Effects of a multiple chronic condition (CC) remote monitoring program on clinical outcomes among older adults

Older adults are faced with an increased risk of comorbid chronic disease such as diabetes. While multiple health behavior change interventions (MHCIs) are known to improve clinical outcomes more than targeted interventions, less is known whether such effects persist in older populations. The objective of the study was to examine the effects of multiple chronic condition (CC) remote monitoring program enrollment and mental health program enrollment on glucose and blood pressure reduction, adjusting for self-monitoring behaviors. In a sample of 594 older adults (age 55+, 14% 65+ years, 46.8% female) evaluated over a 12-month period, statistical models showed that older adults with uncontrolled diabetes (A1c >= 7.0%) had a 7.9 pt. reduction in blood glucose for each additional program enrolled and a 22.7 pt. reduction in blood glucose when enrolled in mental health compared to those not enrolled. Similarly, older adults with uncontrolled hypertension (BP >= 130/80) had a 4.8 pt. reduction in systolic blood pressure for each additional program enrolled and a 7.2 pt. reduction in systolic blood pressure when enrolled in mental health compared to those not enrolled. The findings indicate the potential for multiprogram digital health interventions that incorporate mental health to further improve clinical outcomes in older adults suffering from multiple chronic diseases, namely diabetes and hypertension.

Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other community services for this population.Methods: This pre-post quasi-experimental study compared participants enrolled in a REC for people with histories of homelessness and mental health challenges (n = 92) to an age-and-gender frequency matched control group participating in usual services (n = 92) for this population in Toronto, Ontario. Changes from program enrollment to 12 months in personal empowerment (primary outcome), disease specific quality of life, recovery, health status, health related quality of life, and mastery were assessed. Post-hoc analyses compared subgroups with 1–13 h (n = 37) and 14+ h (n = 37) of REC participation during the study period to the control group. Linear mixed models estimated mean changes and differences in mean changes and 95% confidence intervals.Results: Mean change in perceived empowerment from program enrollment to 12 months in the intervention group [0.10 (95% CI: 0.04, 0.15)] was not significantly different from the control group [0.05 (−0.01, 0.11)], mean difference, 0.05 [(−0.03, 0.13), P = 0.25]. In the post-hoc analysis, the mean change in perceived empowerment for the intervention subgroup with 14+ h of REC participation [0.18 (0.10, 0.26)] was significantly different than in the control group [0.05 (−0.01, 0.11)] mean difference, 0.13 [(0.03, 0.23), P < 0.01]. Mean change in mastery was also significantly different for the intervention subgroup with 14+ h of REC participation [2.03 (1.04, 3.02)] vs. controls [0.60 (−0.15, 1.35)], mean difference, 1.43 [(0.19, 2.66), P = 0.02]. There were no significant differences in other outcomes.Conclusion: With sufficient hours of participation, recovery education may be a helpful adjunct to health and social services for adults with mental health challenges transitioning from homelessness.

The Role of Government-Funded Assistance Programs on HIV Testing Among Poor U.S. Adults

Government-funded assistance program enrollment may play an important role in the overall increase of HIV testing among low-income U.S. adults. We pooled data from the 2016–2018 National Health Interview Survey and limited analyses to respondents aged 18 to 64 years with incomes less than 100% of the U.S. poverty threshold ( N = 9,497). The outcome of interest was ever testing for HIV. Prevalence ratios were used to assess the likelihood of ever testing for HIV and were adjusted for sociodemographic covariates including whether the respondent was a beneficiary of any government-funded assistance programs (e.g., Medicaid; job-placement/training/human services; or Temporary Assistance for Needy Families). After adjusting for significant sociodemographic covariates, government-funded assistance beneficiaries were significantly more likely to ever test for HIV (adjusted prevalence ratio = 1.3; 95% CI = [1.2, 1.4], p < .0001) than adults with incomes less than 100% of the U.S. poverty threshold who did not receive government assistance. Beneficiaries of government-funded assistance programs are more likely to test for HIV.

Evaluation of Hospital-Based Acute Care Utilization by Uninsured Patients Enrolled in Free or Low-Cost Pharmacy Programs

Background: Research is warranted to define the role of affordable pharmacy programs in optimizing healthcare utilization for uninsured patients. Methods: This was a pre-post study including uninsured patients from an internal medicine residency clinic who enrolled in free or low-cost pharmacy programs with clinical pharmacist support. Results: In the period following program enrollment (N=116), there was a mean decrease of 0.23 acute care encounters (hospitalizations and emergency department [ED] visits) per patient (p=0.0210, 95% CI 0.04-0.43). The mean decrease for hospitalizations was also statistically significant (0.17, p=0.0052, 95% CI 0.05-0.28), but the mean decrease for ED visits was not (0.06, p=0.3771, 95% CI -0.08-0.21). Using the national average hospitalization cost of $10,700, the decrease in hospitalizations represents an estimated savings of $246,100. Conclusions: Enrollment in affordable pharmacy programs was found to be associated with decreased acute care encounters.

Motivation and Problem Solving Versus Mobile 360° Videos to Promote Enrollment in the National Diabetes Prevention Program’s Lifestyle Change Program Among People With Prediabetes: Protocol for a Randomized Trial

Background More than 88 million Americans are at risk of developing type 2 diabetes mellitus (T2DM). The National Diabetes Prevention Program’s Lifestyle Change Program (DPP LCP) has been shown to be effective in reducing the risk of progressing from prediabetes to T2DM. However, most individuals who could benefit from the program do not enroll. Objective The aim of this trial is to test the real-world efficacy of 3 mobile phone–based approaches to increasing enrollment in the DPP LCP including a best-practice condition and 2 novel approaches. Methods We will conduct a 3-armed randomized clinical trial comparing enrollment and 1-month engagement in the DPP LCP among adults with prediabetes from 2 health care settings. Participants in the best-practice condition will receive SMS-based notifications that they have prediabetes and a link to a website that explains prediabetes, T2DM, and the DPP LCP. This will be followed by a single question survey, “Would you like the DPP LCP to call you to enroll?” Participants in the 2 intervention arms will receive the same best-practice intervention plus either 2 mobile 360° videos or up to 5 brief phone calls from a health coach trained in a motivational coaching approach known as Motivation and Problem Solving (MAPS). We will collect measures of diabetes-related knowledge, beliefs in the controllability of risk for T2DM, risk perceptions for T2DM, and self-efficacy for lifestyle change pre-intervention and 4 weeks later. The primary outcomes of the study are enrollment in the DPP LCP and 4-week engagement in the DPP LCP. In addition, data on the person-hours needed to deliver the interventions as well as participant feedback about the interventions and their acceptability will be collected. Our primary hypotheses are that the 2 novel interventions will lead to higher enrollment and engagement in the DPP LCP than the best-practice intervention. Secondary hypotheses concern the mechanisms of action of the 2 intervention arms: (1) whether changes in risk perception are associated with program enrollment among participants in the mobile 360° video group and (2) whether changes in self-efficacy for lifestyle change are associated with program enrollment among participants in the MAPS coaching group. Finally, exploratory analyses will examine the cost effectiveness and acceptability of the interventions. Results The project was funded in September 2020; enrollment began in February 2021 and is expected to continue through July 2022. Conclusions We are conducting a test of 2 novel, scalable, mobile phone–based interventions to increase enrollment in the DPP LCP. If effective, they have tremendous potential to be scaled up to help prevent T2DM nationwide. Trial Registration ClinicalTrials.gov NCT04746781; https://clinicaltrials.gov/ct2/show/NCT04746781 International Registered Report Identifier (IRRID) DERR1-10.2196/28884

Disability Insurance in the Great Recession: Ease of Access, Program Enrollment, and Local Hysteresis

We examine the interaction between Social Security Disability Insurance (SSDI) access and economic shocks during the Great Recession by exploiting exogenous variation in SSDI appeals processing time–a measure of hassle or access–between neighboring zip codes assigned to different hearing offices. During the Great Recession, longer processing times led to lower SSDI enrollment in places that experienced more severe labor market downturns. In the full sample, processing time has no clear effect on the pace of employment recovery. However, among severely shocked places with high baseline SSDI enrollment, those with longer processing times saw faster recovery in employment rates.