Browsing by Author "Olsen, Maren"

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    ItemOpen Access
    Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts.
    (Journal of behavioral medicine, 2015-06) Ulmer, Christi S; Bosworth, Hayden B; Germain, Anne; Lindquist, Jennifer; Olsen, Maren; Brancu, Mira; VA Mid-Atlantic Mental Illness Research Education and Clinical Center Registry Workgroup; Beckham, Jean C
    Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about "trouble falling asleep" and "restless/disturbed sleep" were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition.
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    Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group.
    (Frontiers in public health, 2019-01) Smith, Valerie A; Lindquist, Jennifer; Miller, Katherine EM; Shepherd-Banigan, Megan; Olsen, Maren; Campbell-Kotler, Margaret; Henius, Jennifer; Kabat, Margaret; Van Houtven, Courtney Harold
    Introduction: In May 2010, the Caregivers and Veterans Omnibus Health Services Act of 2010, was signed into law in the United States, establishing the Program of Comprehensive Assistance for Family Caregivers (PCAFC) provided through the VA Caregiver Support Program (CSP). Prior to this program, over half of family caregivers reported being untrained for the tasks they needed to provide. The training through PCAFC represents the largest effort to train family caregivers in the U.S., and the features of the program, specifically a monthly stipend to caregivers and access to a Caregiver Support Coordinator at each VA medical center nationally, make it the most comprehensive caregiver support program ever enacted in the U.S. Methods: The purpose of this study is to examine the association between PCAFC participation and caregiver well-being following enrollment, comparing participating PCAFC caregivers to caregivers who applied to but were not approved for PCAFC participation (non-participants). Well-being is defined using three diverse but related outcomes: depressive symptoms, perceived financial strain, and perceived quality of the Veteran's health care. Additional well-being measures also examined include the Zarit Burden Inventory and positive aspects of caregiving. Results: The survey sample comprised of 92 caregivers approved for PCAFC and 66 caregivers not approved. The mean age of responding caregivers was 45; over 90% of caregivers were female; and over 80% of caregivers were married in both groups. We find promising trends in well-being associated with PCAFC participation. First, the perception of financial strain declined among participants compared to non-participants. Second, while depressive symptoms did not improve for the PCAFC caregivers, depressive symptoms increased among non-participants. Third, perceived quality of the Veteran's VA healthcare was no different between participants and non-participants. However, the 158 returned surveys reflect only a 5% response rate; hence this evidence is preliminary. Conclusion: Despite cautioning that results be interpreted as preliminary, this study provides unique descriptive information about young caregivers of U.S. post-9/11 Veterans, and offers a first step in filling the evidence gap about how comprehensive caregiver support in the U.S. may affect caregiver well-being. These preliminary findings should be explored and validated in a larger sample.
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    Health Literacy and Success with Glaucoma Drop Administration.
    (Ophthalmology. Glaucoma, 2022-01) Kang, J Minjy; Chatterjee, Ayan; Rosdahl, Jullia A; Bosworth, Hayden B; Woolson, Sandra; Olsen, Maren; Sexton, Malina; Kirshner, Miriam; Muir, Kelly W

    Purpose

    To assess the relationship between health literacy and successful glaucoma drop administration.

    Design

    Substudy of a single-site interventional randomized controlled trial.

    Participants

    Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence.

    Methods

    Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score.

    Main outcome measures

    Successful drop administration.

    Results

    Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n = 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique.

    Conclusions

    Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.
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    How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial.
    (Ophthalmic research, 2023-01) Buehne, Kristen L; Rosdahl, Jullia A; Hein, Aaron M; Woolson, Sandra; Olsen, Maren; Kirshner, Miriam; Sexton, Malina; Bosworth, Hayden B; Muir, Kelly W

    Introduction

    We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable.

    Methods

    The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization.

    Results

    Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups.

    Conclusions

    A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.
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    ItemOpen Access
    Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease.
    (Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2021-07) Ulmer, Christi S; McCant, Felicia; Stechuchak, Karen M; Olsen, Maren; Bosworth, Hayden B

    Study objectives

    The objectives of this study were to examine the proportion of study participants screening positive for insomnia disorder and/or sleep apnea in veterans engaged in routine health care and known to be at risk for cardiovascular disease and to compare these proportions with those previously documented in medical records.

    Methods

    This was a cross-sectional analysis of baseline data from a randomized clinical intervention trial for patients at risk of cardiovascular disease and a review of study participants' medical records. Participants were veterans ≥ 40 years of age, enrolled in Veterans Affairs primary care, and diagnosed with hypertension and/or hypercholesterolemia. Self-report outcomes were the proportion of patients screening positive for an insomnia disorder and sleep apnea, self-reporting a sleep apnea diagnosis, and endorsing undertreated sleep apnea. Medical record outcomes were the proportion of patients diagnosed with insomnia and sleep apnea.

    Results

    Participants (n = 420) were veterans (84.8% male) with a mean age of 61.1 years. More than half of the sample (52.1%) screened positive for sleep apnea without prior self-reported diagnosis. More than one-third of the sample (39%) screened positive for an insomnia disorder. Medical records revealed considerably lower rates, with 3.8% diagnosed with insomnia, 20.5% diagnosed with sleep apnea, and about 1% diagnosed with both conditions.

    Conclusions

    Undiagnosed and undertreated sleep disorders are common among veterans at risk for cardiovascular disease. Most of the sample (82%) screened positive for, or met, study criteria for sleep apnea or an insomnia disorder. Limitations include the use of self-reported sleep apnea treatment adherence, an insomnia disorder diagnosis based on questionnaire score, and a sample comprised primarily of male veterans. Routine sleep disorders screening in veterans at risk for cardiovascular disease could help to identify those at even greater risk because of the adverse effects of undiagnosed or undertreated sleep disorders.

    Clinical trial registration

    Registry; ClinicalTrials.gov; Name: Cardiovascular Intervention Improvement Telemedicine Study; URL: https://clinicaltrials.gov/ct2/show/NCT01142908; Identifier: NCT01142908.
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    ItemOpen Access
    Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study.
    (Clinical trials (London, England), 2021-06) Rosdahl, Jullia A; Hein, Aaron M; Bosworth, Hayden B; Woolson, Sandra; Olsen, Maren; Kirshner, Miriam; Hung, Anna; Muir, Kelly W

    Background

    Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention.

    Methods/design

    This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months.

    Discussion

    The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
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    Telemedicine cardiovascular risk reduction in veterans.
    (American heart journal, 2013-04) Melnyk, S Dee; Zullig, Leah L; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Stechuchak, Karen M; Edelman, David; Rakley, Susan; Morey, Miriam; Bosworth, Hayden B

    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.
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    Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma.
    (American journal of ophthalmology, 2022-12) Williams, Andrew M; Theophanous, Christos; Muir, Kelly W; Rosdahl, Jullia A; Woolson, Sandra; Olsen, Maren; Bosworth, Hayden B; Hung, Anna

    Purpose

    To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence.

    Design

    Prospective cost-effectiveness analysis of randomized, controlled trial data.

    Methods

    The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months.

    Results

    Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence.

    Conclusions

    An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.