27 results on '"Persell SD"'
Search Results
2. Blood pressure outcomes at 12 months in primary care patients prescribed remote physiological monitoring for hypertension: a prospective cohort study.
- Author
-
Petito LC, Anthony L, Peprah Y, Lee JY, Li J, Sato H, and Persell SD
- Subjects
- Humans, Aged, United States epidemiology, Blood Pressure, Cohort Studies, Prospective Studies, Retrospective Studies, Medicare, Monitoring, Physiologic, Primary Health Care, Blood Pressure Monitoring, Ambulatory, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Hypertension diagnosis, Hypertension drug therapy
- Abstract
Remote patient monitoring (RPM) for hypertension enables automatic transmission of blood pressure (BP) and pulse into the electronic health record (EHR), but its effectiveness in primary care is unknown. This pragmatic matched cohort study using EHR data compared BP outcomes between individuals prescribed RPM and temporally-matched controls from six primary care practices. We retrospectively created a cohort of 288 Medicare-enrolled patients prescribed BP RPM (cases) and 1152 propensity score-matched controls (1:4). Matching was based on age, sex, systolic blood pressure (SBP), marital status, and other characteristics. Outcomes at 3, 6, 9 and 12 months were: controlling high BP (most recent BP < 140/90 mm Hg), antihypertensive medication intensification, and most recent SBP assessed using: all measurements, and office measurements only. At baseline, RPM-prescribed patients and controls had similar ages and systolic BP. BP control diverged at 3 months (RPM: 72.2%, control: 51%, p < 0.001). This difference persisted but decreased over follow-up. After 12 months, the RPM-prescribed cohort had greater BP control (RPM: 71.5%, control: 58.1%, p < 0.001) and lower SBP (132.3 versus 136.5 mm Hg, p = 0.003) using all measurements, but they did not differ using only office measurements (12 month BP control: 60.8% versus 58.1%, p = 0.44; SBP: 135.9 versus 136.5 mm Hg, p = 0.91). At 12 months, the most recent BP measurements were more current for RPM-prescribed patients (median [IQR] 8 [0-109] versus 134 [56-239] days). Net increases in antihypertensive medications by 12 months were similar. Implementation of RPM in primary care could inform hypertension management strategies and increase hypertension control. Registration: ClinicalTrials.gov identifier: NCT05562921., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
3. Prospective Cohort Study of Remote Patient Monitoring with and without Care Coordination for Hypertension in Primary Care.
- Author
-
Persell SD, Petito LC, Anthony L, Peprah Y, Lee JY, Campanella T, Campbell J, Pigott K, Kadric J, Duax CJ, Li J, and Sato H
- Subjects
- Humans, Aged, United States, Prospective Studies, Antihypertensive Agents therapeutic use, Monitoring, Physiologic, Primary Health Care, Blood Pressure Monitoring, Ambulatory, Medicare, Hypertension drug therapy
- Abstract
Background: Out-of-office blood pressure (BP) measurements contribute valuable information for guiding clinical management of hypertension. Measurements from home devices can be directly transmitted to patients' electronic health record for use in remote monitoring programs., Objective: This study aimed to compare in primary care practice care coordinator-assisted implementation of remote patient monitoring (RPM) for hypertension to RPM implementation alone and to usual care., Methods: This was a pragmatic observational cohort study. Patients aged 65 to 85 years with Medicare insurance from two populations were included: those with uncontrolled hypertension and a general hypertension group seeing primary care physicians (PCPs) within one health system. Exposures were clinic-level availability of RPM plus care coordination, RPM alone, or usual care. At two clinics (13 PCPs), nurse care coordinators with PCP approval offered RPM to patients with uncontrolled office BP and assisted with initiation. At two clinics (39 PCPs), RPM was at PCPs' discretion. Twenty clinics continued usual care. Main measures were controlling high BP (<140/90 mm Hg), last office systolic blood pressure (SBP), and proportion with antihypertensive medication intensification., Results: Among the Medicare cohorts with uncontrolled hypertension, 16.7% (39/234) of patients from the care coordination clinics were prescribed RPM versus <1% (4/600) at noncare coordination sites. RPM-enrolled care coordination group patients had higher baseline SBP than the noncare coordination group (148.8 vs. 140.0 mm Hg). After 6 months, in the uncontrolled hypertension cohorts the prevalences of controlling high BP were 32.5% (RPM with care coordination), 30.7 % (RPM alone), and 27.1% (usual care); multivariable adjusted odds ratios (95% confidence interval) were 1.63 (1.12-2.39; p = 0.011) and 1.29 (0.98-1.69; p = 0.068) compared with usual care, respectively., Conclusion: Care coordination facilitated RPM enrollment among poorly controlled hypertension patients and may improve hypertension control in primary care among Medicare patients., Competing Interests: The Northwestern University and the Northwestern Medicine investigators (L.C.P., L.A., Y.P., J.Y.L., S.D.P., J.C., T.C., K.P.) reported receiving grant funding from Omron Healthcare Co. Ltd during the conduct of the study. S.D.P. reported receiving an honorarium for speaking from Omron Healthcare Co. Ltd. J.L. reported receiving salary and reimbursement for travel from Omron Healthcare Co. Ltd. H.S. reported receiving salary and reimbursement for travel from Omron Healthcare Co. Ltd. An employee from Downshift Consulting (C.J.D.) participated and provided input into study meetings and revision of the manuscript. No other disclosures were reported. S.D.P. reported other from Omron Healthcare Co. Ltd, during the conduct of the study; personal fees and other from Omron Healthcare Co. Ltd, personal fees from RAND Corporation, personal fees from the National Committee for Quality Assurance, outside the submitted work; and S.D.P. has served as Chair of the Cardiovascular Measurement Advisory Panel for the National Committee for Quality Assurance., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
- Published
- 2023
- Full Text
- View/download PDF
4. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma.
- Author
-
Krings JG, Gerald JK, Blake KV, Krishnan JA, Reddel HK, Bacharier LB, Dixon AE, Sumino K, Gerald LB, Brownson RC, Persell SD, Clemens CJ, Hiller KM, Castro M, and Martinez FD
- Subjects
- Humans, United States, Formoterol Fumarate therapeutic use, Bronchodilator Agents therapeutic use, Adrenal Cortex Hormones therapeutic use, Nebulizers and Vaporizers, Budesonide therapeutic use, Ethanolamines therapeutic use, Administration, Inhalation, Drug Combinations, Asthma drug therapy, Anti-Asthmatic Agents therapeutic use
- Published
- 2023
- Full Text
- View/download PDF
5. The protocol of the Application of Economics & Social psychology to improve Opioid Prescribing Safety trial 2 (AESOPS-2): Availability of opioid harm.
- Author
-
Kelley MA, Persell SD, Linder JA, Friedberg MW, Meeker D, Fox CR, Goldstein NJ, Knight TK, Zein D, Sullivan MD, and Doctor JN
- Subjects
- Analgesics, Opioid adverse effects, Humans, Multicenter Studies as Topic, Practice Patterns, Physicians', Psychology, Social, Randomized Controlled Trials as Topic, United States, Drug Overdose prevention & control, Opioid-Related Disorders drug therapy, Opioid-Related Disorders epidemiology, Opioid-Related Disorders prevention & control
- Abstract
Background: High levels of opioid prescribing in the United States has resulted in an alarming trend in opioid-related harms. The objective of Trial 2 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-2) is to dampen the intensity and frequency of opioid prescribing in accordance with the Centers for Disease Control and Prevention recommendation to "go low and slow". We aim to accomplish this by notifying clinicians of harmful patient outcomes, which we expect to increase the mental availability of risks associated with opioid use., Methods: The trial is multi-site. Random assignment determines if prescribers to persons who suffer an opioid overdose (fatal or nonfatal) learn of this event (intervention) or practice usual care (control). Clinicians in the intervention group receive a letter notifying them of their patient's overdose. The primary outcome is the change in clinician weekly milligram morphine equivalent (MME) prescribed in a 6-month period before and after receiving the letter. Additional outcomes are the change in the proportion of patients prescribed at least 50 daily MME and in the proportion of patients referred to medication assisted treatment. Group differences in these outcomes will be compared using an intent-to-treat difference-in-differences framework with a mixed-effects regression model to estimate clinician MME., Discussion: The AESOPS-2 trial will provide new knowledge about whether increasing prescribers' awareness of patients' opioid-related overdoses leads to a reduction in opioid prescribing. Additionally, this trial may better inform how to reduce opioid use disorder and opioid overdoses by lowering population exposure to these drugs., Trial Registration: ClinicalTrials.gov: NCT04758637., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
6. Disparities in Elevated Body Mass Index in Youth Receiving Care at Community Health Centers.
- Author
-
Mohanty N, Padilla R, Leo MC, Tilmon S, Akhabue E, Rittner SS, Crawford P, Okihiro M, and Persell SD
- Subjects
- Adolescent, Adult, Child, Cross-Sectional Studies, Ethnicity statistics & numerical data, Female, Humans, Male, Prevalence, United States epidemiology, Young Adult, Body Mass Index, Community Health Centers statistics & numerical data, Pediatric Obesity epidemiology, Pediatric Obesity ethnology
- Abstract
Childhood obesity has increased significantly in the United States. Racial subgroups are often grouped into categories in research, limiting our understanding of disparities. This study describes the prevalence of obesity among youth of diverse racial and ethnic backgrounds receiving care at community health centers (CHCs). This cross-sectional study describes the prevalence of elevated body mass index (BMI) (≥85th percentile) and obesity (≥95th percentile) in youth aged 9 to 19 years receiving care in CHCs in 2014. Multilevel logistic regression estimated the prevalence of elevated BMI and obesity by age, race/ethnicity, and sex. Among 64 925 youth, 40% had elevated BMI and 22% were obese. By race, obesity was lowest in the combined Asian/Pacific Islander category (13%); however, when subgroups were separated, the highest prevalence was among Native Hawaiians (33%) and Other Pacific Islanders (42%) and the lowest in Asians. By sex, Black females and Hispanic and Asian males were more likely to be obese. By age, the highest prevalence of obesity was among those aged 9 to 10 years (25%). Youth served by CHCs have a high prevalence of obesity, with significant differences observed by race, sex, and age. Combining race categories obscures disparities. The heterogeneity of communities warrants research that describes different populations to address obesity., Competing Interests: The authors have no relevant conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
7. Cognitive impairment no dementia and associations with health literacy, self-management skills, and functional health status.
- Author
-
Lovett RM, Curtis LM, Persell SD, Griffith JW, Cobia D, Federman A, and Wolf MS
- Subjects
- Aged, Chronic Disease, Cross-Sectional Studies, Female, Health Status, Humans, Male, Middle Aged, Prevalence, United States epidemiology, Activities of Daily Living, Cognitive Dysfunction epidemiology, Health Literacy, Self-Management
- Abstract
Objectives: To determine the prevalence of cognitive impairment no dementia (CIND) among a diverse, community-based population, and establish associations between CIND and health literacy, chronic disease self-management and functional health status., Methods: 863 primary care adults without dementia aged 55-74. Adjusted logistic and linear regressions were used to assess associations between CIND (None, Mild, Moderate/Severe) and outcomes., Results: 36 % participants exhibited CIND. It was strongly associated with limited health literacy (Newest Vital Signs: Mild [OR 3.25; 95 % CI 1.93, 5.49], Moderate/Severe [OR 6.45; 95 % CI 3.16, 13.2]; Test of Functional Health Literacy in Adults: Mild [OR 3.46; 95 % CI 2.08, 5.75], Moderate/Severe [OR 8.82; 95 % CI 4.87, 16.0]; all p's < 0.001) and poor chronic disease self-management (Mild [B = -11.2; 95 % CI -13.5, -8.90], Moderate/Severe CI [B = -21.0; 95 % CI -23.6, -18.4]; both p's < 0.001). Associations between CIND and functional health status were non-significant., Conclusions: CIND was prevalent in this cohort, and strongly associated with requisite skills for managing everyday health needs., Practice Implications: Attention to subtle declines in chronic disease self-care may assist with CIND identification and care management within this population. When CIND is observed, clinicians should also expect and address difficulties with self-management., Competing Interests: Declaration of Competing Interest SDP receives research support from Omron Healthcare and previously received grant support from Pfizer, Inc. MSW receives research funding from Amgen and Merck, Sharpe & Dohme. He also has served as a paid consultant to Luto U.K., Pfizer and AB Imbev Foundation. RML, LMC, JWG, DC and AF have no conflicts of interest to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
8. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey.
- Author
-
Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis L, Benavente JY, Wismer G, Batio S, Eifler M, Zheng P, Russell A, Arvanitis M, Ladner D, Kwasny M, Persell SD, Rowe T, Linder JA, and Bailey SC
- Subjects
- Adult, Aged, Aged, 80 and over, Betacoronavirus, COVID-19, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pandemics, SARS-CoV-2, Self Report, Surveys and Questionnaires, United States epidemiology, Chronic Disease epidemiology, Coronavirus Infections epidemiology, Coronavirus Infections psychology, Health Knowledge, Attitudes, Practice, Pneumonia, Viral epidemiology, Pneumonia, Viral psychology, Vulnerable Populations
- Abstract
Background: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear., Objective: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions., Design: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study., Setting: 5 academic internal medicine practices and 2 federally qualified health centers., Patients: 630 adults aged 23 to 88 years living with 1 or more chronic conditions., Measurements: Self-reported knowledge, attitudes, and behaviors related to COVID-19., Results: A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response., Limitation: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak., Conclusion: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities., Primary Funding Source: National Institutes of Health.
- Published
- 2020
- Full Text
- View/download PDF
9. Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement.
- Author
-
Rowe TA, Brown T, Lee JY, Linder JA, Friedberg MW, Doctor JN, Meeker D, Ciolino JD, and Persell SD
- Subjects
- Aged, Female, Glycated Hemoglobin, Humans, Male, Prostate-Specific Antigen, Retrospective Studies, United States, Diabetes Mellitus diagnosis, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy, Geriatrics
- Abstract
Importance: The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood., Objective: To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults., Design: Retrospective analysis of overall means and clinician-level variation in performance on three new measures., Subjects: Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017., Measures: Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication., Results: Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8-54% for the PSA measure, 3-35% for the urinalysis/urine culture measure, and 13-49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively., Conclusions: Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.
- Published
- 2020
- Full Text
- View/download PDF
10. Contrasting Perspectives of Practice Leaders and Practice Facilitators May Be Common in Quality Improvement Initiatives.
- Author
-
McHugh M, Brown T, Walunas TL, Liss DT, and Persell SD
- Subjects
- Adult, Attitude of Health Personnel, Female, Humans, Male, Middle Aged, United States, Communication, Guidelines as Topic, Health Facility Administrators psychology, Leadership, Nurse Administrators psychology, Primary Health Care standards, Quality Improvement standards
- Abstract
Practice facilitation is an approach for advancing quality improvement (QI), but its success depends on effective relationships and communication among participants. Our goal was to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators, and factors that may contribute to them. We conducted individual interviews with practice leaders and the practice facilitators assigned to them as part of a program focused on preventive cardiology within primary care practices. We used summative content analysis to quantify the incidence of contrasting perspectives, and bivariate and qualitative analyses to explore relationships between contrasting perspectives and contextual factors. Among the 16 dyads, contrasting perspectives commonly related to the easiest or hardest QI interventions to implement (8 of 16 dyads) and the practice's success implementing interventions (5 of 16 dyads). There was a nonsignificant, inverse correlation (r = -0.19, p = .47) between the number of in-person QI visits from the facilitator and the total number of contrasting perspectives. Turnover of staff was frequently reported in dyads with contrasting perspectives. Although the impact of contrasting perspectives warrants additional study, planners of QI initiatives using practice facilitation should consider taking steps to minimize contrasting perspectives, or the potential adverse consequences of them, by addressing turnover challenges and encouraging opportunities to share perspectives.
- Published
- 2020
- Full Text
- View/download PDF
11. Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial.
- Author
-
Persell SD, Liss DT, Walunas TL, Ciolino JD, Ahmad FS, Brown T, French DD, Hountz R, Iversen K, Lindau ST, Lipiszko D, Makelarski JA, Mazurek K, Murakami L, Peprah Y, Potempa J, Rasmussen LV, Wang A, Wang J, Yeh C, and Kho AN
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, United States, Cardiovascular Diseases prevention & control, Comparative Effectiveness Research, Practice Management, Medical organization & administration, Primary Health Care organization & administration, Quality Improvement
- Abstract
Background: Effective quality improvement (QI) strategies are needed for small practices., Objective: The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care., Design: Two arm, practice-randomized, comparative effectiveness study., Participants: Small and mid-sized primary care practices., Interventions: Practices worked with facilitators on QI for 12 months to implement POC or POC+PM strategies., Measures: Proportion of eligible patients in a practice meeting "ABCS" measures: (Aspirin) Aspirin/antiplatelet therapy for ischemic vascular disease, (Blood pressure) Controlling High Blood Pressure, (Cholesterol) Statin Therapy for the Prevention and Treatment of Cardiovascular Disease, and (Smoking) Tobacco Use: Screening and Cessation Intervention, and the Change Process Capability Questionnaire. Measurements were performed at baseline, 12, and 18 months., Results: A total of 226 practices were randomized, 179 contributed follow-up data. The mean proportion of patients meeting each performance measure was greater at 12 months compared with baseline: Aspirin 0.04 (95% confidence interval: 0.02-0.06), Blood pressure 0.04 (0.02-0.06), Cholesterol 0.05 (0.03-0.07), Smoking 0.05 (0.02-0.07); P<0.001 for each. Improvements were sustained at 18 months. At 12 months, baseline-adjusted difference-in-differences in proportions for the POC+PM arm versus POC was: Aspirin 0.02 (-0.02 to 0.05), Blood pressure -0.01 (-0.04 to 0.03), Cholesterol 0.03 (0.00-0.07), and Smoking 0.02 (-0.02 to 0.06); P>0.05 for all. Change Process Capability Questionnaire improved slightly, mean change 0.30 (0.09-0.51) but did not significantly differ across arms., Conclusion: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
- Published
- 2020
- Full Text
- View/download PDF
12. Social Determinants of Health Training in U.S. Primary Care Residency Programs: A Scoping Review.
- Author
-
Gard LA, Peterson J, Miller C, Ghosh N, Youmans Q, Didwania A, Persell SD, Jean-Jacques M, Ravenna P, O'Brien MJ, and Sanghavi Goel M
- Subjects
- Adult, Female, Humans, Male, United States, Young Adult, Curriculum, Education, Medical methods, Internship and Residency methods, Primary Health Care methods, Social Determinants of Health
- Abstract
Purpose: Medical training has traditionally focused on the proximate determinants of disease, with little focus on how social conditions influence health. The authors conducted a scoping review of existing curricula to understand the current programs designed to teach primary care residents about the social determinants of health (SDH)., Method: In January and March 2017, the authors searched seven databases. Eligible articles focused on primary care residents, described a curriculum related to SDH, were published between January 2007 and January 2017, and were based in the United States., Results: Of the initial 5,523 articles identified, 43 met study eligibility criteria. Most programs (29; 67%) were in internal medicine. Sixteen studies (37%) described the curriculum development process. Overall, 20 programs (47%) were short or one-time sessions, and 15 (35%) were longitudinal programs lasting at least 6 months. Thirty-two programs (74%) reported teaching SDH content using didactics, 22 (51%) incorporated experiential learning, and many programs (n = 38; 88%) employed both. Most studies reported satisfaction and/or self-perceived changes in knowledge or attitudes., Conclusions: The authors identified wide variation in curriculum development, implementation, and evaluation. They highlight curricula that considered community and resident needs, used conceptual frameworks or engaged multiple stakeholders to select content, used multiple delivery methods, and focused evaluation on changes in skills or behaviors. This review highlights the need not only for systematic, standardized approaches to developing and delivering SDH curricula but also for developing rigorous evaluation of the curricula, particularly effects on resident behavior.
- Published
- 2019
- Full Text
- View/download PDF
13. Meeting the Criteria of Medication Therapy Management-Reply.
- Author
-
Persell SD and Wolf MS
- Subjects
- Electronic Health Records, Humans, Medication Therapy Management, United States, White People, Hypertension, Medicare Part D
- Published
- 2018
- Full Text
- View/download PDF
14. Design of healthy hearts in the heartland (H3): A practice-randomized, comparative effectiveness study.
- Author
-
Ciolino JD, Jackson KL, Liss DT, Brown T, Walunas TL, Murakami L, Chung I, Persell SD, and Kho AN
- Subjects
- Adult, Aspirin administration & dosage, Blood Pressure Determination methods, Female, Health Facility Size, Humans, Hypercholesterolemia therapy, Male, Outcome and Process Assessment, Health Care, Platelet Aggregation Inhibitors administration & dosage, Smoking Cessation methods, United States, Cardiovascular Diseases prevention & control, Patient Care Management methods, Patient Care Management organization & administration, Patient Care Management standards, Point-of-Care Systems organization & administration, Primary Health Care methods, Primary Health Care organization & administration, Primary Health Care standards, Quality Improvement
- Abstract
Background: The Healthy Hearts in the Heartland (H3) study is part of a nationwide effort, EvidenceNOW, seeking to better understand the ability of small primary care practices to improve "ABCS" clinical quality measures: appropriate Aspirin therapy, Blood pressure control, Cholesterol management, and Smoking cessation. H3 aimed to assess feasibility of implementing Point-of-Care (POC) or POC plus Population Management (POC + PM) quality improvement (QI) strategies to improve ABCS at practices in Illinois, Indiana, and Wisconsin. We describe the design and randomization of the H3 study., Methods: We conducted a two-arm (1:1, POC:POC + PM), practice-randomized, comparative effectiveness study in 226 primary care practices across four "waves" of randomization with a 12-month intervention period, followed by a six-month sustainability period. Randomization controlled imbalance in nine baseline variables through a modified constrained algorithm. Among others, we used initial, unverified estimates of baseline ABCS values., Results: We randomized 112 and 114 practices to POC and POC + PM arms, respectively. Randomization ensured baseline comparability for all nine key variables, including the ABCS measures indicating proportion of patients at the practice level meeting each quality measure. Median(Inner Quartile Range) values were A: 0.78(0.66-0.86) in POC arm vs. 0.77(0.63-0.86) in POC + PM arm, B: 0.64(0.53-0.73) vs. 0.64(0.53-0.75), C: 0.78(0.63-0.86) vs. 0.75(0.64-0.81), S: 0.80(0.65-0.81) vs. 0.79(0.61-0.91)., Discussion: Surrogate estimates for the true ABCS at baseline coupled with the unique randomization logic achieved adequate baseline balance on these outcomes. Similar practice- or cluster-randomized trials may consider adaptations of this design. Final analyses on 12- and 18-month ABCS outcomes for the H3 study are forthcoming., Trial Registration: This trial is registered on ClinicalTrials.gov (Initial post: 11/05/2015; identifier: NCT02598284; https://clinicaltrials.gov/ct2/show/NCT02598284?term=NCT02598284&rank=1)., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
15. Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.
- Author
-
Kandula NR, Kanaya AM, Liu K, Lee JY, Herrington D, Hulley SB, Persell SD, Lloyd-Jones DM, and Huffman MD
- Subjects
- Adult, Age Distribution, Aged, Atherosclerosis diagnosis, Atherosclerosis epidemiology, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Cohort Studies, Confidence Intervals, Cross-Sectional Studies, Female, Humans, Linear Models, Male, Middle Aged, Odds Ratio, Predictive Value of Tests, Prevalence, Risk Assessment, Severity of Illness Index, Sex Distribution, Survival Analysis, Time Factors, United States, Asian statistics & numerical data, Atherosclerosis ethnology, Cardiovascular Diseases ethnology, Life Expectancy
- Abstract
Background: Ten-year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry., Methods and Results: South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten-year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10-year and lifetime risk strata: (1) high (≥7.5%) 10-year and low (<7.5%) 10-year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10-year predicted risk had a significantly greater CAC burden than those with low 10-year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present., Conclusion: This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non-Hispanic white and African-American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Published
- 2014
- Full Text
- View/download PDF
16. ACC/AHA/SCAI/AMA-Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures, the Society for Cardiovascular Angiography and Interventions, the American Medical Association-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance.
- Author
-
Nallamothu BK, Tommaso CL, Anderson HV, Anderson JL, Cleveland JC Jr, Dudley RA, Duffy PL, Faxon DP, Gurm HS, Hamilton LA, Jensen NC, Josephson RA, Malenka DJ, Maniu CV, McCabe KW, Mortimer JD, Patel MR, Persell SD, Rumsfeld JS, Shunk KA, Smith SC Jr, Stanko SJ, and Watts B
- Subjects
- American Heart Association, American Medical Association, Humans, Quality Assurance, Health Care, United States, Cardiology standards, Percutaneous Coronary Intervention standards
- Published
- 2014
- Full Text
- View/download PDF
17. ACC/AHA/SCAI/AMA-Convened PCPI/NCQA 2013 performance measures for adults undergoing percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures, the Society for Cardiovascular Angiography and Interventions, the American Medical Association-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance.
- Author
-
Nallamothu BK, Tommaso CL, Anderson HV, Anderson JL, Cleveland JC Jr, Dudley RA, Duffy PL, Faxon DP, Gurm HS, Hamilton LA, Jensen NC, Josephson RA, Malenka DJ, Maniu CV, McCabe KW, Mortimer JD, Patel MR, Persell SD, Rumsfeld JS, Shunk KA, Smith SC Jr, Stanko SJ, and Watts B
- Subjects
- Adult, Advisory Committees standards, Coronary Angiography standards, Humans, Research Report standards, Societies, Medical standards, United States, American Heart Association, American Medical Association, Cardiology standards, Clinical Competence standards, Percutaneous Coronary Intervention standards, Quality Assurance, Health Care standards
- Published
- 2014
- Full Text
- View/download PDF
18. Changes in disparities following the implementation of a health information technology-supported quality improvement initiative.
- Author
-
Jean-Jacques M, Persell SD, Thompson JA, Hasnain-Wynia R, and Baker DW
- Subjects
- Adult, Aged, Aged, 80 and over, Ambulatory Care economics, Ambulatory Care standards, American Recovery and Reinvestment Act economics, Female, Healthcare Disparities economics, Humans, Male, Middle Aged, Quality of Health Care economics, United States ethnology, Black or African American ethnology, American Recovery and Reinvestment Act standards, Healthcare Disparities ethnology, Healthcare Disparities standards, Quality of Health Care standards, White People ethnology
- Abstract
Background: Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities., Objectives: To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care., Design: Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative., Patients: Black and white adults receiving care in an academic general internal medicine practice in Chicago., Interventions: The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services., Main Measures: Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measures, Key Results: Quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative., Conclusions: Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.
- Published
- 2012
- Full Text
- View/download PDF
19. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement.
- Author
-
Drozda J Jr, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC Jr, Hellman R, James T 3rd, King ML, Machado EA Jr, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, and Wong JB
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Adult, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antihypertensive Agents therapeutic use, Coronary Artery Disease complications, Coronary Artery Disease physiopathology, Humans, Hypertension complications, Hypertension physiopathology, Medication Adherence, Outcome Assessment, Health Care, Outpatients, Platelet Aggregation Inhibitors, Smoking Cessation, United States, Coronary Artery Disease diagnosis, Coronary Artery Disease therapy, Hypertension diagnosis, Hypertension therapy, Quality Indicators, Health Care standards
- Published
- 2011
- Full Text
- View/download PDF
20. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement.
- Author
-
Drozda J Jr, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC Jr, Hellman R, James T 3rd, King ML, Machado EA Jr, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, and Wong JB
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Adult, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antihypertensive Agents therapeutic use, Coronary Artery Disease complications, Coronary Artery Disease physiopathology, Humans, Hypertension complications, Hypertension physiopathology, Medication Adherence, Outcome Assessment, Health Care, Outpatients, Platelet Aggregation Inhibitors, Smoking Cessation, United States, Coronary Artery Disease diagnosis, Coronary Artery Disease therapy, Hypertension diagnosis, Hypertension therapy, Quality Indicators, Health Care standards
- Published
- 2011
- Full Text
- View/download PDF
21. Prevalence of resistant hypertension in the United States, 2003-2008.
- Author
-
Persell SD
- Subjects
- Adult, Antihypertensive Agents classification, Cardiovascular Diseases physiopathology, Drug Resistance, Drug Therapy methods, Drug Therapy statistics & numerical data, Humans, Hypertension epidemiology, Nutrition Surveys statistics & numerical data, Prevalence, Risk Assessment, Risk Factors, United States epidemiology, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy, Hypertension physiopathology
- Abstract
The prevalence of resistant hypertension is unknown. Much previous knowledge comes from referral populations or clinical trial participants. Using data from the National Health and Nutrition Examination Survey from 2003 through 2008, nonpregnant adults with hypertension were classified as resistant if their blood pressure was ≥140/90 mm Hg and they reported using antihypertensive medications from 3 different drug classes or drugs from ≥4 antihypertensive drug classes regardless of blood pressure. Among US adults with hypertension, 8.9% (SE: 0.6%) met criteria for resistant hypertension. This represented 12.8% (SE: 0.9%) of the antihypertensive drug-treated population. Of all drug-treated adults whose hypertension was uncontrolled, 72.4% (SE: 1.6%) were taking drugs from <3 classes. Compared with those with controlled hypertension using 1 to 3 medication classes, adults with resistant hypertension were more likely to be older, to be non-Hispanic black, and to have higher body mass index (all P<0.001). They were more likely to have albuminuria, reduced renal function, and self-reported medical histories of coronary heart disease, heart failure, stroke, and diabetes mellitus (P<0.001). Most (85.6% [SE: 2.4%]) individuals with resistant hypertension used a diuretic. Of this group, 64.4% (SE: 3.2%) used the relatively weak thiazide diuretic hydrochlorothiazide. Although not rare, resistant hypertension is currently found in only a modest proportion of the hypertensive population. Among those classified here as resistant, inadequate diuretic therapy may be a modifiable therapeutic target. Cardiovascular diseases, diabetes mellitus, obesity, and renal dysfunction were all common in this population.
- Published
- 2011
- Full Text
- View/download PDF
22. Medication reconciliation and hypertension control.
- Author
-
Persell SD, Bailey SC, Tang J, Davis TC, and Wolf MS
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Humans, Logistic Models, Male, Medical Records, Middle Aged, Risk Factors, Treatment Outcome, United States, Ambulatory Care, Antihypertensive Agents therapeutic use, Drug Utilization Review, Hypertension drug therapy, Medication Errors, Primary Health Care
- Abstract
Background: Discrepancies between the medical record and patient medication list are common. The relationship of discrepancies to chronic disease control has not been established., Methods: To determine the frequency and type of antihypertensive medication discrepancies between patient-named antihypertensive medications and the medical record, we performed a cross-sectional study of 315 adults with medically treated hypertension from 6 safety-net clinics in 3 states. We determined the association between medication discrepancies and uncontrolled blood pressure (> or =140/90 mm Hg or > or =130/80 mm Hg if diabetes) using multivariate logistic regression models., Results: Discrepancies were present for 75.2% of patients; 25.7% of patients could not provide the name of any antihypertensive medication they took; 49.5% could name 1 or more antihypertensive medications but had discrepancies between patient-reported antihypertensive medications and those listed in the medical record. Both patients who were unable to name any of their antihypertensive medications and patients with discrepancies between patient-named medications and the medical record were significantly more likely to have uncontrolled blood pressure than patients who named the same medications as the medical record in adjusted analyses, adjusted risk ratios 1.66 (95% confidence interval, 1.31-2.10) and 1.51 (95% confidence interval, 1.11-2.07), respectively. Twelve percent of patients reporting medications took antihypertensive medication that altered potassium metabolism that was not in their medical record., Conclusions: Among patients at safety-net clinics, inability to name one's antihypertensive medications and discrepancies between patient-reported medications and the medical record were very common. Both were strongly associated with inadequate hypertension control. Performing medication reconciliation at the point of care may be an important way to identify patients at high risk for inadequate disease control or safety problems., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
23. Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006.
- Author
-
Marma AK, Berry JD, Ning H, Persell SD, and Lloyd-Jones DM
- Subjects
- Adult, Age Factors, Aged, Algorithms, Cardiovascular Diseases prevention & control, Chi-Square Distribution, Data Interpretation, Statistical, Female, Humans, Male, Middle Aged, Nutrition Surveys, Preventive Health Services, Risk Assessment, Risk Factors, Sex Factors, Time Factors, United States epidemiology, Young Adult, Cardiovascular Diseases epidemiology, Cardiovascular Diseases etiology
- Abstract
Background: National guidelines for primary prevention suggest consideration of lifetime risk for cardiovascular disease in addition to 10-year risk, but it is currently unknown how many US adults would be identified as having low short-term but high lifetime predicted risk if stepwise stratification were used., Methods and Results: We included 6329 cardiovascular disease-free and nonpregnant individuals ages 20 to 79 years, representing approximately 156 million US adults, from the National Health and Nutrition Examination Survey 2003 to 2004 and 2005 to 2006. We assigned 10-year and lifetime predicted risks to stratify participants into 3 groups: low 10-year (<10%)/low lifetime (<39%) predicted risk, low 10-year (<10%)/high lifetime (> or = 39%) predicted risk, and high 10-year (> or = 10%) predicted risk or diagnosed diabetes. The majority of US adults (56%, or 87 million individuals) are at low short-term but high lifetime predicted risk for cardiovascular disease. Twenty-six percent (41 million adults) are at low short-term and low lifetime predicted risk, and only 18% (28 million individuals) are at high short-term predicted risk. The addition of lifetime risk estimation to 10-year risk estimation identifies higher-risk women and younger men in particular., Conclusions: Whereas 82% of US adults are at low short-term risk, two thirds of this group, or 87 million people, are at high lifetime predicted risk for cardiovascular disease. These results provide support for use of a stepwise stratification system aimed at improving risk communication, and they provide a baseline for public health efforts aimed at increasing the proportion of Americans with low short-term and low lifetime risk for cardiovascular disease.
- Published
- 2010
- Full Text
- View/download PDF
24. Patient-directed intervention versus clinician reminders alone to improve aspirin use in diabetes: a cluster randomized trial.
- Author
-
Persell SD, Denecke-Dattalo TA, Dunham DP, and Baker DW
- Subjects
- Aged, Evidence-Based Medicine, Female, Humans, Interviews as Topic, Male, Middle Aged, United States, Aspirin therapeutic use, Diabetes Mellitus drug therapy, Patient Compliance, Physician-Patient Relations, Platelet Aggregation Inhibitors therapeutic use, Reminder Systems
- Abstract
Background: Physician-directed approaches have not eliminated the underuse of effective preventive therapies., Methods: In a cluster-randomized design, 19 physicians caring for 334 eligible patients at least 40 years of age were randomized. All clinicians received computerized reminders at office visits. Intervention physicians received e-mails asking whether aspirin was indicated for each patient. If so, patients received a mailing and nurse telephone call addressing aspirin. The primary outcome was self-reported regular aspirin use., Results: Outcome assessment telephone interviews were completed for 242 (72.5%) patients. At follow-up, aspirin use was reported by 60 (46%) of the 130 intervention patients and 44 (39%) of the 112 reminder-only patients, a nonsignificant 7.2% difference (95% confidence interval: -3.9 to 18 percentage points, p = .20). In the subgroup reporting no aspirin use at baseline and no contraindications, 33 (43%) of the 76 intervention and 22 (30%) of the 74 reminder-only patients used aspirin, a 10% difference accounting for clustering (95% CI: 2.2 to 18 percentage points, p = .013)., Discussion: A patient-directed intervention modestly increased aspirin use among diabetes patients beyond that achieved using computerized clinician reminders for ideal candidates. Obstacles included difficulty contacting patients, real or perceived contraindications, and failure to follow the nurse's advice.
- Published
- 2008
- Full Text
- View/download PDF
25. Assessing the validity of national quality measures for coronary artery disease using an electronic health record.
- Author
-
Persell SD, Wright JM, Thompson JA, Kmetik KS, and Baker DW
- Subjects
- Humans, Retrospective Studies, United States, Ambulatory Care standards, Coronary Artery Disease therapy, Medical Records Systems, Computerized, Outcome and Process Assessment, Health Care methods, Quality Indicators, Health Care
- Abstract
Background: Nationally endorsed, clinical performance measures are available that allow for quality reporting using electronic health records (EHRs). To our knowledge, how well they reflect actual quality of care has not been studied. We sought to evaluate the validity of performance measures for coronary artery disease (CAD) using an ambulatory EHR., Methods: We performed a retrospective electronic medical chart review comparing automated measurement with a 2-step process of automated measurement supplemented by review of free-text notes for apparent quality failures for all patients with CAD from a large internal medicine practice using a commercial EHR. The 7 performance measures included the following: antiplatelet drug, lipid-lowering drug, beta-blocker following myocardial infarction, blood pressure measurement, lipid measurement, low-density lipoprotein cholesterol control, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for patients with diabetes mellitus or left ventricular systolic dysfunction., Results: Performance varied from 81.6% for lipid measurement to 97.6% for blood pressure measurement based on automated measurement. A review of free-text notes for cases failing an automated measure revealed that misclassification was common and that 15% to 81% of apparent quality failures either satisfied the performance measure or met valid exclusion criteria. After including free-text data, the adherence rate ranged from 87.5% for lipid measurement and low-density lipoprotein cholesterol control to 99.2% for blood pressure measurement., Conclusions: Profiling the quality of outpatient CAD care using data from an EHR has significant limitations. Changes in how data are routinely recorded in an EHR are needed to improve the accuracy of this type of quality measurement. Validity testing in different settings is required.
- Published
- 2006
- Full Text
- View/download PDF
26. National Cholesterol Education Program risk assessment and potential for risk misclassification.
- Author
-
Persell SD, Lloyd-Jones DM, and Baker DW
- Subjects
- Adult, Age Distribution, Aged, Confidence Intervals, Coronary Disease prevention & control, Female, Health Education, Humans, Male, Middle Aged, Nutrition Surveys, Sex Distribution, United States, Coronary Disease etiology, Hypercholesterolemia complications, Risk Assessment classification
- Abstract
Background: The National Cholesterol Education Program Adult Treatment Panel report from 2001 (ATP III) recommends clinicians calculate 10-year coronary risk using multivariable methods only for adults with 2 or more risk factors. We aimed to determine who would be falsely classified as low risk using this approach., Methods: We studied 4097 adults aged 20 to 79 years without diagnosed cardiovascular disease or diabetes from the National Health and Nutrition Examination Survey from 1999 to 2002. We determined the proportion with fewer than 2 risk factors who nonetheless had estimated 10-year risk of cardiac death or myocardial infarction > or =10% using multivariable methods., Results: Among persons with fewer than 2 risk factors, 5.3% (95% confidence interval 4.7 to 6.1%), had a 10-year risk > or =10% using the Framingham Risk Score and would be misclassified using the risk factor counting method (this corresponds to approximately 5,640,000 U.S. adults). Compared to individuals whose classification was unchanged, those misclassified as low risk were older (P<0.001) and more likely male (85.5% vs. 41.2%, P<0.001)., Conclusions: Relying on the ATP III risk factor counting method rather than determining risk using multivariable methods in all patients resulted in misclassifiying as low risk over 5 million adults with at least moderately high risk of coronary heart disease, most of whom are middle-aged and older men.
- Published
- 2006
- Full Text
- View/download PDF
27. Aspirin use among adults with diabetes: recent trends and emerging sex disparities.
- Author
-
Persell SD and Baker DW
- Subjects
- Adult, Aged, Cardiovascular Diseases complications, Female, Humans, Male, Middle Aged, Risk Factors, Sex Factors, United States, Aspirin administration & dosage, Diabetes Mellitus
- Abstract
Background: Despite high cardiovascular risk among adults with diabetes mellitus, aspirin use has been low., Methods: To assess recent self-reported regular aspirin use among adults 35 years or older with diabetes, we used statewide telephone surveys conducted in 7 states in 1997 and 20 states in 1999 and 2001 including 875, 3205, and 4272 subjects in 1997, 1999, and 2001, respectively., Results: Aspirin use increased from 37.5% in 1997 to 48.7% in 2001. In 2001, 74.2% (95% confidence interval [CI], 70.9%-77.5%) of diabetic adults with cardiovascular disease, but only 37.9% (95% CI, 35.1%-40.7%) of those without cardiovascular disease, used aspirin regularly, including less than 40% with diagnosed hypertension or hypercholesterolemia or who smoked. After adjusting for cardiac risk factors and socioeconomic characteristics, among those without cardiovascular disease, aspirin use was less common in women aged 35 to 49 years (adjusted rate ratio [RR], 0.35; 95% CI, 0.24-0.51) and 50 to 64 years (RR, 0.69; 95% CI, 0.53-0.88) and in men aged 35 to 49 years (RR, 0.62; 95% CI, 0.43-0.85) compared with men 65 years and older. For those with diagnosed cardiovascular disease, aspirin use was lower among women (RR, 0.81 compared with men; 95% CI, 0.70-0.90) and adults younger than 50 years (RR compared with those >/=65 years, 0.81; 95% CI, 0.61-0.98). The disparity in aspirin use between men and women appeared between 1997 and 2001., Conclusions: Aspirin use among adults with diabetes has increased. However, many high-risk individuals, especially women and those younger than 50 years, do not use this effective and inexpensive therapy.
- Published
- 2004
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.