Search

Background More women than men experience recurrent strokes. Medication adherence is critical to prevent recurrence; however, studies investigating sex differences are limited. We examined sex differences in poststroke medication adherence, overall and by drug class, and identified influencing factors. Methods and Results Patients with first‐ever ischemic stroke were identified from a population‐based study (2008–2019). At 90 days after a stroke, self‐reported medication adherence was defined as never or rarely missing a dose in a typical week for each secondary stroke prevention medication (antihypertensives, cholesterol‐lowering drugs, antiplatelets, anticoagulants). We generated prevalence ratios (PRs) using modified Poisson models to assess sex differences with and without adjustment for potential confounding factors, including demographics, social factors, health system–related, lifestyle‐related, health condition–related, prestrokehealth–related, and stroke‐related factors. Among 1324 participants (48.4% women, 58.0% Mexican American individuals), women were more likely to report nonadherence to cholesterol‐lowering drugs (PR, 1.80 [95% CI, 1.14–2.84]) and antiplatelets (PR, 1.53 [95% CI, 1.003–2.34]). Adjusting for obesity attenuated while adjusting for age, marital status, access to care, smoking, and alcohol consumption accentuated sex differences. Race and ethnicity modified the sex difference in nonadherence to cholesterol‐lowering drugs (Pinteraction=0.054) such that the sex difference was larger in Mexican American individuals (PR, 3.00 [95% CI, 1.65–5.48]) than in non‐Hispanic White individuals (PR, 1.30 [95% CI, 0.52–3.27). No significant sex differences were found for nonadherence to antihypertensives and overall nonadherence. Conclusions Poststroke medication nonadherence was more prevalent among women than men. This was partially due to the confounding effects of lifestyle, marital status, and access to care, suggesting potential subgroups for interventions to improve adherence.

ObjectiveNorm Balance is an approach under the Theory of Planned Behavior (TPB) where subjective norm is weighted by the relative importance of others and self-identity is weighted by the relative importance of self. The relative importance was measured previously by a trade-off measure. In this study, we developed separate measures for the relative importance. The study objectives were to: 1) assess the construct validity of the separate measures; 2) examine the approach of Norm Balance in predicting pharmacists’ intention to collaborate with physicians to improve medication therapy; and 3) establish a modified TPB.MethodsWe selected a random sample of 750 Iowa pharmacists and conducted two surveys. The first survey was to examine intention prediction, and the second survey was to examine behavior prediction by measuring behavior among respondents to the first survey. The relative importance was measured by both the trade-off measure and the separate measures. Exploratory factor analyses were performed for the relative importance of others (separate measures) and subjective norm, and for the relative importance of self (separate measures) and self-identity. Regressions for intention prediction were conducted for TPB with self-identity and the approach of Norm Balance. The same regressions were also conducted for three subgroups according to the median of the relative importance of others (trade-off measure). Moreover, another regression was conducted for behavior prediction.Results239 practicing pharmacists responded to the first survey, and 188 responded to the second survey. The separate measures had cross factor loadings, whereas the trade-off measure had low correlations with other constructs. Both regressions for intention prediction explained 75% of the variance, with self-efficacy and attitude being strong predictors. Self-identity was not a predictor in the TPB with self-identify, but self-identity weighted by the relative importance of self was a significant predictor in the approach of Norm Balance. Regression coefficients of subjective norm and self-identify varied across subgroups. The regression for behavior prediction explained 30% of the variance, with intention and self-efficacy being two predictors.ConclusionThe trade-off measure was better than separate measures. The approach of Norm Balance appears to be a better model than the TPB with self-identity to examine pharmacist-physician collaboration.

Improvements in chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), and multiple myeloma (MM) treatment options have increased the 5-year survival rates for patients with these hematologic malignancies. In addition to cancer management, these patients may need help to manage multiple chronic conditions (MCC). The overall objective of this study is to examine the impact and implementation of a model that coordinates care between oncology and primary care pharmacists for people taking an oral anti-cancer agent (OAAs) and medications for comorbid chronic conditions. This is a multi-center, prospective, single-arm pilot study that will recruit up to 40 patients from Michigan Medicine and Vanderbilt University Medical Center (VUMC). Eligible participants will be 18 years of age or older, prescribed an OAA, have a diagnosis of either CML, CLL or MM, and be diagnosed with and taking medication for at least two specified chronic conditions. The Pharmacists Coordinated Care Oncology Model (PCOM) is a two-month intervention that builds upon current pharmacist clinical responsibilities. Generally, participants will complete a patient-reported outcome measure at 2 and 6 weeks post-OAA initiation that is sent to their oncology pharmacist, and they will also receive a comprehensive medication review at week 4 from a primary care pharmacist for their chronic medications. The pharmacists will communicate about the results via electronic medical record (EMR) and intervene if necessary. The primary endpoints are (1) dose-adjusted OAA proportion of days covered (PDC), and (2) PDC for chronic condition medications. PDCs will be determined via prescription records. The association of OAA and chronic medication PDCs will be quantified via correlation and chi-squared tests. The association between symptom experience and OAA adherence will be examined via correlation analyses. For implementation, characteristics of patient participants, feasibility, acceptability, adoption, fidelity, and trialability will be described. Data will be collected via EMR and pharmacist and patient interviews. Median/IQR for acceptability, adoption and fidelity will be reported, and patient interviews will be analyzed using a grounded theory approach and pharmacist interviews will be analyzed using thematic analyses.

Purpose: Discrepancies between clinicians’ assessment of chemotherapy-induced peripheral neuropathy (CIPN) and patient-reported outcomes (PRO) have been described, though the underlying reasons are unknown. Our objective was to identify potential patient-specific factors associated with under-describing of CIPN to clinicians in women with non-metastatic breast cancer treated with paclitaxel. Methods: Patients enrolled in an observational study (n = 60) completed weekly CIPN PRO using the EORTC CIPN20. Clinician-documented CIPN using the NCI CTCAE were abstracted from the electronic medical record and paired with CIPN20 data at weeks 7 and 10. Patients were classified as under-describers if their CIPN20 was above the 80th percentile of the CIPN20 distribution for that CTCAE grade from an independent clinical trial (N08CA). Demographics, Assessment of Survivor Concerns (ASC), Trust in Oncologist Scale (TiOS), and health literacy assessment were collected post-treatment via survey. Repeated measures cumulative logistic regression models were used to identify factors associated with under-describing CIPN. Results: Forty-two women completed the survey (response rate 70%). Three and 9 patients were categorized as under-describers at weeks 7 and 10, respectively. Women who were not working (OR = 9.00, 95%CI 1.06–76.15), had lower income (OR = 7.04, 95%CI 1.5–32.99), and displayed higher trust in their oncologist’s competence (OR = 1.29, 95%CI 1.03–1.62 for a 0.1-unit increase in score) were more likely to under-describe CIPN symptoms. Conclusions: This preliminary study identified non-working status, low income and trust in oncologist’s competence as potential factors influencing under-description of CIPN to the clinical team. Further work is needed to clarify these relationships and test additional factors.

Background: An innovative approach of Norm Balance is proposed under the Theory of Planned Behavior (TPB). In this approach, the measurement score of subjective norm is weighted by the relative importance of others, and the measurement score of self-identity is weighted by the relative importance of self. The study objective was to examine the effect of Norm Balance to predict behavioral intentions in two groups of college students. Methods: Cross-sectional surveys were used in two studies. For 153 business undergraduates, Study 1 examined three common intentions: eating a low-fat diet, exercising regularly, and dressing business-like. For 176 PharmD students, Study 2 examined three pharmacy-related intentions: informing relatives about counterfeit medications, buying prescription medications online, and completing a pharmacy residency. The relative importance of others vs. self was measured by asking study subjects to allocate 10 points between important others and oneself. Two sets of regressions were conducted and compared across six intentions using the traditional model and the Norm Balance model. Results: The 12 regressions explained 59–77% of intention variance. The variance explained by the two models was similar. When subjective norm or self-identity was non-significant in the traditional model, the corresponding Norm Balance component was significant in the Norm Balance model, except for eating a low-fat diet. When both subjective norm and self-identity were significant in the traditional model, the two Norm Balance components were significant in the Norm Balance model with increased coefficients. Conclusions: The proposed approach of Norm Balance provides a different view about the significance and coefficients of subjective norm and self-identity toward intention prediction.

US Latine adults who prefer the Spanish language for healthcare encounter communication have high risk of health disparitiesm in part from low organizational health literacy, mental health stigma and discrimination. Organizational health literacy includes the provision of culturally responsive, language concordant health information, which supports good comprehension and usefulness and could mitigate some health disparities. We conducted a pilot study to assess commonly provided patient health information handouts about depression treatment and antidepressant consumer medication information sheets. Thirty Latine adults with a Spanish language preference and a history of depression and antidepressant use participated in one phone interview. Descriptive statistics and thematic analysis were used to assess comprehension and usefulness of selected sections extracted verbatim from these documents. Overall, 83% (n = 25) participants reported that all sections were easy to understand, and 97% (n = 29) said that they were useful. Yet, responses to open-ended questions for 53% (n = 16) of participants revealed 'confusing' terminology in at least one section, and 10% (n = 3) expressed concerns about or misunderstood an idiomatic phrase as reinforcing mental health stigma. The seriousness of the organizational health literacy-based issues identified in this and previous studies require that government and health service organizations make necessary and timely revisions to address them.

The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.

Objectives: To describe pharmacists' attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services. Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists' opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics. Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services. Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients. Type: Original Research

Background: Cancer drug therapy is a high-volume, high-risk clinical encounter that requires close coordination across interprofessional clinical teams. Purpose: The Multi-Professional Oncology Safety and Simulation Training (MOSST) program, supported by the National Cancer Institute was launched in Fall 2018. The original workshop was conducted in person. As the COVID pandemic hit the program was transitioned to an on-line/distance simulation program. Method: The full day workshop was moved to an on-line platform using Zoom and the in-person simulations were re-developed as video simulations. We then evaluated learner outcomes identically in each modality using the evaluation metrics from our original workshop. Discussion: We found that the use an of online modality to deliver the MOSST workshop resulted in a high-quality educational experience for the learners and the educational outcomes were comparable.

Abstract BackgroundRemote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. ObjectiveThis study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. MethodsThis was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ≥18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. ResultsIn total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (, 60.4%), non-Hispanic (483/507, 95.3%), and White (429/507, 84.6%). A little over half of the respondents reported having had hypertension for 5 years or more (, 56.6%). About one-third of participants were aware of RBPM (, 32.5%), and 11.8% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (, 55.3%) and their lack of awareness of RBPM (, 42.5%). Most respondents in the RBPM group measure their BP at home (, 91.7%), and 61.7% () engage in daily BP measurement, compared with 62.6% () and 25.1% (), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; , 61.7%) than those in the non-RBPM group (, 15.6%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95% CI 11.35‐150.31; PPP ConclusionsParticipation in RBPM is likely to increase with increased awareness, health providers’ recommendations, and tailoring RBPM services to patients’ preferred electronic communication channels.

Introduction Targeted oral anticancer agents (OAAs) are increasingly used to treat cancer, including haematological malignancies and ovarian cancer, but they can cause serious symptomatic side effects such as arrhythmias, hypertension, and hyperglycaemia. Unaddressed OAA symptoms or inadequately managed symptoms may also lead to unnecessary and unscheduled healthcare use that decreases patient quality of life and financially burdens both patients and the healthcare system. Limited information is available about patient symptoms, self-management behaviours, and use of healthcare services over time while taking targeted OAAs, but is needed to ensure successful OAA therapy. The primary objective is to understand patient experiences and behaviours on initiating targeted OAA, and elicit cancer care clinicians’ (ie, physicians, advanced practice practitioners, nurses, and pharmacists) perspectives on supporting patients during therapy. Study results will inform comprehensive and realistic interventions that minimise disruptions to therapy while maximising quality of life.Methods and analysis We will conduct a remote single-arm, convergent-parallel mixed-methods cohort study within a large academic medical centre. A minimum of 60 patients will be enrolled. Patients will complete several validated patient-reported outcome measures at six timepoints over 6 months. Mixed-effects logistic regression will be used to predict the primary binary outcome of unscheduled healthcare use by patient self-efficacy for symptom self-management. Semistructured interviews will be conducted with patients and clinicians and thematically analysed. Triangulated quantitative and qualitative results will be reported using cross-case comparison joint display.Ethics and dissemination This study protocol is approved by the Institutional Review Board of University of Michigan Medical School (IRBMED). Study results will be published in peer-reviewed journals, presented at conferences, and disseminated to study participants.

Background Telemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring. Objective The objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF). Methods This study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient–provider communication preferences. A joint display was used in the mixed-methods analysis. Results Five themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants’ e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance. Conclusion Patients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.

BackgroundThe successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. ObjectiveThe aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. MethodsA single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (“app group”) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (“no-app group”) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. ResultsA total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. ConclusionsThe adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial RegistrationClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510