (OR, 0.97 for a 1-point increase in depression scale; 95% CI, 0.96-0.99) were less likely to report optimal coordination.Patients with CRC in the VA reported high levels of care coordination. Unlike what has been reported in settings outside the VA, there appears to be no racial/ethnic disparity in reported coordination. However, challenges remain in ensuring coordination of care for patients with less advanced disease and a high symptom burden. Cancer 2015;121:2207-2213. © 2015 American Cancer Society.

Authors
Jackson, GL; Zullig, LL; Phelan, SM; Provenzale, D; Griffin, JM; Clauser, SB; Haggstrom, DA; Jindal, RM; van Ryn, M
MLA Citation
Jackson, GL, Zullig, LL, Phelan, SM, Provenzale, D, Griffin, JM, Clauser, SB, Haggstrom, DA, Jindal, RM, and van Ryn, M. "Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system." Cancer 121.13 (July 2015): 2207-2213.
PMID
25782082
Source
epmc
Published In
Cancer
Volume
121
Issue
13
Publish Date
2015
Start Page
2207
End Page
2213
DOI
10.1002/cncr.29341

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

PATIENT-REPORTED MEDICATION ADHERENCE BARRIERS AMONG VETERANS AFFAIRS PATIENTS WITH CARDIOVASCULAR RISK FACTORS

Authors
Zullig, LL; Stechuchak, K; Goldstein, KM; Olsen, M; McCant, FA; Danus, SM; Crowley, M; Oddone, E; Bosworth, H
MLA Citation
Zullig, LL, Stechuchak, K, Goldstein, KM, Olsen, M, McCant, FA, Danus, SM, Crowley, M, Oddone, E, and Bosworth, H. "PATIENT-REPORTED MEDICATION ADHERENCE BARRIERS AMONG VETERANS AFFAIRS PATIENTS WITH CARDIOVASCULAR RISK FACTORS." April 2015.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
30
Publish Date
2015
Start Page
S224
End Page
S224

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

Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system.

Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans' health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes.

Authors
Zullig, LL; Williams, CD; Fortune-Britt, AG
MLA Citation
Zullig, LL, Williams, CD, and Fortune-Britt, AG. "Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system." Cancer management and research 7 (January 14, 2015): 19-35. (Review)
PMID
25609998
Source
epmc
Published In
Cancer Management and Research
Volume
7
Publish Date
2015
Start Page
19
End Page
35
DOI
10.2147/cmar.s75463

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-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

The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature (vol 10, pg 2189, 2014)

Authors
Bestvina, CM; Zullig, LL; Zafar, SY
MLA Citation
Bestvina, CM, Zullig, LL, and Zafar, SY. "The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature (vol 10, pg 2189, 2014)." FUTURE ONCOLOGY 11.3 (2015): 544-544.
Source
wos-lite
Published In
Future oncology (London, England)
Volume
11
Issue
3
Publish Date
2015
Start Page
544
End Page
544
DOI
10.2217/fon.14.304

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 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. (Review)
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

The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature.

Advances in cancer diagnosis and treatment have led to increased societal costs and out-of-pocket patient cost. We reviewed the literature on the impact of out-of-pocket cancer care costs on the patient experience, and described efforts made to address these costs. A critical appraisal of articles published in the USA from 2004 to 2014 was performed. The literature revealed that even insured patients receiving anticancer therapy are vulnerable to financial distress, which can impel patients to borrow money, deplete their savings, or engage in cost-coping strategies including nonadherence to prescribed treatment. Additional research is required to define financial distress risk factors, patient-physician communication of the costs of cancer care, and supportive care models for patients and survivors with substantial financial burdens.

Authors
Bestvina, CM; Zullig, LL; Yousuf Zafar, S
MLA Citation
Bestvina, CM, Zullig, LL, and Yousuf Zafar, S. "The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature." Future oncology (London, England) 10.14 (November 2014): 2189-2199. (Review)
PMID
25471033
Source
epmc
Published In
Future oncology (London, England)
Volume
10
Issue
14
Publish Date
2014
Start Page
2189
End Page
2199
DOI
10.2217/fon.14.130

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

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

Can we identify patients at risk for discordance in preferred and actual role in cancer treatment decision making?

Authors
Zullig, LL; Rushing, C; Chino, FL; Samsa, G; Altomare, I; Tulsky, JA; Ubel, PA; Nicolla, J; Abernethy, AP; Peppercorn, JM; Zafar, Y
MLA Citation
Zullig, LL, Rushing, C, Chino, FL, Samsa, G, Altomare, I, Tulsky, JA, Ubel, PA, Nicolla, J, Abernethy, AP, Peppercorn, JM, and Zafar, Y. "Can we identify patients at risk for discordance in preferred and actual role in cancer treatment decision making?." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

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

Patient-oncologist cost communication, financial distress, and medication adherence.

Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care.We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions.Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence.Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.

Authors
Bestvina, CM; Zullig, LL; Rushing, C; Chino, F; Samsa, GP; Altomare, I; Tulsky, J; Ubel, P; Schrag, D; Nicolla, J; Abernethy, AP; Peppercorn, J; Zafar, SY
MLA Citation
Bestvina, CM, Zullig, LL, Rushing, C, Chino, F, Samsa, GP, Altomare, I, Tulsky, J, Ubel, P, Schrag, D, Nicolla, J, Abernethy, AP, Peppercorn, J, and Zafar, SY. "Patient-oncologist cost communication, financial distress, and medication adherence." Journal of oncology practice 10.3 (May 2014): 162-167.
PMID
24839274
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
3
Publish Date
2014
Start Page
162
End Page
167
DOI
10.1200/jop.2014.001406

Utilization of Hospital-Based Chaplain Services Among Newly Diagnosed Male Veterans Affairs Colorectal Cancer Patients

The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed in 2008 (67 % response rate). Multivariable logistic regression examined factors associated with chaplain utilization. Of 918 male respondents, 36 % reported utilizing chaplains. Chaplain services were more likely to be utilized by patients with higher pain levels (OR = 1.017; 95 % CI = 0.999-1.035), younger age (age OR = 0.979; 95 % CI = 0.964-0.996), and later cancer stage (early stage OR = 0.743; 95 % CI = 0.559-0.985). Chaplain services are most utilized by younger, sicker patients. © 2012 Springer Science+Business Media New York (Outside the USA).

Authors
Zullig, LL; Jackson, GL; Provenzale, D; Griffin, JM; Phelan, S; Nieuwsma, JA; van Ryn, M
MLA Citation
Zullig, LL, Jackson, GL, Provenzale, D, Griffin, JM, Phelan, S, Nieuwsma, JA, and van Ryn, M. "Utilization of Hospital-Based Chaplain Services Among Newly Diagnosed Male Veterans Affairs Colorectal Cancer Patients." Journal of Religion and Health 53.2 (April 1, 2014): 498-510.
Source
scopus
Published In
Journal of Religion and Health
Volume
53
Issue
2
Publish Date
2014
Start Page
498
End Page
510
DOI
10.1007/s10943-012-9653-2

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. (Letter)
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

GENDER AND RACIAL DIFFERENCES IN CONTROL OF CARDIOVASCULAR DISEASE RISK FACTORS AMONG VETERANS

Authors
Goldstein, KM; Melnyk, SD; Zullig, LL; Stechuchak, K; Oddone, EZ; Bastian, LA; Rakley, S; Olsen, M; Bosworth, H
MLA Citation
Goldstein, KM, Melnyk, SD, Zullig, LL, Stechuchak, K, Oddone, EZ, Bastian, LA, Rakley, S, Olsen, M, and Bosworth, H. "GENDER AND RACIAL DIFFERENCES IN CONTROL OF CARDIOVASCULAR DISEASE RISK FACTORS AMONG VETERANS." April 2014.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
29
Publish Date
2014
Start Page
S103
End Page
S103

A HEALTH LITERACY INTERVENTION TO IMPROVE MEDICATION ADHERENCE USING MEDUCATION (R) TECHNOLOGY

Authors
Zullig, LL; McCant, F; Melnyk, SD; Danus, S
MLA Citation
Zullig, LL, McCant, F, Melnyk, SD, and Danus, S. "A HEALTH LITERACY INTERVENTION TO IMPROVE MEDICATION ADHERENCE USING MEDUCATION (R) TECHNOLOGY." April 2014.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
29
Publish Date
2014
Start Page
S8
End Page
S9

Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients.

The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed in 2008 (67 % response rate). Multivariable logistic regression examined factors associated with chaplain utilization. Of 918 male respondents, 36 % reported utilizing chaplains. Chaplain services were more likely to be utilized by patients with higher pain levels (OR = 1.017; 95 % CI = 0.999-1.035), younger age (age OR = 0.979; 95 % CI = 0.964-0.996), and later cancer stage (early stage OR = 0.743; 95 % CI = 0.559-0.985). Chaplain services are most utilized by younger, sicker patients.

Authors
Zullig, LL; Jackson, GL; Provenzale, D; Griffin, JM; Phelan, S; Nieuwsma, JA; van Ryn, M
MLA Citation
Zullig, LL, Jackson, GL, Provenzale, D, Griffin, JM, Phelan, S, Nieuwsma, JA, and van Ryn, M. "Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients." Journal of religion and health 53.2 (April 2014): 498-510.
PMID
23054482
Source
epmc
Published In
Journal of Religion and Health
Volume
53
Issue
2
Publish Date
2014
Start Page
498
End Page
510
DOI
10.1007/s10943-012-9653-2

Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System.

High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer.Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories.There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics.This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

Authors
van Ryn, M; Phelan, SM; Arora, NK; Haggstrom, DA; Jackson, GL; Zafar, SY; Griffin, JM; Zullig, LL; Provenzale, D; Yeazel, MW; Jindal, RM; Clauser, SB
MLA Citation
van Ryn, M, Phelan, SM, Arora, NK, Haggstrom, DA, Jackson, GL, Zafar, SY, Griffin, JM, Zullig, LL, Provenzale, D, Yeazel, MW, Jindal, RM, and Clauser, SB. "Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.8 (March 2014): 809-815.
PMID
24493712
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
8
Publish Date
2014
Start Page
809
End Page
815
DOI
10.1200/jco.2013.49.4302

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

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

Sustainability of cancer registration in the Kilimanjaro Region of Tanzania--a qualitative assessment.

The projected cancer burden in Africa demands a comprehensive surveillance strategy. Kilimanjaro Christian Medical Centre (KCMC) is developing a population-based cancer registry, and understanding stakeholders' perceptions of factors impacting cancer registration sustainability is critical to its long-term success. We conducted 11 semi-structured qualitative interviews with clinicians and administrators. Interviews were double-coded and evaluated for predetermined and emerging themes. Nearly half (45%) of participants discussed change commitment, stating that the cancer registry would benefit KCMC and that they were committed to it. However, change efficacy was low - participants were not confident in their shared ability to sustain the registry. Most participants (73%) discussed the importance of resource availability and administration support. Several themes emerged across interviews: (i) lack of cancer registry awareness, (ii) ambiguity about its purpose, (iii) the importance of training, (iv) the importance of outcome data, and (v) the importance of international partners. These findings may facilitate cancer registry development and sustainability in similar settings.

Authors
Zullig, LL; Vanderburg, SB; Muiruri, C; Abernethy, A; Weiner, BJ; Bartlett, J
MLA Citation
Zullig, LL, Vanderburg, SB, Muiruri, C, Abernethy, A, Weiner, BJ, and Bartlett, J. "Sustainability of cancer registration in the Kilimanjaro Region of Tanzania--a qualitative assessment." World health & population 15.1 (January 2014): 21-30.
PMID
24702763
Source
epmc
Published In
Journal of World Health and Population
Volume
15
Issue
1
Publish Date
2014
Start Page
21
End Page
30
DOI
10.12927/whp.2014.23721

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

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

An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system

Background Veterans Affairs (VA) manages the largest US integrated health care system. Although quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of research examining racial differences in this care. This study examines racial differences in 2 dimensions of quality of VA CRC care: processes (time to treatment) and outcomes (survival). Patients and Methods Retrospective data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Study patients were white and African American men diagnosed with nonmetastatic CRC between 2003 and 2006 who received definitive CRC surgery. We examined 3 quality indicators: time from (1) surgery to initiation of adjuvant chemotherapy (stages II-III disease), (2) surgery to surveillance colonoscopy (stages I-III disease), and (3) surgery to death (stages I-III disease). Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. Results In unadjusted analyses, there was no evidence of racial differences across the 3 quality measures. In adjusted Cox regression, there were no racial differences in time to initiation of chemotherapy (hazard ratio [HR], 0.82; P =.61) or surgery to death (HR, 0.94; P =.49). In adjus ted Cox regression, among those receiving colonoscopy within 7 to 18 months after surgery, white patients experienced slightly shorter median times to surveillance colonoscopy than did African American patients (367 vs. 383 days; HR, 0.63; P =.02). Conclusion Other than a small racial difference in timing of surveillance colonoscopy, there was little evidence of racial differences in quality of CRC care among VA health care system users. © 2013 Elsevier Inc. All rights reserved.

Authors
Zullig, LL; Jackson, GL; Weinberger, M; Provenzale, D; Reeve, BB; Carpenter, WR
MLA Citation
Zullig, LL, Jackson, GL, Weinberger, M, Provenzale, D, Reeve, BB, and Carpenter, WR. "An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system." Clinical Colorectal Cancer 12.4 (December 1, 2013): 255-260.
Source
scopus
Published In
Clinical colorectal cancer
Volume
12
Issue
4
Publish Date
2013
Start Page
255
End Page
260
DOI
10.1016/j.clcc.2013.06.004

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 2013): 2611-2612.
PMID
24264605
Source
epmc
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

An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system.

Veterans Affairs (VA) manages the largest US integrated health care system. Although quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of research examining racial differences in this care. This study examines racial differences in 2 dimensions of quality of VA CRC care: processes (time to treatment) and outcomes (survival).Retrospective data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Study patients were white and African American men diagnosed with nonmetastatic CRC between 2003 and 2006 who received definitive CRC surgery. We examined 3 quality indicators: time from (1) surgery to initiation of adjuvant chemotherapy (stages II-III disease), (2) surgery to surveillance colonoscopy (stages I-III disease), and (3) surgery to death (stages I-III disease). Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.In unadjusted analyses, there was no evidence of racial differences across the 3 quality measures. In adjusted Cox regression, there were no racial differences in time to initiation of chemotherapy (hazard ratio [HR], 0.82; P = .61) or surgery to death (HR, 0.94; P = .49). In adjusted Cox regression, among those receiving colonoscopy within 7 to 18 months after surgery, white patients experienced slightly shorter median times to surveillance colonoscopy than did African American patients (367 vs. 383 days; HR, 0.63; P = .02).Other than a small racial difference in timing of surveillance colonoscopy, there was little evidence of racial differences in quality of CRC care among VA health care system users.

Authors
Zullig, LL; Jackson, GL; Weinberger, M; Provenzale, D; Reeve, BB; Carpenter, WR
MLA Citation
Zullig, LL, Jackson, GL, Weinberger, M, Provenzale, D, Reeve, BB, and Carpenter, WR. "An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system." Clinical colorectal cancer 12.4 (December 2013): 255-260.
PMID
23988481
Source
epmc
Published In
Clinical colorectal cancer
Volume
12
Issue
4
Publish Date
2013
Start Page
255
End Page
260
DOI
10.1016/j.clcc.2013.06.004

Patient-oncologist cost communication, financial distress, and medication adherence

Authors
Bestvina, CM; Zullig, LL; Rushing, C; Chino, FL; Samsa, G; Altomare, I; Tulsky, JA; Ubel, PA; Schrag, D; Nicolla, J; Abernethy, AP; Peppercorn, JM; Zafar, Y
MLA Citation
Bestvina, CM, Zullig, LL, Rushing, C, Chino, FL, Samsa, G, Altomare, I, Tulsky, JA, Ubel, PA, Schrag, D, Nicolla, J, Abernethy, AP, Peppercorn, JM, and Zafar, Y. "Patient-oncologist cost communication, financial distress, and medication adherence." November 1, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
31
Publish Date
2013

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

Examining potential colorectal cancer care disparities in the Veterans Affairs health care system.

Racial disparities in cancer treatment and outcomes are a national problem. The nationwide Veterans Affairs (VA) health system seeks to provide equal access to quality care. However, the relationship between race and care quality for veterans with colorectal cancer (CRC) treated within the VA is poorly understood. We examined the association between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care.This was an observational, retrospective medical record abstraction of patients with CRC treated in the VA. Two thousand twenty-two patients (white, n = 1,712; African American, n = 310) diagnosed with incident CRC between October 1, 2003, and March 31, 2006, from 128 VA medical centers, were included. We used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for stages II and III, fluorouracil-based adjuvant chemotherapy for stage III, and surveillance colonoscopy for stages I to III). Explanatory variables included demographic and disease characteristics.There were no significant racial differences for receipt of guideline-concordant CRC care. Older age at diagnosis was associated with reduced odds of medical oncology referral and surveillance colonoscopy. Presence of cardiovascular comorbid conditions was associated with reduced odds of medical oncology referral (odds ratio, 0.65; 95% CI, 0.50 to 0.89).In these data, we observed no evidence of racial disparities in CRC care quality. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.

Authors
Zullig, LL; Carpenter, WR; Provenzale, D; Weinberger, M; Reeve, BB; Jackson, GL
MLA Citation
Zullig, LL, Carpenter, WR, Provenzale, D, Weinberger, M, Reeve, BB, and Jackson, GL. "Examining potential colorectal cancer care disparities in the Veterans Affairs health care system." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.28 (October 2013): 3579-3584.
PMID
24002515
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
28
Publish Date
2013
Start Page
3579
End Page
3584
DOI
10.1200/jco.2013.50.4753

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

Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer.

The relationship between prescription medication adherence and financial burden is understudied, particularly in patients seeking financial assistance.

Authors
Zullig, LL; Peppercorn, JM; Schrag, D; Taylor, DH; Lu, Y; Samsa, G; Abernethy, AP; Zafar, SY
MLA Citation
Zullig, LL, Peppercorn, JM, Schrag, D, Taylor, DH, Lu, Y, Samsa, G, Abernethy, AP, and Zafar, SY. "Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer." J Oncol Pract (August 20, 2013).
PMID
23981344
Source
pubmed
Published In
Journal of Oncology Practice
Publish Date
2013
DOI
10.1200/JOP.2013.000971

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

Patterns of care in older patients with squamous cell carcinoma of the head and neck: a surveillance, epidemiology, and end results-medicare analysis.

There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65 years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions.Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992–2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT.Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93–0.94) but not surgery (OR 1.00; 95% CI 0.99–1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007.Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.

Authors
VanderWalde, NA; Meyer, A-M; Liu, H; Tyree, SD; Zullig, LL; Carpenter, WR; Shores, CD; Weissler, MC; Hayes, DN; Fleming, M; Chera, BS
MLA Citation
VanderWalde, NA, Meyer, A-M, Liu, H, Tyree, SD, Zullig, LL, Carpenter, WR, Shores, CD, Weissler, MC, Hayes, DN, Fleming, M, and Chera, BS. "Patterns of care in older patients with squamous cell carcinoma of the head and neck: a surveillance, epidemiology, and end results-medicare analysis." Journal of geriatric oncology 4.3 (July 2013): 262-270.
PMID
24058388
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
4
Issue
3
Publish Date
2013
Start Page
262
End Page
270
DOI
10.1016/j.jgo.2013.03.002

Are there racial differences in colorectal cancer care timeliness among users of the Veterans Affairs Healthcare System?

Authors
Zullig, LL; Jackson, GL; Weinberger, M; Provenzale, DT; Reeve, BB; Carpenter, WR
MLA Citation
Zullig, LL, Jackson, GL, Weinberger, M, Provenzale, DT, Reeve, BB, and Carpenter, WR. "Are there racial differences in colorectal cancer care timeliness among users of the Veterans Affairs Healthcare System?." May 20, 2013.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
31
Issue
15
Publish Date
2013

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

Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration.

Clinical practice guidelines can be used to help develop measures of quality of cancer care. This article describes the use of a Cancer Care Quality Measurement System (CCQMS) to monitor these measures for colorectal cancer in the Veterans Health Administration (VHA). The CCQMS assessed practice guideline concordance primarily based on colon (14 indicators) and rectal (11 indicators) cancer care guidelines of the NCCN. Indicators were developed with input from VHA stakeholders with the goal of examining the continuum of diagnosis, neoadjuvant therapy, surgery, adjuvant therapy, and survivorship surveillance and/or end-of-life care. In addition, 9 measures of timeliness of cancer care were developed. The measures/indicators formed the basis of a computerized data abstraction tool that produced reports on quality of care in real-time as data were entered. The tool was developed for a 28-facility learning collaborative, the Colorectal Cancer Care Collaborative (C4), aimed at improving colorectal cancer (CRC) care quality. Data on 1373 incident stage I-IV CRC cases were entered over approximately 18 months and were used to target and monitor quality improvement activities. The primary opportunity for improvement involved surveillance colonoscopy and services in patients after curative-intent treatment. NCCN Clinical Practice Guidelines in Oncology were successfully used to develop a measurement system for a VHA research-operations quality improvement partnership.

Authors
Jackson, GL; Zullig, LL; Zafar, SY; Powell, AA; Ordin, DL; Gellad, ZF; Abbott, D; Schlosser, JM; Hersh, J; Provenzale, D
MLA Citation
Jackson, GL, Zullig, LL, Zafar, SY, Powell, AA, Ordin, DL, Gellad, ZF, Abbott, D, Schlosser, JM, Hersh, J, and Provenzale, D. "Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration." Journal of the National Comprehensive Cancer Network : JNCCN 11.4 (April 2013): 431-441.
PMID
23584346
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
11
Issue
4
Publish Date
2013
Start Page
431
End Page
441
DOI
10.6004/jnccn.2013.0058

Chemotherapy use and patient treatment preferences in advanced colorectal cancer: a prospective cohort study.

The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer.Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population-based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy.Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer-related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first-line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy.The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens.

Authors
Zafar, SY; Malin, JL; Grambow, SC; Abbott, DH; Kolimaga, JT; Zullig, LL; Weeks, JC; Ayanian, JZ; Kahn, KL; Ganz, PA; Catalano, PJ; West, DW; Provenzale, D; Cancer Care Outcomes Research & Surveillance CanCORS Consortium,
MLA Citation
Zafar, SY, Malin, JL, Grambow, SC, Abbott, DH, Kolimaga, JT, Zullig, LL, Weeks, JC, Ayanian, JZ, Kahn, KL, Ganz, PA, Catalano, PJ, West, DW, Provenzale, D, and Cancer Care Outcomes Research & Surveillance CanCORS Consortium, . "Chemotherapy use and patient treatment preferences in advanced colorectal cancer: a prospective cohort study." Cancer 119.4 (February 2013): 854-862.
PMID
22972673
Source
epmc
Published In
Cancer
Volume
119
Issue
4
Publish Date
2013
Start Page
854
End Page
862
DOI
10.1002/cncr.27815

Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer.

It is unclear why racial differences exist in the frequency of surgery for lung cancer treatment. Comorbidity is an important consideration in selection of patients for lung cancer treatment, including surgery. To assess whether comorbidity contributes to the observed racial differences, we evaluated racial differences in the prevalence of comorbidity and their impact on receipt of surgery.A total of 1,314 patients (1,135 white, 179 black) in the Veterans Health Administration diagnosed with early-stage non-small-cell lung cancer in 2007 were included. The effect of comorbidity on surgery was determined by using generalized linear models with a logit link accounting for patient clustering within Veterans Administration Medical Centers.Compared with whites, blacks had greater prevalence of hypertension, liver disease, renal disease, illicit drug abuse, and poor performance status, but lower prevalence of respiratory disease. The impact of most individual comorbidities on receipt of surgery was similar between blacks and whites, and comorbidity did not influence the race-surgery association in a multivariable analysis. The proportion of blacks not receiving surgery as well as refusing surgery was greater than that among whites.Blacks had a greater prevalence of several comorbid conditions and poor performance status; however, the overall comorbidity score did not differ by race. In general, the effect of comorbidity on receipt of surgery was similar in blacks and whites. Racial differences in comorbidity do not fully explain why blacks undergo lung cancer surgery less often than whites.

Authors
Williams, CD; Stechuchak, KM; Zullig, LL; Provenzale, D; Kelley, MJ
MLA Citation
Williams, CD, Stechuchak, KM, Zullig, LL, Provenzale, D, and Kelley, MJ. "Influence of comorbidity on racial differences in receipt of surgery among US veterans with early-stage non-small-cell lung cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.4 (February 2013): 475-481.
PMID
23269988
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
4
Publish Date
2013
Start Page
475
End Page
481
DOI
10.1200/jco.2012.44.1170

Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer.

BACKGROUND: We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and sociodemographic factors. METHODS: Self-administered questionnaires were returned in the fall of 2009 by 1109 eligible male US veterans who were diagnosed with CRC at any Veterans Affairs facility in 2008. Questionnaires assessed stigma, feelings of blame, and depressive symptoms as well as other facets of health, cancer characteristics, and quality and type of medical care. We report the prevalence of cancer stigma, self-blame, and perceived blame from others. We used multivariate linear regression to assess the association between these factors and a measure of depressive symptoms. Covariates included several measures of overall health, cancer progression, symptom severity, and sociodemographic factors. RESULTS: Thirty one percent of respondents endorsed at least one item in a measure of cancer stigma and 25% reported feeling that it was at least 'a little true' that they were to blame for their illness. All three independent variables were associated with depressive symptoms in bivariate models; cancer stigma and self-blame were significantly associated with depressive symptoms in the multivariate model. CONCLUSIONS: Cancer stigma and self-blame are problems for a significant minority of men with CRC and are independent predictors of depressive symptoms. They may represent an important source of stress in men with CRC.

Authors
Phelan, SM; Griffin, JM; Jackson, GL; Zafar, SY; Hellerstedt, W; Stahre, M; Nelson, D; Zullig, LL; Burgess, DJ; van Ryn, M
MLA Citation
Phelan, SM, Griffin, JM, Jackson, GL, Zafar, SY, Hellerstedt, W, Stahre, M, Nelson, D, Zullig, LL, Burgess, DJ, and van Ryn, M. "Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer." Psycho-oncology 22.1 (January 2013): 65-73.
PMID
21954081
Source
epmc
Published In
Psycho-Oncology
Volume
22
Issue
1
Publish Date
2013
Start Page
65
End Page
73
DOI
10.1002/pon.2048

Cancer registration needs assessment at a tertiary medical centre in Kilimanjaro, Tanzania.

Cancer burden is increasing in Africa more than in any other continent, but population-based tracking of cancer incidence is incomplete. Cancer registries can improve understanding of cancer incidence. To assess organizational readiness to sustain registry development, we conducted a survey assessing change efficacy, resource availability and change commitment at the Kilimanjaro Christian Medical Centre (KCMC), an academic hospital in Moshi, Tanzania. Fifty-two surveys were returned (80% response rate). There was strong reliability among change efficacy and commitment survey items, with Cronbach's alphas of 0.93 and 0.77, respectively. Clinicians, nurses and administrators conveyed similar responses regarding change efficacy. Clinicians had similar responses for change commitment. Echoing opinion in many low- and middle-income countries, approximately one-third of respondents indicated there were no funds to maintain the registry, and funds were not obtainable. For most resources, respondents felt that resources were sufficient or attainable. Respondents were generally confident and committed to registry implementation. Lessons learned at KCMC may be more broadly relevant.

Authors
Zullig, LL; Muiruri, C; Abernethy, A; Weiner, BJ; Bartlett, J; Oneko, O; Zafar, SY
MLA Citation
Zullig, LL, Muiruri, C, Abernethy, A, Weiner, BJ, Bartlett, J, Oneko, O, and Zafar, SY. "Cancer registration needs assessment at a tertiary medical centre in Kilimanjaro, Tanzania." World health & population 14.2 (January 2013): 12-23.
PMID
23713208
Source
epmc
Published In
Journal of World Health and Population
Volume
14
Issue
2
Publish Date
2013
Start Page
12
End Page
23
DOI
10.12927/whp.2013.23271

The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer.

Non-small cell lung cancer is the leading cause of cancer-related mortality in the United States. Patients with late-stage disease (stage 3/4) have five-year survival rates of 2%-15%. Care quality may be measured as time to receiving recommended care and, ultimately, survival. This study examined the association between race and receipt of timely non-small cell lung cancer care and survival among Veterans Affairs health care system patients.Data were from the External Peer Review Program, a nationwide Veterans Affairs quality-monitoring program. We included Caucasian or African American patients with pathologically confirmed late-stage non-small cell lung cancer in 2006 and 2007. We examined three quality measures: time from diagnosis to (1) treatment initiation, (2) palliative care or hospice referral, and (3) death. Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.After controlling for patient and disease characteristics using Cox regression, there were no racial differences in time to initiation of treatment (72 days for African American versus 65 days for Caucasian patients, hazard ratio 1.04, P = 0.80) or palliative care or hospice referral (129 days versus 116 days, hazard ratio 1.10, P = 0.34). However, the adjusted model found longer survival for African American patients than for Caucasian patients (133 days versus 117 days, hazard ratio 0.31, P < 0.01).For process measures of care quality (eg, time to initiation of treatment and referral to supportive care) the Veterans Affairs health care system provides racially equitable care. The small racial difference in survival time of approximately 2 weeks is not clinically meaningful. Future work should validate this possible trend prospectively, with longer periods of follow-up, in other veteran groups.

Authors
Zullig, LL; Carpenter, WR; Provenzale, DT; Weinberger, M; Reeve, BB; Williams, CD; Jackson, GL
MLA Citation
Zullig, LL, Carpenter, WR, Provenzale, DT, Weinberger, M, Reeve, BB, Williams, CD, and Jackson, GL. "The association of race with timeliness of care and survival among Veterans Affairs health care system patients with late-stage non-small cell lung cancer." Cancer management and research 5 (January 2013): 157-163.
PMID
23900515
Source
epmc
Published In
Cancer Management and Research
Volume
5
Publish Date
2013
Start Page
157
End Page
163
DOI
10.2147/cmar.s46688

Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer

Background We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and sociodemographic factors. Methods Self-administered questionnaires were returned in the fall of 2009 by 1109 eligible male US veterans who were diagnosed with CRC at any Veterans Affairs facility in 2008. Questionnaires assessed stigma, feelings of blame, and depressive symptoms as well as other facets of health, cancer characteristics, and quality and type of medical care. We report the prevalence of cancer stigma, self-blame, and perceived blame from others. We used multivariate linear regression to assess the association between these factors and a measure of depressive symptoms. Covariates included several measures of overall health, cancer progression, symptom severity, and sociodemographic factors. Results Thirty one percent of respondents endorsed at least one item in a measure of cancer stigma and 25% reported feeling that it was at least 'a little true' that they were to blame for their illness. All three independent variables were associated with depressive symptoms in bivariate models; cancer stigma and self-blame were significantly associated with depressive symptoms in the multivariate model. Conclusions Cancer stigma and self-blame are problems for a significant minority of men with CRC and are independent predictors of depressive symptoms. They may represent an important source of stress in men with CRC. Copyright © 2011 John Wiley & Sons, Ltd.

Authors
Phelan, SM; Griffin, JM; Jackson, GL; Zafar, SY; Hellerstedt, W; Stahre, M; Nelson, D; Zullig, LL; Burgess, DJ; Ryn, MV
MLA Citation
Phelan, SM, Griffin, JM, Jackson, GL, Zafar, SY, Hellerstedt, W, Stahre, M, Nelson, D, Zullig, LL, Burgess, DJ, and Ryn, MV. "Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer." Psycho-Oncology 22.1 (2013): 65-73.
Source
scival
Published In
Psycho-Oncology
Volume
22
Issue
1
Publish Date
2013
Start Page
65
End Page
73
DOI
10.1002/pon.2048

Chemotherapy use and patient treatment preferences in advanced colorectal cancer: A prospective cohort study

Background: The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer. METHODS: Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population-based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy. RESULTS: Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer-related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first-line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy. CONCLUSIONS: The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens. Cancer 2013. © 2012 American Cancer Society. The authors investigate how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer. The majority of patients receive such treatment even if they express negative or marginal preferences or beliefs regarding chemotherapy. Copyright © 2012 American Cancer Society.

Authors
Zafar, SY; Malin, JL; Grambow, SC; Abbott, DH; Kolimaga, JT; Zullig, LL; Weeks, JC; Ayanian, JZ; Kahn, KL; Ganz, PA; Catalano, PJ; West, DW; Provenzale, D
MLA Citation
Zafar, SY, Malin, JL, Grambow, SC, Abbott, DH, Kolimaga, JT, Zullig, LL, Weeks, JC, Ayanian, JZ, Kahn, KL, Ganz, PA, Catalano, PJ, West, DW, and Provenzale, D. "Chemotherapy use and patient treatment preferences in advanced colorectal cancer: A prospective cohort study." Cancer 119.4 (2013): 854-862.
Source
scival
Published In
Cancer
Volume
119
Issue
4
Publish Date
2013
Start Page
854
End Page
862
DOI
10.1002/cncr.27815

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

Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system

Authors
Zullig, LL; Carpenter, WR; Abbott, DH; Provenzale, DT; Weinberger, M; Reeve, BB; Jackson, GL
MLA Citation
Zullig, LL, Carpenter, WR, Abbott, DH, Provenzale, DT, Weinberger, M, Reeve, BB, and Jackson, GL. "Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system." JOURNAL OF CLINICAL ONCOLOGY 30.34 (December 1, 2012).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
34
Publish Date
2012

Copayment assistance and adherence to prescription medication among patients with cancer

Authors
Zullig, LL; Peppercorn, JM; Schrag, D; Taylor, DH; Zhong, X; Samsa, G; Abernethy, AP; Zafar, Y
MLA Citation
Zullig, LL, Peppercorn, JM, Schrag, D, Taylor, DH, Zhong, X, Samsa, G, Abernethy, AP, and Zafar, Y. "Copayment assistance and adherence to prescription medication among patients with cancer." JOURNAL OF CLINICAL ONCOLOGY 30.34 (December 1, 2012).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
34
Publish Date
2012

Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.

229 Background: Racial disparities in cancer treatment and outcomes are a substantial problem nationally. The Veterans Affairs (VA) health system is nationwide, with goals of being equal access and delivering high-quality care; however, the presence or extent of racial disparities in CRC treatment and outcomes within the VA is poorly understood. We examined the relationship between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care in the VA.We identified 2,896 patients diagnosed with incident CRC between October 1, 2003 and March 31, 2006 from 128 VAMCs. We included white and black patients with invasive, non-metastatic disease, known comorbidity status, age, and marital status. Multivariable logistic regression examined the association between race and receipt of guideline-concordant care (CT scan, preoperative CEA, clear surgical margins, referral to medical oncology for stages II to III; receipt of 5FU-based adjuvant chemotherapy for stage III; receipt of surveillance colonoscopy for stages I-III). Explanatory variables included demographic and disease characteristics.In the final sample of 2,022 men, mean age at diagnosis was 68 years; 85% were white, 52%, married, and 38% lived in the South. Stage was evenly distributed. No significant racial differences existed for most guidelines. Compared to blacks, whites were more likely to undergo surveillance colonoscopy 6 to 18 months following surgery (OR=1.32, 95% CI 1.01-1.73, p=0.04) and marginally more likely to be referred to medical oncology (OR=1.46, 95% CI 1.00-2.13, p=0.05). Patients who were 75 years or older at diagnosis (p<0.01) or with cardiovascular-related comorbidities (OR=0.65, 95% CI 0.50-0.89, p=0.01) were less likely to be referred to a medical oncologist than their younger, healthier counterparts.In general, the VA provides high quality, equal access cancer care; however, there may be room for improvement.

Authors
Carpenter, WR; Abbott, DH; Provenzale, DT; Weinberger, M; Reeve, BB; Jackson, GL
MLA Citation
Carpenter, WR, Abbott, DH, Provenzale, DT, Weinberger, M, Reeve, BB, and Jackson, GL. "Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30.34_suppl (December 2012): 229-.
PMID
28146949
Source
epmc
Published In
Journal of Clinical Oncology
Volume
30
Issue
34_suppl
Publish Date
2012
Start Page
229

Attitudes and intentions regarding abortion provision among medical school students in South Africa.

CONTEXT: Although South Africa liberalized its abortion law in 1996, significant barriers still impede service provision, including the lack of trained and willing providers. A better understanding is needed of medical students' attitudes, beliefs and intentions regarding abortion provision. METHODS: Surveys about abortion attitudes, beliefs and practice intentions were conducted in 2005 and 2007 among 1,308 medical school students attending the University of Cape Town and Walter Sisulu University in South Africa. Bivariate and multivariate analyses identified associations between students' characteristics and their general and conditional support for abortion provision, as well as their intention to act according to personal attitudes and beliefs. RESULTS: Seventy percent of medical students believed that women should have the right to decide whether to have an abortion, and large majorities thought that abortion should be legal in a variety of medical circumstances. Nearly one-quarter of students intended to perform abortions once they were qualified, and 72% said that conscientiously objecting clinicians should be required to refer women for such services. However, one-fifth of students believed that abortion should not be allowed for any reason. Advanced medical students were more likely than others to support abortion provision. In multivariate analyses, year in medical school, race or ethnicity, religious affiliation, relationship status and sexual experience were associated with attitudes, beliefs and intentions regarding provision. CONCLUSIONS: Academic medical institutions must ensure that students understand their responsibilities with respect to abortion care--regardless of their personal views--and must provide appropriate abortion training to those who are willing to offer these services in the future.

Authors
Wheeler, SB; Zullig, LL; Reeve, BB; Buga, GA; Morroni, C
MLA Citation
Wheeler, SB, Zullig, LL, Reeve, BB, Buga, GA, and Morroni, C. "Attitudes and intentions regarding abortion provision among medical school students in South Africa." International perspectives on sexual and reproductive health 38.3 (September 2012): 154-163.
PMID
23018137
Source
epmc
Published In
International Perspectives on Sexual and Reproductive Health
Volume
38
Issue
3
Publish Date
2012
Start Page
154
End Page
163

Comparison of adverse events during 5-fluorouracil versus 5-fluorouracil/oxaliplatin adjuvant chemotherapy for stage III colon cancer: a population-based analysis.

In clinical trials, combined 5-fluorouracil (5FU) plus oxaliplatin improves the survival of patients who have resected, stage III colon cancer with manageable toxicity. However, the tolerability of this in the general population of patients with colon cancer is uncertain.Adverse outcomes were compared in patients with stage III colon cancer who received either 5FU or 5FU/oxaliplatin within 120 days of undergoing resection versus a control group of patients with stage II colon cancer who did not receive chemotherapy in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and in data from the New York State Cancer Registry linked to Medicare and Medicaid. Hospitalizations, emergency room (ER) visits, and outpatient adverse events (AEs) were measured in claims from 30 days to 9 months after patients underwent resection. Multiple logistic regression was used to calculate adjusted odds ratios of events by treatment. Propensity score matching was used to minimize selection bias.Adverse outcomes were more frequent for chemotherapy recipients. AE rates were higher in patients who received 5FU/oxaliplatin (81%) compared with patients who received 5FU alone (72%), in the SEER-Medicare data. The effect of oxaliplatin on AEs was greater in older patients: The odds ratio was 2.10 (95% confidence interval, 1.53-2.87) for patients aged ≥ 75 years versus 1.75 (95% confidence interval, 1.39-2.21) for patients aged <75 years. ER use was high in Medicaid patients (83% of those who received chemotherapy), but neither ER use nor hospitalization was increased by oxaliplatin. The 60-day mortality rate was 1% to 3% for patients who received 5FU alone and 1% to 2% for patients who received combined 5FU/oxaliplatin.The incremental harms of adjuvant chemotherapy with 5FU/oxaliplatin versus 5FU alone were modest in patients with stage III colon cancer who were insured by Medicare and Medicaid. The additional harms in patients aged ≥ 75 years largely were restricted to outpatient events and did not extend to an increased rate of hospitalization or early death.

Authors
Sanoff, HK; Carpenter, WR; Freburger, J; Li, L; Chen, K; Zullig, LL; Goldberg, RM; Schymura, MJ; Schrag, D
MLA Citation
Sanoff, HK, Carpenter, WR, Freburger, J, Li, L, Chen, K, Zullig, LL, Goldberg, RM, Schymura, MJ, and Schrag, D. "Comparison of adverse events during 5-fluorouracil versus 5-fluorouracil/oxaliplatin adjuvant chemotherapy for stage III colon cancer: a population-based analysis." Cancer 118.17 (September 2012): 4309-4320.
PMID
22294436
Source
epmc
Published In
Cancer
Volume
118
Issue
17
Publish Date
2012
Start Page
4309
End Page
4320
DOI
10.1002/cncr.27422

A surveillance system for monitoring, public reporting, and improving minority access to cancer clinical trials.

The Institute of Medicine (IOM) has recommended that each person with cancer should have access to clinical trials, which have been associated with improving care quality and disparities. With no effective enrollment monitoring system, patterns of trial enrollment remain unclear.We developed a population-based, statewide system designed to facilitate monitoring of cancer trial enrollment and targeting of future interventions to improve it.Person-level cancer incidence data from the North Carolina Central Cancer Registry (NCCCR), person-level treatment trial accrual data from the National Cancer Institute (NCI), and county-level Area Resource Files (ARF) measures for 12 years, 1996-2007, were studied. Deidentified person-level data necessitated county-level analysis. Enrollment rates were estimated as the ratio of trial enrollment to cancer incidence for each race, gender, year, and county combination. Multivariable analysis examined factors associated with trial accrual. Sensitivity analyses examined spurious fluctuations and temporal discordance of incidence and enrollment.The NCI treatment trial enrollment rate was 2.39% for whites and 2.20% for minorities from 1996 to 2007, and 2.88% and 2.47%, respectively, from 2005 to 2007. Numerous counties had no minority enrollment. The 2005-2007 enrollment rates for white and minority females was 4.04% and 3.59%, respectively, and for white and minority males was 1.74% and 1.36%, respectively. Counties with a medical school or NCI Community Clinical Oncology Program (CCOP)-affiliated practice had higher trial enrollment.We examined NCI trial accrual only - industry-sponsored and investigator-initiated trials were excluded; however, studies comprise the majority of all clinical trial participants. Delays in data availability may hinder the immediacy of population-based analyses.Model stability and consistency suggest that this system is effective for population-based enrollment surveillance. For North Carolina, it suggests a worsening disparity in minority trial enrollment, though our analyses elucidate targets for intervention. Regional enrollment variation suggests the importance of access to clinical research networks and infrastructure. Substantial gender differences merit further examination.

Authors
Carpenter, WR; Tyree, S; Wu, Y; Meyer, A-M; DiMartino, L; Zullig, L; Godley, PA
MLA Citation
Carpenter, WR, Tyree, S, Wu, Y, Meyer, A-M, DiMartino, L, Zullig, L, and Godley, PA. "A surveillance system for monitoring, public reporting, and improving minority access to cancer clinical trials." Clinical trials (London, England) 9.4 (August 2012): 426-435.
PMID
22761398
Source
epmc
Published In
Clinical Trials
Volume
9
Issue
4
Publish Date
2012
Start Page
426
End Page
435
DOI
10.1177/1740774512449531

Cancer incidence among patients of the U.S. Veterans Affairs Health Care System.

Approximately 40,000 incident cancer cases are reported in the Veterans Affairs Central Cancer Registry (VACCR) annually (approximately 3% of U.S. cancer cases). Our objective was to provide the first comprehensive description of cancer incidence as reported in VACCR.Data were obtained from VACCR for incident cancers diagnosed in VA. Analyses focused on 2007 data. Cancer incidence among VA patients was compared to the general U.S. cancer population.In 2007, 97.5% of VA cancers were diagnosed among men. Approximately 78.5% of newly diagnosed patients were White, 19.0% Black, and 2.5% were another race. Median age at diagnosis was 66 years. The geographic distribution of cancer patients in VA aligns that of VA users. The most commonly diagnosed cancers were similar between VA and the U.S. male cancer population. The five most frequently diagnosed cancers among VA cancer patients were: prostate (31.8%), lung/bronchus (18.8%), colon/rectum (8.6%), urinary bladder (3.6%), and skin melanomas (3.4%). VA patients were diagnosed at an earlier stage of disease for the three most commonly diagnosed cancers--lung/bronchus, colon/rectum, and prostate--compared to the U.S. male cancer population.Registry data indicate that incident cancers in VA in 2007 approximately mirrored those observed among U.S. men.

Authors
Zullig, LL; Jackson, GL; Dorn, RA; Provenzale, DT; McNeil, R; Thomas, CM; Kelley, MJ
MLA Citation
Zullig, LL, Jackson, GL, Dorn, RA, Provenzale, DT, McNeil, R, Thomas, CM, and Kelley, MJ. "Cancer incidence among patients of the U.S. Veterans Affairs Health Care System." Military medicine 177.6 (June 2012): 693-701.
PMID
22730846
Source
epmc
Published In
Military medicine
Volume
177
Issue
6
Publish Date
2012
Start Page
693
End Page
701
DOI
10.7205/milmed-d-11-00434

Patterns of care in elderly patients with squamous cell carcinoma of the head and neck: A SEER-Medicare analysis

Authors
VanderWalde, NA; Meyer, A-M; Tyree, SD; Zullig, LL; Carpenter, WR; Weissler, MC; Shores, CG; Hayes, DN; Chera, BS
MLA Citation
VanderWalde, NA, Meyer, A-M, Tyree, SD, Zullig, LL, Carpenter, WR, Weissler, MC, Shores, CG, Hayes, DN, and Chera, BS. "Patterns of care in elderly patients with squamous cell carcinoma of the head and neck: A SEER-Medicare analysis." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Assessment of cancer registries (CR) in low- and middle-income countries (LMCs)

Authors
Zullig, LL; Vanderburg, S; Johnson, D; Oneko, O; Muiruri, C; Ntabaye, M; Abernethy, AP; Bartlett, J; Zafar, Y
MLA Citation
Zullig, LL, Vanderburg, S, Johnson, D, Oneko, O, Muiruri, C, Ntabaye, M, Abernethy, AP, Bartlett, J, and Zafar, Y. "Assessment of cancer registries (CR) in low- and middle-income countries (LMCs)." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer?

Patients must have transportation to the treatment site before they can access appropriate cancer care. This article describes factors associated with patients experiencing transportation-related barriers to accessing cancer care.The Cancer Care Assessment & Responsive Evaluation Studies (C-CARES) questionnaire was mailed to Veterans Affairs (VA) patients with colorectal cancer (CRC) during the fall of 2009. Eligible patients were diagnosed at any VA facility in 2008, they were men, and alive at the time of the mailing. A total of 1409 surveys were returned (approximately 67% response rate). To assess transportation barriers, patients were asked how often it was difficult to get transportation to or from treatment. Symptoms were assessed using validated Patient-Reported Outcomes Measurement Information System (PROMIS) scales for fatigue, pain, and depression. Multivariate logistic regression was used to examine determinants of transportation barriers.A minority of respondents (19%) reported transportation barriers. Patients experiencing pain (OR, 1.04; 95% CI, 1.02-1.06) had greater odds of transportation barriers than patients without this symptom. Patients who reported no primary social support (OR, 6.13; 95% CI, 3.10-12.14) or nonspousal support (OR, 2.00; 95% CI, 1.40-2.87) were more likely to experience transportation barriers than patients whose spouses provided social support.Patients with uncontrolled pain or less social support have greater odds of transportation barriers. The directional association between social support, symptoms, and transportation cannot be determined in this data.Inquiring about accessible transportation should become a routine part of cancer care, particularly for patients with known risk factors.

Authors
Zullig, LL; Jackson, GL; Provenzale, D; Griffin, JM; Phelan, S; van Ryn, M
MLA Citation
Zullig, LL, Jackson, GL, Provenzale, D, Griffin, JM, Phelan, S, and van Ryn, M. "Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer?." Clinical colorectal cancer 11.1 (March 2012): 60-65.
PMID
21803001
Source
epmc
Published In
Clinical colorectal cancer
Volume
11
Issue
1
Publish Date
2012
Start Page
60
End Page
65
DOI
10.1016/j.clcc.2011.05.001

Sustainability and performance of the National Cancer Institute's Community Clinical Oncology Program.

The National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) contributes one third of NCI treatment trial enrollment ("accrual") and most cancer prevention and control (CP/C) trial enrollment. Prior research indicated that the local clinical environment influenced CCOP accrual performance during the 1990s. As the NCI seeks to improve the operations of the clinical trials system following critical reports by the Institute of Medicine and the NCI Operational Efficiency Working Group, the current relevance of the local environmental context on accrual performance is unknown.This longitudinal quasi-experimental study used panel data on 45 CCOPs nationally for years 2000-2007. Multivariable models examine organizational, research network, and environmental factors associated with accrual to treatment trials, CP/C trials, and trials overall.For total trial accrual and treatment trial accrual, the number of active CCOP physicians and the number of trials were associated with CCOP performance. Factors differ for CP/C trials. CCOPs in areas with fewer medical school-affiliated hospitals had greater treatment trial accrual.Findings suggest a shift in the relevance of the clinical environment since the 1990s, as well as changes in CCOP structure associated with accrual performance. Rather than a limited number of physicians being responsible for the preponderance of trial accrual, there is a trend toward accrual among a larger number of physicians each accruing relatively fewer patients to trial. Understanding this dynamic in the context of CCOP efficiency may inform and strengthen CCOP organization and physician practice.

Authors
Carpenter, WR; Fortune-Greeley, AK; Zullig, LL; Lee, S-Y; Weiner, BJ
MLA Citation
Carpenter, WR, Fortune-Greeley, AK, Zullig, LL, Lee, S-Y, and Weiner, BJ. "Sustainability and performance of the National Cancer Institute's Community Clinical Oncology Program." Contemporary clinical trials 33.1 (January 2012): 46-54.
PMID
21986391
Source
epmc
Published In
Contemporary Clinical Trials
Volume
33
Issue
1
Publish Date
2012
Start Page
46
End Page
54
DOI
10.1016/j.cct.2011.09.007

Knowledge of termination of pregnancy (TOP) legislation and attitudes toward TOP clinical training among medical students attending two South African universities.

Provision of safe, voluntary, termination of pregnancy (TOP) in South Africa is challenged by an insufficient number of TOP-trained clinicians. Medical students' understanding of TOP legality and their attitudes toward TOP training are indicators for future service provision. We administered a 63-item questionnaire to explore these issues at the University of Cape Town and Walter Sisulu University. Ordinary least squares regression assessed predictors of TOP legislation knowledge and training attitudes.Of 1308 students, 95% knew that TOP was legal in South Africa, but few (27%) understood the specific provisions of the legislation beyond 13 weeks' gestation. Sixty-three percent desired more information about TOP. In multivariate models, female, white and sexually experienced students and students more advanced in school had better legislation knowledge (all p < .01). Attending religious services regularly (p < .01) was associated with lack of support for TOP training, whereas being in a relationship (p < .01) was associated with support for TOP training.

Authors
Wheeler, SB; Zullig, L; Jungerwirth, R; Reeve, BB; Buga, GA; Morroni, C
MLA Citation
Wheeler, SB, Zullig, L, Jungerwirth, R, Reeve, BB, Buga, GA, and Morroni, C. "Knowledge of termination of pregnancy (TOP) legislation and attitudes toward TOP clinical training among medical students attending two South African universities." World health & population 14.1 (January 2012): 5-18.
PMID
23135069
Source
epmc
Published In
Journal of World Health and Population
Volume
14
Issue
1
Publish Date
2012
Start Page
5
End Page
18

Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study.

We describe early dissemination patterns for first-line bevacizumab given for metastatic colorectal cancer treatment.We analyzed patient surveys and medical records for a population-based cohort with metastatic colorectal cancer treated in multiple regions and health systems in the United States (US). Eligible patients were diagnosed with metastatic colorectal cancer and initiated first-line chemotherapy after US Food & Drug Administration (FDA) bevacizumab approval in February 2004. First-line bevacizumab therapy was defined as receiving bevacizumab within 8 weeks of starting chemotherapy for metastatic colorectal cancer. We evaluated factors associated with first-line bevacizumab treatment using logistic regression.Among 355 patients, 31% received first-line bevacizumab in the two years after FDA approval, including 26% of men, 41% of women, and 16% of those ≥ 75 years. Use rose sharply within 6 months after FDA approval, then plateaued. 20% of patients received bevacizumab in combination with irinotecan; 53% received it with oxaliplatin. Men were less likely than women to receive bevacizumab (adjusted OR 0.55; 95% CI 0.32-0.93; p = 0.026). Patients ≥ 75 years were less likely to receive bevacizumab than patients < 55 years (adjusted OR 0.13; 95% CI 0.04-0.46; p = 0.001).One-third of eligible metastatic colorectal cancer patients received first-line bevacizumab shortly after FDA approval. Most patients did not receive bevacizumab as part of the regimen used in the pivotal study leading to FDA approval.

Authors
Zafar, SY; Malin, JL; Grambow, SC; Abbott, DH; Schrag, D; Kolimaga, JT; Zullig, LL; Weeks, JC; Fouad, MN; Ayanian, JZ; Wallace, R; Kahn, KL; Ganz, PA; Catalano, P; West, DW; Provenzale, D; Cancer Care and Outcomes Research and Surveillance (CanCORS) Consortium,
MLA Citation
Zafar, SY, Malin, JL, Grambow, SC, Abbott, DH, Schrag, D, Kolimaga, JT, Zullig, LL, Weeks, JC, Fouad, MN, Ayanian, JZ, Wallace, R, Kahn, KL, Ganz, PA, Catalano, P, West, DW, Provenzale, D, and Cancer Care and Outcomes Research and Surveillance (CanCORS) Consortium, . "Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study." BMC cancer 11 (August 16, 2011): 354-.
PMID
21846341
Source
epmc
Published In
BMC Cancer
Volume
11
Publish Date
2011
Start Page
354
DOI
10.1186/1471-2407-11-354

Use of psychosocial support services among male Veterans Affairs colorectal cancer patients.

The authors describe use of psychosocial services within +/- 3 months of diagnosis among male colorectal cancer (CRC) patients treated within the Veterans Affairs (VA) health care system. Analysis included 1,199 patients with CRC treated at 27 VA medical centers primarily diagnosed between the periods 2005 to 2007. Of the patients, 78.6% received some form of psychosocial support, including 50.5% social work, 58.9% chaplain, 6.2% psychologist, 7.1% psychiatry, 3.5% mental health nurse, and 4.4% other. Logistic regression results indicate that rectal cancer patients were less likely to receive psychosocial services (odds ratio = .65, 95% confidence interval [0.43, 0.97]). The majority of patients in the VA receive some type of psychosocial service at the time of CRC diagnosis.

Authors
Hamilton, NS; Jackson, GL; Abbott, DH; Zullig, LL; Provenzale, D
MLA Citation
Hamilton, NS, Jackson, GL, Abbott, DH, Zullig, LL, and Provenzale, D. "Use of psychosocial support services among male Veterans Affairs colorectal cancer patients." Journal of psychosocial oncology 29.3 (January 2011): 242-253.
PMID
21590571
Source
epmc
Published In
Journal of Psychosocial Oncology
Volume
29
Issue
3
Publish Date
2011
Start Page
242
End Page
253
DOI
10.1080/07347332.2011.563346

Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs.

The Veterans Affairs (VA) healthcare system treats approximately 3% of patients with cancer in the United States each year. We measured the quality of nonmetastatic colorectal cancer (CRC) care in VA as indicated by concordance with National Comprehensive Cancer Network practice guidelines (six indicators) and timeliness of care (three indicators).A retrospective medical record abstraction was done for 2,492 patients with incident stages I to III CRC diagnosed between October 1, 2003, and March 31, 2006, who underwent definitive CRC surgery. Patients were treated at one or more of 128 VA medical centers. The proportion of patients receiving guideline-concordant care and time intervals between care processes were calculated.More than 80% of patients had preoperative carcinoembryonic antigen determination (ie, stages II to III disease) and documented clear surgical margins (ie, stages II to III disease). Between 72% and 80% of patients had appropriate referral to a medical oncologist (ie, stages II to III disease), preoperative computed tomography scan of the abdomen and pelvis (ie, stages II to III disease), and adjuvant fluorouracil-based chemotherapy (ie, stage III disease). Less than half of patients with stages I to III CRC (43.5%) had a follow-up colonoscopy 7 to 18 months after surgery. The mean number of days between major treatment events included the following: 26.6 days (standard deviation [SD], 38.2; median, 20 days) between diagnosis and initiation of treatment (in stages II to III disease); 64.8 [corrected] days (SD, 54.9; median, 50 days) between definitive surgery and start of adjuvant chemotherapy (in stages II to III disease); and 444.2 [corrected] days (SD, 182.1; median, 393 days) between definitive surgery and follow-up colonoscopies (in stages I to III disease).Although there is opportunity for improvement in the area of cancer surveillance, the VA performs well in meeting established guidelines for diagnosis and treatment of CRC.

Authors
Jackson, GL; Melton, LD; Abbott, DH; Zullig, LL; Ordin, DL; Grambow, SC; Hamilton, NS; Zafar, SY; Gellad, ZF; Kelley, MJ; Provenzale, D
MLA Citation
Jackson, GL, Melton, LD, Abbott, DH, Zullig, LL, Ordin, DL, Grambow, SC, Hamilton, NS, Zafar, SY, Gellad, ZF, Kelley, MJ, and Provenzale, D. "Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 28.19 (July 2010): 3176-3181.
PMID
20516431
Source
epmc
Published In
Journal of Clinical Oncology
Volume
28
Issue
19
Publish Date
2010
Start Page
3176
End Page
3181
DOI
10.1200/jco.2009.26.7948

Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System.

The goals of this study are to evaluate determinants of the time in the medical system until a colorectal cancer diagnosis and to explore characteristics associated with stage at diagnosis.We examined medical records and survey data for 468 patients with colorectal cancer at 15 Veterans Affairs medical centers. Patients were classified as screen-detected, bleeding-detected, or other (resulting from the evaluation of another medical concern). Patients who presented emergently with obstruction or perforation were excluded. We used Cox proportional hazards models to determine predictors of time in the medical system until diagnosis. Logistic regression models were used to determine predictors of stage at diagnosis.We excluded 21 subjects who presented emergently, leaving 447 subjects; the mean age was 67 years and 98% were male, 66% Caucasian, and 43% stage I or II. Diagnosis was by screening for 39%, bleeding symptoms for 27%, and other for 34%. The median times to diagnosis were 73-91 days and were not significantly different by diagnostic category. In the multivariable model for time to diagnosis, older age, having comorbidities, and Atlantic region were associated with a longer time to diagnosis. In the multivariable model for stage-at-diagnosis, only the diagnostic category was associated with stage; the screen-detected category was associated with decreased risk of late-stage cancer.Our results point to several factors associated with a longer time from the initial clinical event until diagnosis. This increased time in the health care system did not clearly translate into more advanced disease at diagnosis.

Authors
Fisher, DA; Zullig, LL; Grambow, SC; Abbott, DH; Sandler, RS; Fletcher, RH; El-Serag, HB; Provenzale, D
MLA Citation
Fisher, DA, Zullig, LL, Grambow, SC, Abbott, DH, Sandler, RS, Fletcher, RH, El-Serag, HB, and Provenzale, D. "Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System." Digestive diseases and sciences 55.5 (May 2010): 1434-1441.
PMID
20238248
Source
epmc
Published In
Digestive Diseases and Sciences
Volume
55
Issue
5
Publish Date
2010
Start Page
1434
End Page
1441
DOI
10.1007/s10620-010-1174-9

Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative.

The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care.In the present report we describe one such initiative aimed at enhancing the continuum of colorectal cancer (CRC) care, including diagnosis, treatment and surveillance-the Colorectal Cancer Care Collaborative (C4).We describe the process and thinking that led to two parallel quality improvement "collaboratives" that addressed (1) CRC screening and diagnostic follow-up and (2) the guideline concordance and timeliness of CRC treatment. Additionally, we discuss ongoing effort to spread lessons learned during the first stages of the project, which initially occurred at only a subset of VA facilities, throughout the VA health care system. The description of this initiative is organized around key questions that must be answered when developing, sustaining and spreading multi-component quality improvement interventions.We conclude with a discussion of lessons learned that we believe would apply to similar initiatives elsewhere, even if they address different clinical issues in health care settings with different organizational structures.

Authors
Jackson, GL; Powell, AA; Ordin, DL; Schlosser, JE; Murawsky, J; Hersh, J; Ponte, G; Zullig, LL; Erb, F; Parlier, R; Haggstrom, DA; Koets, N; Mills, PD; Francis, J; Kelley, MJ; Davies, ML; Provenzale, D; VA Colorectal Cancer Care Planning Committee Members,
MLA Citation
Jackson, GL, Powell, AA, Ordin, DL, Schlosser, JE, Murawsky, J, Hersh, J, Ponte, G, Zullig, LL, Erb, F, Parlier, R, Haggstrom, DA, Koets, N, Mills, PD, Francis, J, Kelley, MJ, Davies, ML, Provenzale, D, and VA Colorectal Cancer Care Planning Committee Members, . "Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative." Journal of general internal medicine 25 Suppl 1 (January 2010): 38-43.
PMID
20077150
Source
epmc
Published In
Journal of General Internal Medicine
Volume
25 Suppl 1
Publish Date
2010
Start Page
38
End Page
43
DOI
10.1007/s11606-009-1155-x

Factors associated with chemotherapy receipt and intensity for stage IV colorectal cancer (CRC): A multihealth system, population-based study

Authors
Zafar, Y; Grambow, SC; Abbott, DH; Malin, JL; Zullig, LL; Kolimaga, JT; Provenzale, DT; Comm, CS
MLA Citation
Zafar, Y, Grambow, SC, Abbott, DH, Malin, JL, Zullig, LL, Kolimaga, JT, Provenzale, DT, and Comm, CS. "Factors associated with chemotherapy receipt and intensity for stage IV colorectal cancer (CRC): A multihealth system, population-based study." May 20, 2009.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
27
Issue
15
Publish Date
2009

Factors associated with chemotherapy receipt and intensity for stage IV colorectal cancer (CRC): A multihealth system, population-based study.

6519 Background: Little is known about chemotherapy practice patterns for patients with stage IV CRC.Cancer Outcomes Research & Surveillance Consortium (CanCORS) is a prospective cohort study including patients with incident CRC sampled from a set of defined populations and health systems. Eligible patients for this analysis (n = 742) had stage IV CRC and abstracted medical record data, including stage, chemotherapy, comorbidity (measured by the Adult Comorbidity Evaluation 27 index), and sociodemographic data. Logistic regression models were used to evaluate factors associated with chemotherapy receipt and intensity.A majority of patients were male (62%) and white (62%). 27% were ≥75 years old, and 14% had severe comorbidity. 34% had private insurance, 32% had public insurance (including Medicare/Medicaid), 18% were Veterans Affairs patients, 4% had no insurance, and 13% were missing insurance information. Overall, 77% received chemotherapy, and 57% received >1 line of therapy. Patients were less likely to receive chemotherapy if they were older (65-74 vs. <55 years = adjusted odds ratio [OR] 0.14, 95%CI 0.06-0.33, p < 0.001; ≥75 vs. <55 years = OR 0.04, 95%CI 0.02-0.64, p < 0.001), or had severe comorbidity (OR 0.38; 95%CI 0.23-0.64; p < 0.001). When treated, patients ≥75 years were more likely to receive capecitabine vs. 5-fluorouracil (5-FU) (p < 0.001), less likely to receive >1 line of therapy (p < 0.001), and less likely to receive oxaliplatin or irinotecan combination therapy vs. a single-agent fluorouracil (p < 0.001). Although only 4% were uninsured, lack of insurance did not appear to be a factor in receipt of chemotherapy. Patients with public vs. private insurance were more likely to receive chemotherapy (OR 2.58; 95%CI 1.49-4.47; p < 0.001) but were less likely to receive combination therapy versus a single-agent 5-FU (p = 0.02).The elderly are less likely to receive standard therapy. While patients with public insurance are more likely to receive chemotherapy, they are less likely to receive recommended first-line combination regimens. Future research should investigate how insurance coverage and demographics influence physician and patient preferences for advanced CRC treatment. No significant financial relationships to disclose.

Authors
Zafar, Y; Grambow, SC; Abbott, DH; Malin, JL; Zullig, LL; Kolimaga, JT; Provenzale, DT
MLA Citation
Zafar, Y, Grambow, SC, Abbott, DH, Malin, JL, Zullig, LL, Kolimaga, JT, and Provenzale, DT. "Factors associated with chemotherapy receipt and intensity for stage IV colorectal cancer (CRC): A multihealth system, population-based study." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.15_suppl (May 2009): 6519-.
PMID
27964025
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
15_suppl
Publish Date
2009
Start Page
6519

Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system.

The Veterans Health Administration (VHA) has recently launched several nationwide initiatives to improve the quality of its colorectal cancer (CRC) screening and care. The timeliness of follow-up diagnostic tests in patients who have positive noncolonoscopic CRC screening tests is one of the target areas of these initiatives. Multiple aspects of colon cancer care are being monitored, and the degree of adherence to accepted quality measures is being assessed. The purpose of this review is to describe the background leading to these initiatives and their expected impact on CRC screening and management in the VHA.

Authors
Chao, HH; Schwartz, AR; Hersh, J; Hunnibell, L; Jackson, GL; Provenzale, DT; Schlosser, J; Stapleton, LM; Zullig, LL; Rose, MG
MLA Citation
Chao, HH, Schwartz, AR, Hersh, J, Hunnibell, L, Jackson, GL, Provenzale, DT, Schlosser, J, Stapleton, LM, Zullig, LL, and Rose, MG. "Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system." Clinical colorectal cancer 8.1 (January 2009): 22-28. (Review)
PMID
19203893
Source
epmc
Published In
Clinical colorectal cancer
Volume
8
Issue
1
Publish Date
2009
Start Page
22
End Page
28
DOI
10.3816/ccc.2009.n.004

Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems

Authors
Zafar, SY; Abernethy, AP; Abbott, DH; Grambow, SC; Marcello, JE; Herndon, JE; Rowe, KL; Kolimaga, JT; Zullig, LL; Patwardhan, MB; Provenzale, DT
MLA Citation
Zafar, SY, Abernethy, AP, Abbott, DH, Grambow, SC, Marcello, JE, Herndon, JE, Rowe, KL, Kolimaga, JT, Zullig, LL, Patwardhan, MB, and Provenzale, DT. "Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems." BMC Cancer 8.1 (December 2008).
Source
crossref
Published In
BMC Cancer
Volume
8
Issue
1
Publish Date
2008
DOI
10.1186/1471-2407-8-345

Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems.

Stage at diagnosis plays a significant role in colorectal cancer (CRC) survival. Understanding which factors contribute to a more advanced stage at diagnosis is vital to improving overall survival. Comorbidity, race, and age are known to impact receipt of cancer therapy and survival, but the relationship of these factors to stage at diagnosis of CRC is less clear. The objective of this study is to investigate how comorbidity, race and age influence stage of CRC diagnosis.Two distinct healthcare populations in the United States (US) were retrospectively studied. Using the Cancer Care Outcomes Research and Surveillance Consortium database, we identified CRC patients treated at 15 Veterans Administration (VA) hospitals from 2003-2007. We assessed metastatic CRC patients treated from 2003-2006 at 10 non-VA, fee-for-service (FFS) practices. Stage at diagnosis was dichotomized (non-metastatic, metastatic). Race was dichotomized (white, non-white). Charlson comorbidity index and age at diagnosis were calculated. Associations between stage, comorbidity, race, and age were determined by logistic regression.342 VA and 340 FFS patients were included. Populations differed by the proportion of patients with metastatic CRC at diagnosis (VA 27% and FFS 77%) reflecting differences in eligibility criteria for inclusion. VA patients were mean (standard deviation; SD) age 67 (11), Charlson index 2.0 (1.0), and were 63% white. FFS patients were mean age 61 (13), Charlson index 1.6 (1.0), and were 73% white. In the VA cohort, higher comorbidity was associated with earlier stage at diagnosis after adjusting for age and race (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.58-1.00; p = 0.045); no such significant relationship was identified in the FFS cohort (OR 1.09, 95% CI 0.82-1.44; p = 0.57). In both cohorts, no association was found between stage at diagnosis and either age or race.Higher comorbidity may lead to earlier stage of CRC diagnosis. Multiple factors, perhaps including increased interactions with the healthcare system due to comorbidity, might contribute to this finding. Such increased interactions are seen among patients within a healthcare system like the VA system in the US versus sporadic interactions which may be seen with FFS healthcare.

Authors
Zafar, SY; Abernethy, AP; Abbott, DH; Grambow, SC; Marcello, JE; Herndon, JE; Rowe, KL; Kolimaga, JT; Zullig, LL; Patwardhan, MB; Provenzale, DT
MLA Citation
Zafar, SY, Abernethy, AP, Abbott, DH, Grambow, SC, Marcello, JE, Herndon, JE, Rowe, KL, Kolimaga, JT, Zullig, LL, Patwardhan, MB, and Provenzale, DT. "Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems." BMC cancer 8 (November 25, 2008): 345-.
PMID
19032772
Source
epmc
Published In
BMC Cancer
Volume
8
Publish Date
2008
Start Page
345
DOI
10.1186/1471-2407-8-345
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