scholarly journals Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial (Preprint)

2018 ◽  
Author(s):  
Stacie L Daugherty ◽  
Suma Vupputuri ◽  
Rebecca Hanratty ◽  
John F Steiner ◽  
Julie A Maertens ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Racial Disparities ◽  
Stereotype Threat ◽  
Primary Outcome ◽  
Racial Bias ◽  
The United States ◽  
Uncontrolled Hypertension ◽  
Values Affirmation

BACKGROUND Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient’s ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies. OBJECTIVE The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat. METHODS The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients’ adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients’ prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes. RESULTS This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes. CONCLUSIONS The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition—hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations. CLINICALTRIAL ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB). INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12498

scholarly journals The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis

10.2196/17776 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e17776 ◽  
Author(s):  
Ran Li ◽  
Ning Liang ◽  
Fanlong Bu ◽  
Therese Hesketh
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Mobile Health ◽  
Meta Analysis ◽  
Self Management ◽  
Narrative Synthesis ◽  
Management Behavior ◽  
Mhealth Intervention

Background Effective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)–based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. Objective This systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. Methods A systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. Results A total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, −3.78 mm Hg (P<.001; 95% CI −4.67 to −2.89) and −1.57 mm Hg (P<.001; 95% CI −2.28 to −0.86), respectively. Subgroup analyses showed consistent reductions in SBP and DBP across different frequencies of reminders, interactive patterns, intervention functions, and study duration subgroups. A total of 16 studies reported better medication adherence and behavioral change in the intervention groups, while 8 showed no significant change. Six studies included an economic evaluation, which drew inconsistent conclusions. However, potentially long-term financial benefits were mentioned in all economic evaluations. All studies were assessed to be at high risk of bias. Conclusions This review found that mHealth self-management interventions were effective in BP control. The outcomes of this review showed improvements in self-management behavior and medication adherence. The most successful mHealth intervention combined the feature of tailored messages, interactive communication, and multifaceted functions. Further research with longer duration and cultural adaptation is necessary. With increasing disease burden from hypertension globally, mHealth offers a potentially effective method for self-management and control of BP. mHealth can be easily integrated into existing health care systems. Trial Registration PROSPERO CRD42019152062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=152062

Abstract T MP100: Improving Encounter Frequency, Physician Prescribing, or Patient Adherence - What Works Best for Controlling Blood Pressure? Results From a Validated Micro-Simulation Model

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Valy Fontil ◽  
Kirsten Bibbins-Domingo ◽  
Dhruv Kazi ◽  
Pamela Coxson ◽  
Steve Sidney ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Patient Adherence ◽  
The United States ◽  
Control Model ◽  
Uncontrolled Hypertension ◽  
Base Case ◽  
Treatment Intensification ◽  
Case Scenario ◽  
Base Case Scenario

Background: Only half of hypertensive adults achieve blood pressure (BP) control in the United States. Methods: We developed the BP Control Model to simulate physician- and patient-level processes relevant in achieving BP control. We validated the model by simulating the intervention arm of a recent multicenter clinical trial and used the validated model to examine the effects of isolated improvements in three modifiable processes on BP control. Data from national surveys, cohort studies, and trials were used to parameterize the model. We simulated 5,000 hypothetical adult patients with uncontrolled hypertension (systolic BP≥ 140) using probability sampling of participants from the 2009-2010 National Health and Nutrition Examination Survey. We modeled 50% improvements and ideal scenarios for each process parameter. Outcome: We reported outcomes in terms of BP control (% with SBP < 140 mmHg), and average change in BP at 52 weeks. Results: In our validation analysis, the model-predicted BP control was similar to what was achieved in the VIPER-BP clinical trial (63.5% vs. 63.8%). In our base case scenario, 24% of the NHANES-derived cohort achieved BP control at 52 weeks. In scenarios with 50% improvements, the model predicted small increases in BP control, but substantially larger and more variable effects when processes were idealized (Table). Control was reached in 77% with ideal treatment intensification, 44% with ideal encounter frequency, only 32% with ideal adherence, and 97% when all three processes were idealized. Conclusion: While improving patient adherence to medications would improve BP control, healthcare systems can achieve similar or greater success by focusing on increasing the frequency of clinical encounters and improving physicians’ prescribing behavior. The BP Control Model can be used to predict how much improvement to expect from such interventions.

scholarly journals HEALTH CARE STEREOTYPE THREAT AND INCIDENCE OF CHRONIC DISEASE IN THE UNITED STATES

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1021-1021
Author(s):  
F. Wheaton ◽  
C. Roman ◽  
C.S. Thomas ◽  
C. Abdou Kamperveen
Keyword(s):  
United States ◽  
Health Care ◽  
Chronic Disease ◽  
Stereotype Threat ◽  
The United States

scholarly journals Effects of Emotional Response on Adherence to Antihypertensive Medication and Blood Pressure Improvement

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Robert D. Keeley ◽  
Margaret Driscoll
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Emotional Response ◽  
Antihypertensive Medication ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Behavioral Risk ◽  
Improve Medication Adherence ◽  
Pharmacy Refill ◽  
Adherence Score

Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence.Objective. Explore the effects of emotional response (ER) on adherence to antihypertensive medication and on systolic blood pressure (SBP) improvement.Design. We studied 101 adults with diabetes and hypertension. The primary outcome, 90-day “percentage of days covered” adherence score, was determined from pharmacy refill records. The secondary outcome was change in SBP over 90 days. ER was classified as positive, negative, or neutral.Results. Average adherence was 71.6% (SD 31.4%), and negative and positive ER were endorsed by 25% and 9% of subjects, respectively. Gender moderated the effect of positive or negative versus neutral ER on adherence (interactionP=0.003); regardless of gender, negative and positive ER were associated with similarly high and low adherence, respectively, but males endorsing neutral ER had significantly higher adherence than their female counterparts (85.6% versus 57.1%,Fvalue = 15.3,P=0.0002). Adherence mediated ER's effect on SBP improvement: among participants with negative, but not positive or neutral, ER, increasing adherence and SBP improvement were correlated (Spearman’sr=0.49,P=0.02).Conclusions. Negative, but not positive or neutral, ER predicted better medication adherence and a correlation between medication adherence and improvement in SBP.

scholarly journals A Racially Unbiased, Machine Learning Approach to Prediction of Mortality: Algorithm Development Study (Preprint)

2020 ◽  
Author(s):  
Angier Allen ◽  
Samson Mataraso ◽  
Anna Siefkas ◽  
Hoyt Burdick ◽  
Gregory Braden ◽  
...  
Keyword(s):  
Machine Learning ◽  
Health Care ◽  
Intensive Care ◽  
Racial Disparities ◽  
Equal Opportunity ◽  
Racial Bias ◽  
Learning Algorithm ◽  
Early Warning Score ◽  
Machine Learning Algorithm ◽  
Saps Ii

BACKGROUND Racial disparities in health care are well documented in the United States. As machine learning methods become more common in health care settings, it is important to ensure that these methods do not contribute to racial disparities through biased predictions or differential accuracy across racial groups. OBJECTIVE The goal of the research was to assess a machine learning algorithm intentionally developed to minimize bias in in-hospital mortality predictions between white and nonwhite patient groups. METHODS Bias was minimized through preprocessing of algorithm training data. We performed a retrospective analysis of electronic health record data from patients admitted to the intensive care unit (ICU) at a large academic health center between 2001 and 2012, drawing data from the Medical Information Mart for Intensive Care–III database. Patients were included if they had at least 10 hours of available measurements after ICU admission, had at least one of every measurement used for model prediction, and had recorded race/ethnicity data. Bias was assessed through the equal opportunity difference. Model performance in terms of bias and accuracy was compared with the Modified Early Warning Score (MEWS), the Simplified Acute Physiology Score II (SAPS II), and the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE). RESULTS The machine learning algorithm was found to be more accurate than all comparators, with a higher sensitivity, specificity, and area under the receiver operating characteristic. The machine learning algorithm was found to be unbiased (equal opportunity difference 0.016, <i>P</i>=.20). APACHE was also found to be unbiased (equal opportunity difference 0.019, <i>P</i>=.11), while SAPS II and MEWS were found to have significant bias (equal opportunity difference 0.038, <i>P</i>=.006 and equal opportunity difference 0.074, <i>P</i><.001, respectively). CONCLUSIONS This study indicates there may be significant racial bias in commonly used severity scoring systems and that machine learning algorithms may reduce bias while improving on the accuracy of these methods.

scholarly journals Hypertension Control in the United States 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age- and Race-Ethnicity Groups

Hypertension ◽  
2021 ◽  
Author(s):  
Brent M. Egan ◽  
Jiexiang Li ◽  
Susan E. Sutherland ◽  
Michael K. Rakotz ◽  
Gregory D. Wozniak
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Health Care ◽  
Access To Care ◽  
Odds Ratio ◽  
Treatment Effectiveness ◽  
The United States ◽  
Hypertension Control ◽  
Race Ethnicity ◽  
Hispanic White

Hypertension control (United States) increased from 1999 to 2000 to 2009 to 2010, plateaued during 2009 to 2014, then fell during 2015 to 2018. We sought explanatory factors for declining hypertension control and assessed whether specific age (18–39, 40–59, ≥60 years) or race-ethnicity groups (Non-Hispanic White, NH [B]lack, Hispanic) were disproportionately impacted. Adults with hypertension in National Health and Nutrition Examination Surveys during the plateau (2009–2014) and decline (2015–2018) in hypertension control were studied. Definitions: hypertension, blood pressure (mm Hg) ≥140 and/or ≥90 mm Hg or self-reported antihypertensive medications (Treated); Aware, ‘Yes” to, “Have you been told you have hypertension?”; Treatment effectiveness, proportion of treated adults controlled; control, blood pressure <140/<90. Comparing 2009 to 2014 to 2015 to 2018, blood pressure control fell among all adults (−7.5% absolute, P <0.001). Hypertension awareness (−3.4%, P =0.01), treatment (−4.6%, P =0.004), and treatment effectiveness (−6.0%, P <0.0001) fell, despite unchanged access to care (health care insurance, source, and visits [−0.2%, P =0.97]). Antihypertensive monotherapy rose (+4.2%, P =0.04), although treatment resistance factors increased (obesity +4.0%, P =0.02, diabetes +2.3%, P =0.02). Hypertension control fell across age (18–39 [−4.9%, P =0.30]; 40–59 [−9.9%, P =0.0003]; ≥60 years [−6.5%, P =0.005]) and race-ethnicity groups (Non-Hispanic White [−8.5%, P =0.0007]; NHB −7.4%, P =0.002]; Hispanic [−5.2%, P =0.06]). Racial/ethnic disparities in hypertension control versus Non-Hispanic White were attenuated after adjusting for modifiable factors including education, obesity and access to care; NHB (odds ratio, 0.79 unadjusted versus 0.84 adjusted); Hispanic (odds ratio 0.74 unadjusted versus 0.98 adjusted). Improving hypertension control and reducing disparities require greater and more equitable access to high quality health care and healthier lifestyles.

Abstract P313: Self-reported Sleep Disturbance is Associated With Poor Hypertension Self-management in Latinos

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Billy A Caceres ◽  
Niurka Suero-Tejada ◽  
Leah Estrada ◽  
Suzanne Bakken
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Sleep Disturbance ◽  
Sex Education ◽  
Sleep Disturbances ◽  
Self Management ◽  
Uncontrolled Hypertension ◽  
Measurement Information ◽  
Cross Sectional ◽  
Patient Reported

Background: Antihypertensive medication adherence is an important determinant of hypertension control. Although Latinos have high rates of uncontrolled hypertension, factors associated with anti-hypertensive medication adherence in this population are poorly understood. Self-reported sleep disturbance is associated with impaired chronic disease self-management in the general population. To date, no study has examined the association of sleep disturbance with hypertension self-management among Latinos. Hypothesis: Sleep disturbances will be associated with poor anti-hypertensive medication adherence and higher rates of uncontrolled hypertension in Latinos. Methods: We used cross-sectional data from the Washington Heights/Inwood Comparative Effectiveness Research (WICER) Project to assess the link between sleep disturbance with anti-hypertensive medication adherence and uncontrolled hypertension among Latinos with hypertension. The 8-item Morisky Medication Adherence Scale (MMAS) was used to assess medication adherence (alpha 0.75; range 0-8). The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance measure was used (alpha 0.75; range 4-20). Uncontrolled hypertension was defined as a systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg. Multiple logistic regression models were used to examine the associations of self-reported sleep disturbance with low medication adherence (MMAS <6). In addition, we examined whether sleep disturbance was associated with uncontrolled hypertension. Models were adjusted for age, sex, education, preferred language, insurance status, comorbid conditions, and anxiety. Results: The final sample consisted of 1,116 Latino participants with hypertension (mean age 63.2, 76.8% were female, and 69.5% had completed less than a high school education). The mean MMAS and PROMIS sleep disturbance scores were 1.9 and 10.1, respectively. A total of 341 (30.4%) participants were classified as having low medication adherence. Participants with low medication adherence were more likely to be younger (p <0.001), single (p <0.001), and have lower educational attainment (p <0.01). After covariate adjustment, a one-point increase in sleep disturbance was associated with higher odds of low medication adherence (AOR 1.05, 95% CI [1.01-1.09]). Sleep disturbance was also associated with higher odds of uncontrolled hypertension (AOR 1.04, 95% CI [1.01-1.07]). Conclusions: Reducing sleep disturbance in Latinos may be an important target for improving hypertension self-management. It remains unclear whether sleep disturbances are a cause of poor hypertension self-management in these patients. Additional research that incorporates longitudinal designs is needed to examine associations between sleep disturbance and hypertension self-management among Latinos.

Sign in / Sign up

Export Citation Format

Share Document