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14. Using administrative data to identify mental illness: What approach is best?

Author

Frayne, Susan M., Miller, Donald R., Sharkansky, Erica J., Jackson, Valerie W., Wang, Fei, Halanych, Jewell H., Berlowitz, Dan R., Kader, Boris, Rosen, Craig S., and Keane, Terence M.

Subjects
Mental illness -- Care and treatment, Mental illness -- Reports, Algorithms -- Usage, Databases -- Usage, Medical care -- Quality management, Medical care -- Reports, Algorithm, CD-ROM catalog, CD-ROM database, Database, Health
Published
2010

24. FIVE AUTHORS REPLY

Author

Halanych, Jewell H., Safford, Monika M., Kertesz, Stefan G., Person, Sharina D., and Kiefe, Catarina I.

Published
2010
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27. Disparities in Diabetes Care: Impact of Mental Illness

Author

Frayne, Susan M., Halanych, Jewell H., Miller, Donald R., Wang, Fei, Lin, Hai, Pogach, Leonard, Sharkansky, Erica J., Keane, Terence M., Skinner, Katherine M., Rosen, Craig S., and Berlowitz, Dan R.

Published
2005

28. Awareness and management of chronic disease, insurance status, and health professional shortage areas in the REasons for Geographic And Racial Differences in Stroke (REGARDS): a cross-sectional study

Author

Durant Raegan W, Parmar Gaurav, Shuaib Faisal, Le Anh, Brown Todd M, Roth David L, Hovater Martha, Halanych Jewell H, Shikany James M, Prineas Ronald J, Samdarshi Tandaw J, and Safford Monika M

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care. Methods We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors. Results 2,261 residents lived in HPSA counties and 15,197 in non-HPSA counties. Among the uninsured, HPSA residents had higher awareness of both hypertension (adjusted OR 2.30, 95% CI 1.08, 4.89) and hyperlipidemia (adjusted OR 1.50, 95% CI 1.01, 2.22) compared to non-HPSA residents. Also among the uninsured, HPSA residents with hypertension had lower blood pressure control (adjusted OR 0.45, 95% CI 0.29, 0.71) compared with non-HPSA residents. Similar differences in awareness and control according to HPSA residence were absent among the insured. Conclusions Despite similar or higher awareness of some chronic diseases, uninsured HPSA residents may achieve control of hypertension at lower rates compared to uninsured non-HPSA residents. Federal allocations in HPSAs should target improved quality of care as well as increasing the number of available physicians.

Published
2012
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29. Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Author

Halanych Jewell H, Allison Jeroan J, Agee Bonita S, Funkhouser Ellen, Salanitro Amanda H, Houston Thomas K, Litaker Mark S, Levine Deborah A, and Safford Monika M

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. Methods We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c ≥ for diabetes, BP ≥ 140/90 mmHg (≥ 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) ≥ 130 mg/dl (≥ 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. Results Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP ≥ 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. Conclusions The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.

Published
2010
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37. Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Author

Salanitro, Amanda H., Funkhouser, Ellen M., Agee, Bonita S., Allison, Jeroan J., Halanych, Jewell H., Houston, Thomas K., Litaker, Mark S., Levine, Deborah A., Safford, Monika M., Salanitro, Amanda H., Funkhouser, Ellen M., Agee, Bonita S., Allison, Jeroan J., Halanych, Jewell H., Houston, Thomas K., Litaker, Mark S., Levine, Deborah A., and Safford, Monika M.

Abstract

BACKGROUND: Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. METHODS: We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c >/= for diabetes, BP >/= 140/90 mmHg (>/= 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) >/= 130 mg/dl (>/= 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. RESULTS: Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP >/= 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. CONCLUSIONS: The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.

Published
2010

38. Trust in physicians and blood pressure control in blacks and whites being treated for hypertension in the REGARDS study.

Author

Durant, Raegan W, Durant, Raegan W, McClure, Leslie A, Halanych, Jewell H, Lewis, Cora E, Prineas, Ronald J, Glasser, Stephen P, Safford, Monika M, Durant, Raegan W, Durant, Raegan W, McClure, Leslie A, Halanych, Jewell H, Lewis, Cora E, Prineas, Ronald J, Glasser, Stephen P, and Safford, Monika M

Abstract

Trust in physicians was not related to blood pressure control among Blacks and Whites with treated hypertension in this sample. The racial disparity in blood pressure control was not completely explained by trust in physicians or medication adherence, and a better understanding of the mechanisms leading to this disparity is needed.

Published
2010

44. Abstract P42: Health Professional Shortage Areas, Insurance Status, and Cardiovascular Disease Prevention in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Author

Brown, Todd M, primary, Parmar, Gaurav, additional, Durant, Raegan W, additional, Halanych, Jewell, additional, Hovater, Martha, additional, Muntner, Paul, additional, Prineas, Ronald J, additional, Roth, David, additional, Samdarshi, Tandaw E, additional, and Safford, Monika M, additional

Published
2011
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45. Abstract P28: Awareness and Management of CVD Risk Factors and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Author

Safford, Monika M, primary, Parmar, Gaurav, additional, Brown, Todd M, additional, Hovater, Martha, additional, Roth, David, additional, Halanych, Jewell H, additional, Shikany, James M, additional, Prineas, Ronald J, additional, Samdarshi, Tandaw, additional, and Durant, Raegan W, additional

Published
2011
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