Browsing by Author "Whitney, Colette"

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    Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.
    (JACC. CardioOncology, 2022-06-21) Zullig, Leah L; Sung, Anthony D; Khouri, Michel G; Jazowski, Shelley; Shah, Nishant P; Sitlinger, Andrea; Blalock, Dan V; Whitney, Colette; Kikuchi, Robin; Bosworth, Hayden B; Crowley, Matthew J; Goldstein, Karen M; Klem, Igor; Oeffinger, Kevin C; Dent, Susan
    There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed.
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    Efficacy of Hypertension Self-Management Classes Among Patients at a Federally Qualified Health Center.
    (Preventing chronic disease, 2021-07-15) Eck, Cameron; Biola, Holly; Hayes, Tiffany; Bulgin, Dominique; Whitney, Colette; Raman, Rohith; Bakovic, Melanie; Caesar, Awanya; Becerra-Soberon, Rosa; Chaplain, Joan; Granger, Bradi B
    Structural racism has contributed to persistent racial disparities in hypertension control, with Black men suffering the highest prevalence of uncontrolled hypertension. Lincoln Community Health Center, our urban Federally Qualified Health Center (FQHC), aimed to use hypertension self-management classes to improve hypertension control among our clinic patients, particularly Black men. Patients attending classes learned about hypertension, were given blood pressure cuffs to use at home, and had the opportunity to speak to physicians in a group setting. We used a nonexperimental quality improvement intervention design to identify baseline differences between participants who attended multiple classes and those who attended only 1 class. Participants who attended multiple classes, most of whom were Black men, achieved an average blood pressure reduction of 19.1/14.8 mm Hg. Although the classes were effective, current policies around health insurance reimbursement and federal quality reporting standards hamper the ability of health care providers to implement such patient education initiatives.
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    Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review.
    (Patient education and counseling, 2022-12) Lewinski, Allison A; Jazowski, Shelley A; Goldstein, Karen M; Whitney, Colette; Bosworth, Hayden B; Zullig, Leah L

    Objective

    Clinical inertia, the absence of treatment initiation or intensification for patients not achieving evidence-based therapeutic goals, is a primary contributor to poor clinical outcomes. Effectively combating clinical inertia requires coordinated action on the part of multiple representatives including patients, clinicians, health systems, and the pharmaceutical industry. Despite intervention attempts by these representatives, barriers to overcoming clinical inertia in cardiovascular disease (CVD) risk factor control remain.

    Methods

    We conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia.

    Results

    Effective interventions included dynamic forms of patient and clinician education, monitoring of real-time patient data to facilitate shared decision-making, or a combination of these approaches. Based on findings, we describe three possible multi-level approaches to counter clinical inertia - a collaborative approach to clinician training, use of a population health manager, and use of electronic monitoring and reminder devices.

    Conclusion

    To reduce clinical inertia and achieve optimal CVD risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs.

    Practice implications

    Representatives (e.g., patients, clinicians, health systems, and the pharmaceutical industry) could consider approaches to identify and monitor non-adherence to address clinical inertia.