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Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence.

In Brief As part of comprehensive clinical care for people with diabetes, there is a need for multifaceted interventions that address the primary lifestyle factors that contribute to women's type [...]

The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma.

OBJECTIVE--There is a dearth of information on the extent to which diabetic patients receive care congruent with the chronic care model (CCM) and evidence-based behavioral counseling. This study evaluates a [...]

OBJECTIVE--There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care settings. This report presents 12-month follow-up results from a computer-assisted, patient-centered [...]

Abstract Interactive health technologies (IHTs), whether used as an adjunct to clinical care or as a stand-alone program, provide a means to efficiently deliver both standardized information and tailored health [...]

OBJECTIVE--To evaluate associations between psychosocial and social-environmental variables and diabetes self-management, and diabetes control. RESEARCH DESIGN AND METHODS--Baseline data from a type 2 diabetes self-management randomized trial with 463 adults [...]

Use of digital communication technologies (DCT) shows promise for enhancing outcomes and efficiencies in asthma care management. However, little is known about the impact of DCT interventions on healthcare personnel requirements and costs, thus making it difficult for providers and health systems to understand the value of these interventions. This study evaluated the differences in healthcare personnel requirements and costs between usual asthma care (UC) and a DCT intervention (Breathewell) aimed at maintaining guidelines-based asthma care while reducing health care staffing requirements. We used data from a pragmatic, randomized controlled trial conducted in a large integrated health system involving 14,978 patients diagnosed with asthma. To evaluate differences in staffing requirements and cost between Breathewell and UC needed to deliver guideline-based care we used electronic health record (EHR) events, provider time tracking surveys, and invoicing. Differences in cost were reported at the patient and health system level. The Breathewell intervention significantly reduced personnel requirements with a larger percentage of participants requiring no personnel time (45% vs. 5%, p< .001) and smaller percentage of participants requiring follow-up outreach (44% vs. 68%, p< .001). Extrapolated to the total health system, cost for the Breathewell intervention was $16,278 less than usual care. The intervention became cost savings at a sample size of at least 957 patients diagnosed with asthma. At the population level, using DCT to compliment current asthma care practice presents an opportunity to reduce healthcare personnel requirements while maintaining population-based asthma control measures.A new program was implemented in a healthcare system to identify patients in need of further clinical evaluation for asthma using an automated system instead of through nurse outreach. This study identified the cost and staff requirements of this new program compared to what was normally done by the staff. We collected information from the electronic health record on patients use of the system and we asked staff to complete surveys to identify how much time they spent reaching out to patients. Almost half (45%) of patients did not need clinical evaluation reducing staff evaluation. Overall, the automated outreach program is just over $16,000 less than what is normally done. If this was done in a different health system, it would require at least 957 patients diagnosed with asthma to be cost savings. Using automated outreach can provide a way to reduce the time required of clinic staff without negatively impacting patients.

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Background: The increasing prevalence of fetal alcohol spectrum disorders is a critical public health issue. Two behaviors, consuming alcohol and using less effective pregnancy prevention, may result in alcohol-exposed pregnancies (AEPs) in individuals who can become pregnant. In the context of alcohol screening and brief intervention (SBI) services, cutoff scores on widely used alcohol risk assessments (eg, Alcohol Use Disorders Identification Test, U.S. version [USAUDIT]) may fail to identify individuals whose relatively low alcohol consumption may still put them at risk for an AEP due to their pregnancy prevention method.Methods: To identify this gap in alcohol SBI service delivery, we examined data from 2 reproductive healthcare systems implementing alcohol SBI, to explore the prevalence of individuals who met both of the following risk conditions: reported any alcohol use on the USAUDIT and a pregnancy prevention method less than 88% effective. Electronic health records for individuals aged 18 to 49 presenting for preventive care in 2021 were analyzed.Results: Of 11 567 screened, 7638 reported some alcohol use, but screened at a lower-risk level and were not flagged to receive an alcohol-focused brief intervention (BI). Of these, 1477 were using a method of pregnancy prevention that was less than 88% effective. In addition, 118 of the 1676 who screened positive on the USAUDIT were using less effective contraception and did not receive a BI. In summary, the number of individuals at risk of an AEP who did not receive an alcohol BI was 1595 (13.8%) of the total patients screened for at-risk alcohol use.Conclusions: There is a need for system modifications to assess multiple behaviors simultaneously and alert providers when a combination of behaviors increases a specific health risk, such as an AEP. Tailored alcohol BIs that include the risks/benefits of various pregnancy prevention methods to reduce AEPs provide opportunities to enhance the reach of standard alcohol SBI services.

Standardized screening, brief intervention, and referral to treatment (SBIRT) is effective when used by health care professionals to assess, educate, and intervene to address risky alcohol use. To accelerate SBIRT training within academic settings, the Substance Abuse and Mental Health Services Administration funded implementation of its SBIRT curriculum to promote its use by future health care professionals. We report on how SBIRT content was implemented within nursing, social work, psychology, and family medicine residency programs at a state university. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) evaluation framework was used to compare delivery of SBIRT curriculum across health professions. Survey data measured changes in student knowledge, confidence, and responsibility to use SBIRT for alcohol and drugs, pre- and post-SBIRT training. Twelve months postgraduation follow-up surveys examined maintenance of outcomes and SBIRT use in practice. Observational data explored fidelity and adaptations made to curriculum content and delivery logistics. Results indicated that instructor adoption, fidelity, and format varied across health professional training programs, with adaptations made to improve fit, role alignment, and cultural relevance. Despite variation in curriculum delivery, students demonstrated significant gains in knowledge and confidence, (p< .001). Key implementation and maintenance challenges included time constraints, instructor buy-in, competing accreditation requirements, and costs for using the university simulation laboratory to practice SBIRT. Strengths supporting maintenance included flexibility to adapt curriculum, department champions, and electronic resources to support curriculum delivery. Results suggest that adaptations maximizing the feasibility and fit of SBIRT within existing courses enhanced its adoption and maintenance potential without sacrificing effectiveness.

Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation of a remotely delivered, family-based financial incentive intervention for cigarette smoking among Alaskan ANAI people.

Much research focuses on producing maximal intervention effects. This has generally not resulted in interventions being rapidly or widely adopted or seen as feasible given resources, time, and expertise constraints in the majority of real-world settings. We present a definition and key characteristics of a minimum intervention needed to produce change (MINC). To illustrate use of a MINC condition, we describe a computer-assisted, interactive minimal intervention, titled Healthy Habits, used in three different controlled studies and its effects. This minimal intervention produced modest to sizable health behavior and psychosocial improvements, depending on the intensity of personal contacts, producing larger effects at longer-term assessments. MINC comparison conditions could help to advance both health care and health research, especially comparative effectiveness research. Policy and funding implications of requiring an intervention to be demonstrated more effective than a simpler, less costly MINC alternative are discussed.

There has been little discussion of or research on the key translational issue of how to integrate patient self-management programs across multiple primary care clinics within an HMO. The purpose of this study was to summarize our experiences and lessons learned in trying to integrate information from a web-based diabetes self-management program into primary care and the electronic health record (EHR). We describe plans, implementation, adaptations made, and data on patient and physician reactions to the My Path diabetes self-management program provided to 331 adult primary care patients. Mixed methods results revealed that, despite the availability of a state-of-the-art EHR, the intervention was not well integrated into primary care. Information from health-promotion and disease management programs, even within the same organization and with advanced EHR systems, is challenging to integrate into busy primary care.

Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials-the Mediterranean Lifestyle Program and ¡Viva Bien!. Results from these two trials, including readiness for dissemination, are evaluated using the RE-AIM framework in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Program adaptations produced relative high reach as well as consistent and replicated effectiveness and maintenance, and were adopted by a high percentage of primary care offices and clinicians approached. We discuss key findings, lessons learned, future directions for related research, and use of RE-AIM for program development, adaptation, scale-up, and evaluation.

Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ¡Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives. Recruitment, intervention, and participant costs were estimated at $45,896, $432,433, and $179,697, respectively. This translates to $4,634 in intervention costs per ¡Viva Bien! participant; $7,723 in both per unit reduction in hemoglobin A1c and per unit reduction in body mass index. Although costs may be higher than interventions that address one risk factor, potential risks for longer-term health-care costs are high for this at-risk group. Given the benefits of ¡Viva Bien!, cost reductions are recommended to enhance its efficiency, adoption, and long-term maintenance without diluting its effectiveness.

Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended longterm lifestyle changes and reduce heart disease risk. To test the longer-term (24-month) effects of a previously successful, culturally adapted, multiple-healthbehavior- change program, ¡Viva Bien!, 280 Latinas were randomly assigned to usual care or ¡Viva Bien!. Treatment included group meetings to promote a culturally adapted Mediterranean diet, physical activity, supportive resources, problem solving, stress-management practices, and smoking cessation. ¡Viva Bien! participants achieved and maintained some lifestyle improvements from baseline through 24 months, including significant improvements for psychosocial outcomes, fat intake, social-environmental support, body mass index, and hemoglobin A1c. Effects tended to diminish over time. The ¡Viva Bien! multiple-behavior program was effective in improving and maintaining some psychosocial, behavioral, and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes, a high-risk, underserved population (ClinicalTrials.gov number, NCT00233259).

Background:American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska.Methods:The study used baseline data from “Got Neqpiaq?” a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3–5 years, enrolled in Head Start in 12 communities in southwest Alaska (n= 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured.Results:Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels.Conclusions:The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov#NCT03601299.

PURPOSEthis study reports on methods and strategies employed to increase participation rates in diabetes interventions and discusses the reach and representativeness of the Diabetes Priority Program.METHODSA passive mail-out procedure was used to contact patients of participating primary care physicians. Patients who did not return the refusal postcard were contacted. Several attempts were made to contact potential participants. Brochures, "wrong number" postcards, posters, and reports for clinic staff were strategies used to increase participation.RESULTSThe recruitment process resulted in a participation rate of 83% among patients who were contacted and eligible. These participants appeared to be representative of both nonparticipants and persons with diabetes in Colorado. In contrast, a low percentage of primary care physicians, estimated at 3%, took part in the program despite efforts to make the program brief, nonintrusive, and compatible with usual care.CONCLUSIONSRecruitment is currently challenging and will become even more difficult with the privacy regulations that affect healthcare research and the public distrust of solicitations. To increase participation rates, it is important that the clinic staff promotes and supports the program, and that participant lists are accurate and adequate in size.