4,849 research outputs found
Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions
This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers
Redesigning treatment strategies in type 2 diabetes by treatment intensification and patient education
Type 2 diabetes is a complex disease that is characterized by insufficient insulin production or utilization. Type 2 diabetes is associated with complications such as diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, atherosclerosis, peripheral artery disease and coronary heart disease. Three important risk factors for complications are hyperglycemia, hypertension and dyslipidemia.
Effective diabetes care involves self-management of the disease with proper nutrition, physical exercise and pharmacological agents that can control levels of glucose, cholesterol and blood pressure. With the rise in the prevalence of diabetes and often ineffective treatment intensification it is necessary to consider new treatment strategies. Patient centered approaches along with treatment intensification and diabetes education can be one such strategy to improve diabetes care. Diabetes education can be helpful as it helps in promoting healthy behaviors and appropriate diabetes self-management.
The objective of this study was to evaluate the effectiveness of providing patient education and intensifying treatment in patients with Type 2 diabetes and determine if there were significant changes observed in HbA1c, LDLc, blood pressure and adherence. This study specifically reported changes in patients at the 3 month follow up. The study was a prospective, cluster randomized controlled trial. There were a total of 240 patients enrolled in the study: 175 were in the intervention group and 65 were in the control group. Treatment was intensified according to pre-approved protocols and diabetes education was provided to patients in the intervention group.
There was significant decrease in HbA1c and LDLc levels within the intervention group but the difference was not significant within the control group. There was no decrease in blood pressure within the intervention or the control group. HbA1c, systolic blood pressure and diastolic blood pressure was significantly different in between the groups at baseline but not during 3 month follow up. There was no statistically significant difference between the underlying distributions of the adherence scores of protocol and the adherence scores of control at baseline or 3 month follow up.
The results from the 3 month follow up strongly indicated that treatment intensification along with patient education can be an effective way to treat diabetes. These results also emphasized the importance of a patient centered approach and diabetes education. The public health significance of this study is that it can be very helpful to optimize treatment strategies in diabetes while addressing behavioral and psychological needs of a patient. This can improve self-management of diabetes, which is one of the very important aspects of diabetes care
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Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: A mixed methods study.
BackgroundGiven the high prevalence of chronic kidney disease (CKD), primary care physicians (PCPs) frequently manage early stage CKD. Nonetheless, there are challenges in providing optimal CKD care in the primary care setting. This study sought to understand PCPs' perceptions of barriers and facilitators to the optimal management of CKD.Study designMixed methods study.Settings and participantsCommunity-based PCPs in four US cities: Baltimore, MD; St. Louis, MO; Raleigh, NC and San Francisco, CA.MethodologyWe used a self-administered questionnaire and conducted 4 focus groups of PCPs (n = 8 PCPs/focus group) in each city to identify key barriers and facilitators to management of patients with CKD in primary care.Analytic approachWe conducted descriptive analyses of the survey data. Major themes were identified from audio-recorded interviews that were transcribed and coded by the research team.ResultsOf 32 participating PCPs, 31 (97%) had been in practice for >10 years, and 29 (91%) practiced in a non-academic setting. PCPs identified multiple barriers to managing CKD in primary care including at the level of the patient (e.g., low awareness of CKD, poor adherence to treatment recommendations), the provider (e.g., staying current with CKD guidelines), and the health care system (e.g., inflexible electronic medical record, limited time and resources). PCPs desired electronic prompts and lab decision support, concise guidelines, and healthcare financing reform to improve CKD care.ConclusionsPCPs face substantial but modifiable barriers in providing care to patients with CKD. Interventions that address these barriers and promote facilitative tools may improve PCPs' effectiveness and capacity to care for patients with CKD
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Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.
BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918
Self Care Among Filipino Immigrants in the United States Who Have Hypertension
Hypertension (HTN) is a leading risk factor in the development of cardiovascular disease (CVD) and stroke—two major causes of mortality and morbidity in the United States (US)—across all racial and ethnic groups, including Filipino immigrants. The results of early and recent studies that explored HTN among Filipinos in the US have consistently revealed a prevalence rate that is highest among Asian Americans. There is also evidence in the literature that indicates this population’s sub-optimal control and management of HTN when compared with other Asian American subgroups. Despite this reported alarming information about HTN for this population, there is a noticeable lack of studies on HTN among Filipinos in the US, especially those that explore the unique factors that might influence how this group experience and manage this chronic illness. The purpose of this study was to explore self-care among Filipino immigrants (n=163) who have HTN, and its relationship to acculturation, acculturative stress, HTN self-efficacy, and patient activation using the Transactional Model of Stress and Coping (TMSC) as a theoretical framework. The study results revealed that HTN self-efficacy (=0.27, t(116)=3.045, p=0.003) and patient activation (=0.21, t(116)=2.292, p=.024) significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further, a test of mediation on the role of patient activation in the relationship between HTN self-care and patient activation was conducted. The results of the bias corrected estimate of the indirect effect revealed that patient activation had a mediating role between HTN self efficacy and HTN self care (B=.15; CI95% = .0356, .3239) for this sample. Findings from this study highlight the importance of addressing HTN self efficacy and patient activation in improving HTN self care that would not only improve individual health outcomes but could also potentially reduce health inequity for this population
Effectiveness of clinical dashboards as audit and feedback or clinical decision support tools on medication use and test ordering: a systematic review of randomized controlled trials
BACKGROUND
Clinical dashboards used as audit and feedback (A&F) or clinical decision support systems (CDSS) are increasingly adopted in healthcare. However, their effectiveness in changing the behavior of clinicians or patients is still unclear. This systematic review aims to investigate the effectiveness of clinical dashboards used as CDSS or A&F tools (as a standalone intervention or part of a multifaceted intervention) in primary care or hospital settings on medication prescription/adherence and test ordering.
METHODS
Seven major databases were searched for relevant studies, from inception to August 2021. Two authors independently extracted data, assessed the risk of bias using the Cochrane RoB II scale, and evaluated the certainty of evidence using GRADE. Data on trial characteristics and intervention effect sizes were extracted. A narrative synthesis was performed to summarize the findings of the included trials.
RESULTS
Eleven randomized trials were included. Eight trials evaluated clinical dashboards as standalone interventions and provided conflicting evidence on changes in antibiotic prescribing and no effects on statin prescribing compared to usual care. Dashboards increased medication adherence in patients with inflammatory arthritis but not in kidney transplant recipients. Three trials investigated dashboards as part of multicomponent interventions revealing decreased use of opioids for low back pain, increased proportion of patients receiving cardiovascular risk screening, and reduced antibiotic prescribing for upper respiratory tract infections.
CONCLUSION
There is limited evidence that dashboards integrated into electronic medical record systems and used as feedback or decision support tools may be associated with improvements in medication use and test ordering
Hypertension Control, an Annotated Bibliography
The hypertension bibliography was developed by the U.S. Centers for Disease Control and Prevention (CDC) and RTI International with the assistance of Resolve to Save Lives and Johns Hopkins Bloomberg School of Public Health. It is designed to serve as a resource in the implementation of hypertension prevention and management programs.HTN-Bibliography_Final_2018.pdfIntroduction -- The Burden of Hypertension -- Hypertension Treatment Protocols -- Task Sharing -- .Medical Supplies -- Patient-Centered Services -- Information System
Nurse led interventions in Hypertension
This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.Hypertension is predominantly detected and managed in primary or community care
settings. Nurses are key members of the multidisciplinary primary care team, and are
commonly involved in measuring or managing blood pressure. Nurses undertake a range of
tasks in hypertension care and many randomised controlled trials of different nurse led
interventions have been conducted, providing evidence from different populations. There is
good evidence to support better blood pressure outcomes when nurses deliver care face to
face, but not remotely. Other important components of these complex interventions appear
to be the inclusion of a structured care algorithm, ability to prescribe or altering
medications, and maintaining contact at least monthly until blood pressure is controlled to
target. There is limited reporting of the costs of interventions and evidence for cost
effectiveness of nurse led care compared to usual care is lacking, and there is no clear
evidence from longer term follow up of the effect of nurse led interventions on
cardiovascular outcomes. The design of programmes for nurse led care in hypertension
should take account of the existing evidence and areas of uncertainly. Nurses generally work
within teams and future studies of team approaches to hypertension, either including or led
by nurses, are needed. Any future studies of nurse led care should include a robust cost
effectiveness analysis
Conquering hypertension in Vietnam-solutions at grassroots level: study protocol of a cluster randomized controlled trial
BACKGROUND: Vietnam has been experiencing an epidemiologic transition to that of a lower-middle income country with an increasing prevalence of non-communicable diseases. The key risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam, particularly hypertension (HTN). Inasmuch, the burden of CVD will continue to increase in the Vietnamese population unless effective prevention and control measures are put in place. The objectives of the proposed project are to evaluate the implementation and effectiveness of two multi-faceted community and clinic-based strategies on the control of elevated blood pressure (BP) among adults in Vietnam via a cluster randomized trial design.
METHODS: Sixteen communities will be randomized to either an intervention (8 communities) or a comparison group (8 communities). Eligible and consenting adult study participants with HTN (n = 680) will be assigned to intervention/comparison status based on the community in which they reside. Both comparison and intervention groups will receive a multi-level intervention modeled after the Vietnam National Hypertension Program including education and practice change modules for health care providers, accessible reading materials for patients, and a multi-media community awareness program. In addition, the intervention group only will receive three carefully selected enhancements integrated into routine clinical care: (1) expanded community health worker services, (2) home BP self-monitoring, and (3) a storytelling intervention, which consists of interactive, literacy-appropriate, and culturally sensitive multi-media storytelling modules for motivating behavior change through the power of patients speaking in their own voices. The storytelling intervention will be delivered by DVDs with serial installments at baseline and at 3, 6, and 9 months after trial enrollment. Changes in BP will be assessed in both groups at several follow-up time points. Implementation outcomes will be assessed as well.
DISCUSSION: Results from this full-scale trial will provide health policymakers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03590691 . Registered on July 17, 2018. Protocol version: 6. Date: August 15, 2019
Generating And Validating A Global Framework Of Pharmaceutical Development Goals And Corresponding Indicators
INTRODUCTION:
The imperative of meeting current global healthcare challenges requires advancing pharmacy practice in a global context. This research aimed to design and develop a valid and consented set of global goal-oriented pharmaceutical development frameworks and corresponding indicators to support and guide systematic practice transformation needed to meet the national and global pharmaceutical healthcare demands of changing population demographics.
METHODS:
Part 1 of the research project
This research used a mixed-methods approach. A series of international expert focus groups were conducted to evaluate the acceptance of a set of proposed global pharmaceutical development goals (PDGs). This was followed by recruiting global pharmacy leaders who participated in a modified nominal group technique to further develop the content of the initial PDGs framework. In a subsequent study, a qualitative modified Delphi approach was employed by a panel of international experts to ensure the credibility and content validity of the framework outputs and generate consensus on a final matrix of the proposed global PDGs.
Part 2 of the research project
A content analysis of the relevant collated data followed by a Delphi process of an international Expert Group was performed to identify and establish initial consensus on potential indicators aligned with the published PDGs framework. Delphi method’s outcomes were used to conduct a global cross-sectional online questionnaire to assess and validate the relevancy and availability of the proposed indicators.
RESULTS:
Part 1 of the research project
A globally validated and consented set of systematic PDGs (systematic framework) for development comprising 21 PDGs along with their descriptions and mechanisms to shape and guide global pharmacy practice transformation.
Part 2 of the research project
A set of correlated and validated transnational evidence-based indicators that will monitor national-level progress and measure the advancement of the 21 PDGs worldwide across workforce/education, practice, and pharmaceutical science.
CONCLUSION:
A systematic and globally consented set of PDGs, along with evidence-based progress indicators, was generated to monitor the sustainable advancement of pharmaceutical practice and support a needs-based roadmap for pharmacy practice transformation
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