Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

<p>Abstract</p> <p>Background</p> <p>Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.</p> <p>Methods</p> <p>Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.</p> <p>Results</p> <p>The weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354), >65 years of age (OR = 1.369 95%CI 1.368-1.371), African American (OR = 1.892 95%CI 1.889-1.894), not educated beyond high school (OR = 1.400 955CI 1.399-1.402), uninsured (OR = 1.308 95%CI 1.3-6-1.310), without a HCP (OR = 1.216 95%CI 1.215-1.218), and living in a household with an annual income of < $50,000 (OR = 1.429 95%CI 1.428-1.431).</p> <p>Conclusions</p> <p>Analysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.</p

A population-based cross-sectional study of health service deficits among U.S. adults with depressive symptoms

BACKGROUND: Depression is a psychiatric condition that affects approximately one in five U.S. adults in their lifetime. No study that we know of has examined depressive symptoms and health service deficits in rural compared with non-rural populations. Four factors constitute the variable health service deficits: did not have health insurance, did not have a healthcare provider, deferred medical care because of cost and did not have a routine medical exam, all within the last 12 months. The aim of this study was to ascertain the prevalence of health service deficits in rural versus non-rural adults with depressive symptoms. Examining depressive symptoms by health service deficits is important because it allows us to approximate those with the condition who might not be receiving care for it. By analyzing national, population-based data, this study sought to fill in some important epidemiological gaps regarding depressive symptoms and health service deficits. METHODS: For this analysis the population of interest was U.S. adults identified as currently having depressive symptoms using the PHQ-8 criteria. Behavior Risk Factor Surveillance Survey 2006 data were used in this analysis. Health service deficits was the primary dependent variable. Multivariate logistic regression analysis was performed to examine health service deficits experienced by adults with depression controlling for socioeconomic status, race and ethnicity and geographic locale (rural or non-rural). RESULTS: Logistic regression analysis yielded that U.S. adults currently having depressive symptoms who were of low socioeconomic status, Hispanic ethnicity, or living in a rural locale were more likely to have at least one health service deficit. CONCLUSION: Analyzing data collected by a large surveillance system such as BRFSS, allows for an analysis incorporating an array of covariates not available from clinically-based data such as electronic health records. By identifying clinically depressed U.S. adults who also have at least one health service deficit, we were able to ascertain those most likely not receiving care for this debilitating condition. We believe community pharmacists are well suited to assist in connecting depressed, vulnerable populations with appropriate and needed care. This care would be best provided by an inter-professional team led by a primary care provider

The Application of Informatics in Delineating the Proof of Concept for Creating Knowledge of the Value Added by Interprofessional Practice and Education

The resurgence of interest in the promise of interprofessional education and collaborative practice (IPECP) to positively impact health outcomes, requires the collection of appropriate data that can be analyzed and from which information and knowledge linking IPECP interventions to improved health outcomes might be produced and reported to stakeholders such as health systems, policy makers and regulators, payers, and accreditation agencies. To generate such knowledge the National Center for Interprofessional Practice and Education at the University of Minnesota has developed three strategies, the first two of which are: (1) creating an IPECP research agenda, and (2) a national Nexus Innovation Network (NIN) of intervention projects that are generating data that are being input and housed in a National Center Data Repository (NCDR). In this paper, the informatics platform supporting the work of these first two strategies is presented as the third interconnected strategy for knowledge generation. The proof of concept for the informatics strategy is developed in this paper by describing: data input from the NIN into the NCDR, the linking and merging of those data to produce analyzable data files that incorporate institutional and individual level data, and the production of meaningful analyses to create and provide relevant information and knowledge. This paper is organized around the concepts of data, information and knowledge—the three conceptual foundations of informatics

Creating the Evidence through Comparative Effectiveness Research for Interprofessional Education and Collaborative Practice by Deploying a National Intervention Network and a National Data Repository

Background: There is currently a resurgence of interest in interprofessional education and collaborative practice (IPECP) and its potential to positively impact health outcomes at both the patient level and population level, healthcare delivery, and health professions education. This resurgence of interest led to the creation of the National Center on Interprofessional Collaborative Practice and Education in October 2012. Methods: This paper describes three intertwined knowledge generation strategies of the National Center on Interprofessional Practice and Education: (1) the development of a Nexus Incubator Network, (2) the undertaking of comparative effectiveness research, and (3) the creation of a National Center Data Repository. Results: As these strategies are implemented over time they will result in the production of empirically grounded knowledge regarding the direction and scope of the impact, if any, of IPECP on well-defined health and healthcare outcomes including the possible improvement of the patient experience of care. Conclusions: Among the motivating factors for the National Center and the three strategies adopted and addressed herein is the need for rigorously produced, scientifically sound evidence regarding IPECP and whether or not it has the capacity to positively affect the patient experience of care, the health of populations, and the per capita cost of healthcare

The Impact of Rural Training Experiences on Medical Students: A Critical Review

Purpose To address the growing shortage of rural physicians, several medical schools have developed rural training experiences for their students. However, little is known about the educational impact of these experiences. Thus the authors conducted a critical review of North American studies examining medical student outcomes associated with rural training experiences. Method A comprehensive search strategy was used to identify studies about undergraduate medical education in a rural setting searching Pub Med from 1966 to June 2009. The researchers evaluated titles and abstracts to identify publications that appeared to report measures associated with undergraduate medical school rural training experience. Only those studies with a measurable outcome such as career choice, practice location, clinical competency and student satisfaction were analyzed. Results The review identified a total of 72 studies. Most were single cohort studies or cohort studies with control groups, with career choice and practice location the most commonly reported measure. The majority reported that rural experiences influenced students towards primary care specialties and to consider rural practice. Studies using self-report found that students generally valued the experience and had a high degree of satisfaction. Conclusions 2 This review shows that placement in rural settings is a positive learning experience that students and preceptors value. While the evidence supports that these rotations influence practice site and career choice, it is not clear whether they reinforce pre-existing interest or have the ability to motivate previously uninterested students to consider a career in primary care or rural medicine

The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018.

IntroductionIf interprofessional collaborative practice is to be an important component of healthcare reform, then an evidentiary base connecting interprofessional education to interprofessional practice with significantly improved health and healthcare outcomes is an unconditional necessity. This study is a scoping review of the current peer reviewed literature linking interprofessional collaborative care and interprofessional collaborative practice to clearly identified healthcare and/or patient health-related outcomes. The research question for this review was: What does the evidence from the past decade reveal about the impact of Interprofessional collaborative practice on patient-related outcomes in the US healthcare system?Materials and methodsA modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was followed.ResultsOf an initial 375 articles retrieved 20 met review criteria. The most common professions represented in the studies reviewed were physicians, pharmacists and nurses. Primary care was the most common care delivery setting and measures related to chronic disease the most commonly measured outcomes. No study identified negative impacts of interprofessional collaborative practice. Eight outcome categories emerged from a content analysis of the findings of the reviewed studies.ConclusionsThe results suggest a need for more research on the measurable impact of interprofessional collaborative practice and/or care on patient health-related outcomes to further document its benefits and to explore the models, systems and nature of collaborations that best improve population health, increase patient satisfaction, and reduce cost of care

A Population-Based, Cross-Sectional Study Examining Health Services Deficits of US Veterans Using 2014 Behavioral Risk Factor Surveillance System Data: Is Rural Residency an Independent Risk Factor after Controlling for Multiple Covariates?

Introduction: In 2014, it was reported that there was a backlog of an estimated 1.2 million claims nationwide at the United States Veterans Administration (VA). This ecological occurrence opened up a space for asking and answering some important questions about health service deficits (HSD) of US veterans, which is the focus of the research reported on in this paper. The purpose of this study was to ascertain if rural veterans were more likely to experience HSDs than urban military veterans after controlling for a number of covariates. Methods: Bivariate and multivariate data analysis strategies were used to examine 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey data. HSD was the dependent variable. Results: Two multivariate models were tested. The first logistic regression analysis yielded that rural veterans had higher odds of having at least one HSD. The second yielded that rural US veterans in 2014 who had higher odds of having at least one HSD were: 18–64 years of age, unemployed seeking employment, living in households with annual incomes lower than $75,000, without a university degree, not part of a married or unmarried couple, a current smoker, and/or a binge drinker within the last 30 days. Conclusions: The study described here fills identified epidemiological gaps in our knowledge regarding rural US military veterans and HSDs. The findings are not only interesting but important, and should be used to inform interventions to reduce HSDs for rural veterans

Disparities in Adult African American Women's Knowledge of Heart Attack and Stroke Symptomatology: An Analysis of 2003–2005 Behavioral Risk Factor Surveillance Survey Data

ABSTRACT Background: Heart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women. Methods: This was a cross-sectional study analyzing 2003–2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable. Results: Twenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0–8 points) were more likely to be aged 18–34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income <$35,000 (OR = 1.46, CI 1.45, 1.47), and have a primary healthcare provider (OR = 1.22, CI 1.20, 1.23). Conclusions: The findings indicated that knowledge of heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63301/1/jwh.2007.0599.pd