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Addressing the social needsofhypertensive patients: The role of patient-physician communication as a predictor of medication adherence [Meeting Abstract]

Schoenthaler, A; Knafl, G; Fiscella, K; Ogedegbe, G
BACKGROUND: Poor medication adherence is a significant public health problem in patients with hypertension. The patient-physician relationship offers an ideal opportunity to address patient non-adherence as physicians' communication skills contribute to as much as 50%of the quality of care patients' receive. Despite this evidence, there is no empirical data on how the informational and relational aspects of patient-physician communication affect patient's actual medication-taking behaviors. The aim of this study was to evaluate the impact of patient-physician communication on medication adherence among a sample of primary care physicians and their Black and White hypertensive patients. METHODS: Cohort study of 92 hypertensive patients (mean age: 60 years) and 27 primary care physicians (mean age: 36 years) in two safety-net primary care practices in New York City. Patient-physician encounters were audiotaped at baseline; medication adherence data were gathered continuously over the 3- month study with an electronic monitoring device. Audiotape analyses of patient physician communication were coded using the Medical Interaction Process System. Six categories of communication were computed: 1) patient centeredness; 2) patient assertiveness; 3) psychosocial focus; 4) information exchange; 5) physician disclosure-promoting; and 6) physician verbal dominance. Frequencies of content codes were also calculated for the proportion of the discussion specific to: hypertension; antihypertensive medications; patient-physician social conversation; and discussions about patient's social circumstances (i.e., patient's living situation, relationship with spouse/partner). Adaptive statistical modeling methods based on likelihood cross validation were used to analyze the adherence data. RESULTS: The majority of patients were Black, 58% women, and most were seeing the same physician for at least 1 year. Approximately half of physicians were White (56%), 67% women, and have been in practice for 6 years. Fifty eight percent of patients exhibited poor adherence to prescribed antihypertensive medications. Two categories of patient-physician communication predicted poor medication adherence in the multivariate adaptive logistic regression model: fewer discussions about patients' social circumstances (OR: 6.03, 95CI:2.15- 17) and about their antihypertensive medications (OR: 5.64, 95CI:1.49-21.3). CONCLUSIONS: The odds of poor medication adherence are nearly six times greater when patient-physician interactions do not address patients' social circumstances or their medication regimen. These findings support the importance of adherence counseling and attending to the social determinants of health in routine care of low-income patients in ambulatory practices
EMBASE:615581008
ISSN: 0884-8734
CID: 2554212

Erratum to: Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study [Correction]

Gyamfi, Joyce; Plange-Rhule, Jacob; Iwelunmor, Juliet; Lee, Debbie; Blackstone, Sarah R; Mitchell, Alicia; Ntim, Michael; Apusiga, Kingsley; Tayo, Bamidele; Yeboah-Awudzi, Kwasi; Cooper, Richard; Ogedegbe, Gbenga
PMCID:5356329
PMID: 28314385
ISSN: 1472-6963
CID: 2494342

REDUCING THE HARM OF SMOKING AMONG HOMELESS SMOKERS IN A RANDOMIZED CONTROLLED TRIAL TARGETING CESSATION [Meeting Abstract]

Ojo-Fati, Olamide; Thomas, Janet; Everson-Rose, Susan A; Vogel, Rachel Isaksson; Ogedegbe, Gbenga; Okuyemi, Kola
ISI:000398947203473
ISSN: 1532-4796
CID: 2559942

'I BELIEVE HIGH BLOOD PRESSURE CAN KILL ME:' PATIENTS' PERCEPTIONS OF AN INTERVENTION TO CONTROL HYPERTENSION IN GHANA [Meeting Abstract]

Blackstone, Sarah; Iwelunmor, Juliet; Gyamfi, Joyce; Quakyi, Nana Kofi; Ogedegbe, Gbenga
ISI:000398947202356
ISSN: 1532-4796
CID: 2559922

Exploring stakeholders' perceptions of a task-shifting strategy for hypertension control in Ghana: a qualitative study

Iwelunmor, Juliet; Gyamfi, Joyce; Plange-Rhule, Jacob; Blackstone, Sarah; Quakyi, Nana Kofi; Ntim, Michael; Zizi, Ferdinand; Yeboah-Awudzi, Kwasi; Nang-Belfubah, Alexis; Ogedegbe, Gbenga
BACKGROUND: The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. METHODS: Using focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques. RESULTS: Analysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program. CONCLUSION: The findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings.
PMCID:5320716
PMID: 28222754
ISSN: 1471-2458
CID: 2459902

Modifiable Risk Factors Versus Age on Developing High Predicted Cardiovascular Disease Risk in Blacks

Bress, Adam P; Colantonio, Lisandro D; Booth, John N 3rd; Spruill, Tanya M; Ravenell, Joseph; Butler, Mark; Shallcross, Amanda J; Seals, Samantha R; Reynolds, Kristi; Ogedegbe, Gbenga; Shimbo, Daichi; Muntner, Paul
BACKGROUND: Clinical guidelines recommend using predicted atherosclerotic cardiovascular disease (ASCVD) risk to inform treatment decisions. The objective was to compare the contribution of changes in modifiable risk factors versus aging to the development of high 10-year predicted ASCVD risk. METHODS AND RESULTS: A prospective follow-up was done of the Jackson Heart Study, an exclusively black cohort at visit 1 (2000-2004) and visit 3 (2009-2012). Analyses included 1115 black participants without high 10-year predicted ASCVD risk (<7.5%), hypertension, diabetes mellitus, or ASCVD at visit 1. We used the Pooled Cohort equations to calculate the incidence of high (>/=7.5%) 10-year predicted ASCVD risk at visit 3. We recalculated the percentage with high 10-year predicted ASCVD risk at visit 3 assuming each risk factor (age, systolic blood pressure, antihypertensive medication use, diabetes mellitus, smoking, total and high-density lipoprotein cholesterol), one at a time, did not change from visit 1. The mean age at visit 1 was 45.2+/-9.5 years. Overall, 30.9% (95% CI 28.3-33.4%) of participants developed high 10-year predicted ASCVD risk. Aging accounted for 59.7% (95% CI 54.2-65.1%) of the development of high 10-year predicted ASCVD risk compared with 32.8% (95% CI 27.0-38.2%) for increases in systolic blood pressure or antihypertensive medication initiation and 12.8% (95% CI 9.6-16.5%) for incident diabetes mellitus. Among participants <50 years, the contribution of increases in systolic blood pressure or antihypertensive medication initiation was similar to aging. CONCLUSIONS: Increases in systolic blood pressure and antihypertensive medication initiation are major contributors to the development of high 10-year predicted ASCVD risk in blacks, particularly among younger adults.
PMCID:5523782
PMID: 28179220
ISSN: 2047-9980
CID: 2436242

Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study

Gyamfi, Joyce; Plange-Rhule, Jacob; Iwelunmor, Juliet; Lee, Debbie; Blackstone, Sarah R; Mitchell, Alicia; Ntim, Michael; Apusiga, Kingsley; Tayo, Bamidele; Yeboah-Awudzi, Kwasi; Cooper, Richard; Ogedegbe, Gbenga
BACKGROUND: Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses' knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). METHODS: A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses' satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. RESULTS: A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses' knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. CONCLUSIONS: Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. TRIAL REGISTRATION: Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013.
PMCID:5288999
PMID: 28148255
ISSN: 1472-6963
CID: 2424452

What do You Need to Get Male Partners of Pregnant Women Tested for HIV in Resource Limited Settings? The Baby Shower Cluster Randomized Trial

Ezeanolue, Echezona E; Obiefune, Michael C; Yang, Wei; Ezeanolue, Chinenye O; Pharr, Jennifer; Osuji, Alice; Ogidi, Amaka G; Hunt, Aaron T; Patel, Dina; Ogedegbe, Gbenga; Ehiri, John E
Male partner involvement has the potential to increase uptake of interventions to prevent mother-to-child transmission of HIV (PMTCT). Finding cultural appropriate strategies to promote male partner involvement in PMTCT programs remains an abiding public health challenge. We assessed whether a congregation-based intervention, the Healthy Beginning Initiative (HBI), would lead to increased uptake of HIV testing among male partners of pregnant women during pregnancy. A cluster-randomized controlled trial of forty churches in Southeastern Nigeria randomly assigned to either the HBI (intervention group; IG) or standard of care referral to a health facility (control group; CG) was conducted. Participants in the IG received education and were offered onsite HIV testing. Overall, 2498 male partners enrolled and participated, a participation rate of 88.9%. Results showed that male partners in the IG were 12 times more likely to have had an HIV test compared to male partners of pregnant women in the CG (CG = 37.71% vs. IG = 84.00%; adjusted odds ratio = 11.9; p < .01). Culturally appropriate and community-based interventions can be effective in increasing HIV testing and counseling among male partners of pregnant women.
PMCID:5288443
PMID: 27933462
ISSN: 1573-3254
CID: 2354412

Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries

Vedanthan, Rajesh; Bernabe-Ortiz, Antonio; Herasme, Omarys I; Joshi, Rohina; Lopez-Jaramillo, Patricio; Thrift, Amanda G; Webster, Jacqui; Webster, Ruth; Yeates, Karen; Gyamfi, Joyce; Ieremia, Merina; Johnson, Claire; Kamano, Jemima H; Lazo-Porras, Maria; Limbani, Felix; Liu, Peter; McCready, Tara; Miranda, J Jaime; Mohan, Sailesh; Ogedegbe, Olugbenga; Oldenburg, Brian; Ovbiagele, Bruce; Owolabi, Mayowa; Peiris, David; Ponce-Lucero, Vilarmina; Praveen, Devarsetty; Pillay, Arti; Schwalm, Jon-David; Tobe, Sheldon W; Trieu, Kathy; Yusoff, Khalid; Fuster, Valentin
Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Treatment and control rates are very low in low- and middle-income countries. There is an urgent need to address this problem. The Global Alliance for Chronic Diseases sponsored research projects focus on controlling hypertension, including community engagement, salt reduction, salt substitution, task redistribution, mHealth, and fixed-dose combination therapies. This paper reviews the rationale for each approach and summarizes the experience of some of the research teams. The studies demonstrate innovative and practical methods for improving hypertension control.
PMCID:5131527
PMID: 27886793
ISSN: 1558-2264
CID: 2411492

Tailored Behavioral Intervention Among Blacks With Metabolic Syndrome and Sleep Apnea: Results of the MetSO Trial

Jean-Louis, Girardin; Newsome, Valerie; Williams, Natasha J; Zizi, Ferdinand; Ravenell, Joseph; Ogedegbe, Gbenga
Study Objectives: To assess effectiveness of a culturally and linguistically tailored telephone-delivered intervention to increase adherence to physician-recommended evaluation and treatment of obstructive sleep apnea (OSA) among blacks. Methods: In a two-arm randomized controlled trial, we evaluated effectiveness of the tailored intervention among blacks with metabolic syndrome, relative to those in an attention control arm (n = 380; mean age = 58 +/- 13; female = 71%). The intervention was designed to enhance adherence using culturally and linguistically tailored OSA health messages delivered by a trained health educator based on patients' readiness to change and unique barriers preventing desired behavior changes. Results: Analysis showed 69.4% of the patients in the intervention arm attended initial consultation with a sleep specialist, compared to 36.7% in the control arm; 74.7% of those in the intervention arm and 66.7% in the control arm completed diagnostic evaluation; and 86.4% in the intervention arm and 88.9% in the control arm adhered to PAP treatment based on subjective report. Logistic regression analyses adjusting for sociodemographic factors indicated patients in the intervention arm were 3.17 times more likely to attend initial consultation, compared to those in the control arm. Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation or treatment. Conclusion: The intervention was successful in promoting importance of sleep consultation and evaluation of OSA among blacks, while there was no significant group difference in laboratory-based evaluation and treatment adherence rates. It seems that the fundamental barrier to OSA care in that population may be the importance of seeking OSA care.
PMCID:6084749
PMID: 28364475
ISSN: 1550-9109
CID: 2509062