Browsing by Subject "chronic disease"
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Item Open Access A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.(Patient preference and adherence, 2016-01) Zullig, Leah L; Granger, Bradi B; Bosworth, Hayden BThe problem
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.Meeting of experts
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.Commentary of expert opinion
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.Item Open Access Global Chronic Disease Research Training for Fellows(2010-03) Bloomfield, Gerald S; Huffman, Mark DThe growing interest in global chronic disease research is not matched by workforce capacity at present.1 The dearth of researchers with global chronic disease backgrounds and training has led to the creation of novel funding opportunities for young researchers, particularly fellows. As 2 cardiology fellows in global cardiovascular disease research training through the US National Institutes of Health (NIH) Fogarty International Clinical Research Fellows’ (FICR-F) program, we have a unique perspective on the challenges and opportunities in this area. Here, we present our perspective on potential funding pathways, areas of interest germane to global cardiovascular disease research, the importance of an overseas training component, forms of “home” institutional support that can be helpful, and personal challenges and opportunities that merit consideration.Item Open Access Health Forests: Scaling Up Urban Forests as a Health Response(2022-04-21) Toker, RachelIn the eastern United States, urban lifestyles, conditions, and constraints are causing a rise in chronic diseases like heart disease, stroke, and diabetes, which cost trillions of dollars annually to treat. Given the importance of forests for ecological restoration, this study explores whether regenerating native forest patches that incorporate health treatments (or “Health Forests”) in at-risk urban neighborhoods -- as a unified place-based response -- can treat these diseases more cost-effectively while accessing healthcare funding sources to improve environmental outcomes. The study suggests that Health Forests, distributed at large enough scale, could improve health outcomes and restore regional ecosystems at substantial cost savings. Nature experiences lower blood sugar, blood pressure, and cortisol levels, and they improve concentration, immune function, and heart rate variability; however, focused medical research showing treatment efficacy is still needed to enable corporate healthcare payers to justify funding this effort. This study finds that, if creating and operating Health Forests causes even a 20% net reduction of annual covered medical expenditures due to chronic diseases, corporate healthcare payers could reap substantial financial benefits from doing so.Item Open Access Implementation of an Online Family Health History Tool using Research Assistants in Rural North Carolina(2018) Wittmer, Ashley NicoleIntroduction: Chronic diseases have been increasing globally for decades, while the leading chronic diseases worldwide are cancer, cardiovascular disease (CVD), chronic respiratory disease, and diabetes.1 Behavioral risk factors of chronic diseases that can be modified include physical activity, diet, alcohol consumption and tobacco use.3 4 Several guidelines for screening and prevention recommend that family health history (FHH) is collected by primary care providers for disease risk stratification and management.6 7 MeTree, developed in 2014, is a computerized, patient-facing program that collects information about family health history and generates decision support for providers and patients.6 15 There are several potential barriers to implementation of an online FHH software tool including health literacy, computer skills, and behavioral components. This study collects FHH information through MeTree in a rural population in North Carolina through a unique implementation process using research assistants to manually and verbally assist participants. The aims of this study are to characterize the quality of pedigrees collected and to estimate familial disease aggregation among the families of participants.
Methods: This study enrolled 44 participants from an ongoing study conducted by collaborators from Duke University Health System, Duke Clinical Research Institute,
University of North Carolina Pembroke, and Southeastern Regional Medical Center. To collect FHH information, participants constructed family pedigree in MeTree, one family member at a time with the help of one study research assistant. Once participants created a full family pedigree, an individual risk assessment was generated by MeTree.
Results: More than half of the participants were female (n= 30, 68.2%). The ethnic group that composed the largest part of our study population were Lumbee Indians (n=23, 52.3%) followed by White/Caucasians (n=13, 29.5%) and African Americans (n=7, 15.9%). For quality, the average score across all pedigrees was higher than 65% for all seven components of the criteria. The total number of diseases present among all participants and relatives in the study was 930 (Table 3). Cancer was present in 81.8% of pedigrees and made up 12.2% of all reported diseases. Twenty-five percent of all pedigrees had at least one family member that was diagnosed with lung cancer. Diabetes was also frequently reported and was observed in 75% of all pedigrees. Kidney Disease was reported in at least one or more relatives in 52.3% of pedigrees.
Conclusions: Using a patient-facing online Health Information Technology tool such as MeTree could potentially lead to better health outcomes due to risk assessment and individually-targeted prevention strategies. MeTree may be an important tool to use to address the large burden of chronic diseases in this region.
Item Open Access Improving diabetes medication adherence: successful, scalable interventions.(Patient preference and adherence, 2015-01) Zullig, Leah L; Gellad, Walid F; Moaddeb, Jivan; Crowley, Matthew J; Shrank, William; Granger, Bradi B; Granger, Christopher B; Trygstad, Troy; Liu, Larry Z; Bosworth, Hayden BEffective 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.Item Open Access Multicomponent interventions for enhancing primary care: a systematic review.(The British journal of general practice : the journal of the Royal College of General Practitioners, 2021-01) Jimenez, Geronimo; Matchar, David; Koh, Gerald Choon-Huat; Car, JosipBackground
Many countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.Aim
To identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success - that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and setting
Systematic review and narrative synthesis.Method
Electronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the '4Cs' (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.Results
From 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.Conclusion
Most analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.Item Open Access Redesigning Care of Hospitalized Young Adults With Chronic Childhood-Onset Disease.(Cureus, 2022-08) Feeney, Colby D; Platt, Alyssa; Rhodes, Jesse; Marcantonio, Yasmin; Patel-Nguyen, Sonya; White, Tyler; Wilson, Jonathan A; Pendergast, Jane; Ming, David YBackground Young adults with chronic childhood-onset disease (CCOD) are routinely admitted to internal medicine hospitalist services, yet most lack transition preparation to adult care. Providers and patients feel the strain of admissions to adult services in part due to their medical and social complexity. Methods We performed a descriptive study of a care redesign project for young adults with CCOD hospitalized at a large, tertiary care academic hospital. We describe the process of implementation of the Med-Peds (MP) service line and characterize patients cared for by the service. We measured and analyzed patient demographics, process implementation, healthcare screening, and healthcare utilization data. Results During the 16 months of the study period, 254 patients were cared for by the MP service line, accounting for 385 hospitalizations. The most common CCODs were sickle cell disease (22.4%) and type 1 diabetes (14.6%). The majority (76%) of patients completed transition readiness assessment, and 38.6% completed social determinant of health (SDH) screening during their admission. Patients had high prevalence of SDH with 66.7% having an unmet social need. The average length of stay was 6.6 days and the average 30-day readmission rate was 20.0%. Conclusions There is opportunity to redesign the inpatient care of young adult patients with CCOD. The MP service line is a care model that can be integrated into existing hospital medicine teams with MP physicians. Hospitals should consider redesigning care for young adults with CCOD to meet the transitional and social needs unique to this patient population.