Medicine and Health Sciences Commons^™

Patient-Provider Communication About Cognition And The Role Of Memory Concerns: A Descriptive Study, Nikki L. Hill, Emily Bratlee-Whitaker, Heejung Jang, Sakshi Bhargava, Andrea Yevchak Sillner, Justin Do, Jacqueline Mogle

Student Papers, Posters & Projects

BACKGROUND: Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns.

METHODS: We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory …

Barriers To Colorectal Cancer Screening For Low-Income Hispanic Men In Urban Areas Between 50-75, Alex Vega

Rowan-Virtua Research Day

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Although CRC screening rates have improved in non-Hispanic whites (NHW), Hispanic adult males (HAM) aged 50-75 in urban areas continue to experience low screening rates and higher CRC morbidity and mortality. This review aims to identify the barriers to CRC screening among HAM and propose targeted interventions to increase screening rates. A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key search terms included "colorectal cancer", "screening", "Hispanic adult males", "urban", "barriers", and "interventions". Factors identified include poverty, language …

Improving Depression Screening Completion Rates For Medicare Patients In A Primary Care Setting, Kenneth J. Haluska

Evidence-Based Practice Project Reports

The United States Preventative Services Task Force recommends screening the general adult population for depression (Siu et al., 2016). Despite increasing clinical practice guidelines recommending depression screening, only 40-50% of depressed older adults are recognized and treated (Phoh et al., 2017). The purpose of this evidence-based practice (EBP) project was to implement a medical assistant (MA) depression screening protocol, using the PHQ-9 and staff education, to improve depression screening completion rates in Medicare patients in a primary care setting. An exhaustive literature search of eight databases yielded 14 pieces of evidence that made recommendations for best practice. The evidence was …

Attitudes, Beliefs, And Perceptions On Cannabis Among Older Adults Aged 65 And Older: A Cross-Sectional Survey., Alex M Kleidon, Andrew M Peterson, Ilene Warner-Maron, Allen Glicksman

PCOM Scholarly Papers

OBJECTIVE: With the rise of medical and recreational cannabis use among older adults, concerns about the potential risks and benefits of cannabis use are increasing. This pilot study aimed to determine the attitudes, beliefs, and perceptions of older adults toward cannabis as a medicinal product, to establish a foundation for future research on how healthcare providers communicate with this population regarding cannabis.

METHODS: A cross-sectional survey was conducted on adults aged 65 and older living in Philadelphia. The survey included questions related to participants' demographics, knowledge, attitudes, beliefs, and perceptions of cannabis. Participants were recruited via flyer distributions, publications in …

An Electronic Health Record-Based Intervention To Increase Follow-Up Office Visits And Decrease Rehospitalization In Older Adults, Jerry Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, Sarah Cutrona, Leslie Harrold, Shawn Gagne, Peggy Preusse, Jennifer Donovan, Abir Kanaan, George Reed, Lawrence Garber

Jennifer Tjia

OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

DESIGN: Randomized controlled trial.

SETTING: Large multispecialty group practice.

PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home.

INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule …

Trust And Satisfaction With Physicians, Insurers, And The Medical Profession, Rajesh Balkrishnan, Elizabeth Dugan, Fabian Camacho, Mark Hall

Elizabeth Dugan

BACKGROUND: Conceptual or theoretical analysts of trust in medical settings distinguish among markedly different objects or types of trust. However, little is known about how similar or different these types of trust are in reality and the relationship of trust with satisfaction. OBJECTIVES: This exploratory study conducted a comparison among trust in one's personal physician, health insurer, and in the medical profession, and examined whether the relationship between trust and satisfaction differs according to the type of trust in question. RESEARCH DESIGN: Random national telephone survey using validated multi-item measures of trust and satisfaction. SUBJECTS: A total of 1117 individuals …

An Exploration Of Patients' Trust In Physicians In Training, Denise Bonds, Kristie Foley, Elizabeth Dugan, Mark Hall, Pam Extrom

Elizabeth Dugan

Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary care patients of an academic medical center staffed by internal medicine residents after a visit to their primary care provider. Participants were adults. The group was racially diverse (50% non-white), English-speaking, and from lower socioeconomic groups. The 10-page survey consisted of 7 sections (Physician Trust Scale, Patient Demographics, Patient Health and Well-Being, Patient-Physician Relationship Characteristics, Global Doctor …

The Impact On Patient Trust Of Legalising Physician Aid In Dying, Mark Hall, Felicia Trachtenberg, Elizabeth Dugan

Elizabeth Dugan

OBJECTIVE: Little empirical evidence exists to support either side of the ongoing debate over whether legalising physician aid in dying would undermine patient trust. DESIGN: A random national sample of 1117 US adults were asked about their level of agreement with a statement that they would trust their doctor less if "euthanasia were legal [and] doctors were allowed to help patients die". RESULTS: There was disagreement by 58% of the participants, and agreement by only 20% that legalising euthanasia would cause them to trust their personal physician less. The remainder were neutral. These attitudes were the same in men and …

The Effects Of Implementation Of The Agency For Health Care Policy And Research Urinary Incontinence Guidelines In Primary Care Practices, Deirdre Bland, Elizabeth Dugan, Stuart Cohen, John Preisser, Cralen Davis, Paul Mcgann, Patricia Suggs, Katherine Pearce

Elizabeth Dugan

OBJECTIVES: To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI). DESIGN: Group randomized trial, conducted from 1996 to 1997. SETTING: Internal medicine and family medicine community practices. PARTICIPANTS: Forty-one primary care practices, including 57 physicians and their staff and 1,145 patients aged 60 and older. INTERVENTION: Twenty of the 41 primary care practices in North Carolina were randomized to a composite intervention that included a 3-hour continuing medical education accredited course, training in …

The Impact Of A Video Intervention On The Use Of Low Vision Assistive Devices, Robert Goldstein, Elizabeth Dugan, Felicia Trachtenberg, Eli Peli

Elizabeth Dugan

PURPOSE: An image-enhanced educational and motivational video was developed for patients with low vision and their caretakers. Impact on knowledge, self-efficacy, and attitudes was assessed. METHODS: The video incorporated cognitive restructuring to change emotional response; a "virtual home"; a veridical simulation of vision with age-related macular degeneration and contrast enhancement of the video. Subjects (median age 77.5) were randomized into control (n=79) and intervention (n=75) groups. Telephone interviews were at baseline, 2 weeks and 3 months. Main outcome measures were: knowledge (eight questions), self-efficacy score (seven questions), adaptive behaviors (10 questions), willingness to use devices, and emotional response (4-point scales). …

Baseline Experience With Modified Mini Mental State Exam: The Women's Health Initiative Memory Study (Whims), Stephen Rapp, Mark Espeland, Patricia Hogan, Beverly Jones, Elizabeth Dugan

Elizabeth Dugan

The Modified Mini Mental State Exam (3MS) is widely used for screening global cognitive functioning, however little is known about its performance in clinical trials. We report the distribution of 3MS scores among women enrolled in the Women's Health Initiative Memory Study (WHIMS) and describe differences in these scores associated with age, education, and ethnicity. The 3MS exams were administered to 7,480 women aged 65-80 who had volunteered for and were eligible for a clinical trial on postmenopausal hormone therapy. General linear models were used to describe demographic differences among scores. Factor analysis was used to characterize the correlational structure …

How Patients' Trust Relates To Their Involvement In Medical Care, Felicia Trachtenberg, Elizabeth Dugan, Mark Hall

Elizabeth Dugan

OBJECTIVES: To examine the connection between patients' trust and their attitudes toward seeking care, participating in medical decision making, and adhering to treatment recommendations. METHODS: Data were collected from a national telephone survey of English-speaking adults (N=553) in 1999. Eligibility requirements were some type of public or private health care coverage and having seen a physician or other health professional at least twice in the past 2 years. Five questions on preferred role in medical care were asked. Trust in physicians and satisfaction with care were separately measured using validated scales. RESULTS: The most significant predictor of patients' preferred role …

The Driving Dilemma: The Complete Resource Guide For Older Drivers And Their Families, Elizabeth Dugan

Elizabeth Dugan

Publisher's Description: The Driving Dilemma is a comprehensive resource for older drivers and their families facing questions about driving safety. Dr. Dugan provides clear, useful information about the effects of age, medical conditions, and medications on driving. She offers practical advice on how to discuss this issue with loved ones. The book provides not only the facts, but also a research-based approach to communication, with useful sample dialogue scripts that will help you discuss driving with your loved ones. Also included are state-by-state listings of available resources, making this book a total information source for families. Citation: Dugan E. The …

Primary Care, Economic Barriers To Health Care, And Use Of Colorectal Cancer Screening Tests Among Medicare Enrollees Over Time, Chyke Doubeni, Adeyinka Laiyemo, Angela Higgins, Carrie Klabunde, George Reed, Terry Field, Robert Fletcher

Chyke A. Doubeni

PURPOSE: Colorectal cancer (CRC) screening remains underutilized. The objective of this study was to examine the impact of primary care and economic barriers to health care on CRC testing relative to the 2001 Medicare expansion of screening coverage.

METHODS: Medicare Current Beneficiary Survey data were use to study community-dwelling enrollees aged 65 to 80 years, free of renal disease and CRC, and who participated in the survey in 2000 (n = 8,330), 2003 (n = 7,889), or 2005 (n = 7,614). Three outcomes were examined: colonoscopy/sigmoidoscopy within 5 years (recent endoscopy), endoscopy more than 5 years previously, and fecal occult …

Socioeconomic And Racial Patterns Of Colorectal Cancer Screening Among Medicare Enrollees In 2000 To 2005, Chyke Doubeni, Adeyinka Laiyemo, George Reed, Terry Field, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Lower rates of screening among minorities and low-income populations contribute to colorectal cancer health disparities. Therefore, we examined patterns of colorectal cancer screening and associations with race-ethnicity, education, and income over time. METHODS: Repeated cross-sectional data from the Medicare Current Beneficiary Survey of noninstitutionalized colorectal cancer-free Medicare enrollees ages 65 to 80 years interviewed in 2000 (n = 8,355), 2003 (n = 7,922), and 2005 (n = 7,646). We examined rates of colonoscopy/sigmoidoscopy use within 5 years (recent endoscopy), colonoscopy/sigmoidoscopy use >5 years previously, or fecal occult blood test (FOBT) within 2 years. RESULTS: Among those included in the …

Race And Colorectal Cancer Disparities: Health-Care Utilization Vs Different Cancer Susceptibilities, Adeyinka Laiyemo, Chyke Doubeni, Paul Pinsky, V. Doria-Rose, Robert Bresalier, Lois Lamerato, E. Crawford, Paul Kvale, Mona Fouad, Thomas Hickey, Thomas Riley, Joel Weissfeld, Robert Schoen, Pamela Marcus, Philip Prorok, Christine Berg

Chyke A. Doubeni

BACKGROUND: It is unclear whether the disproportionately higher incidence and mortality from colorectal cancer among blacks compared with whites reflect differences in health-care utilization or colorectal cancer susceptibility. METHODS: A total of 60, 572 non-Hispanic white and black participants in the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial underwent trial-sponsored screening flexible sigmoidoscopy (FSG) without biopsy at baseline in 10 geographically dispersed centers from November 1993 to July 2001. Subjects with polyps or mass lesions detected by FSG were referred to their physicians for diagnostic workup, the cost of which was not covered by PLCO. The records …

Neighborhood Socioeconomic Deprivation And Mortality: Nih-Aarp Diet And Health Study, Jacqueline M. Major, Chyke A. Doubeni, Neal D. Freedman, Yikyung Park, Min Lian, Albert R. Hollenbeck, Arthur Schatzkin, Barry I. Graubard, Rashmi Sinha

Chyke A. Doubeni

PURPOSE: Residing in deprived areas may increase risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. The aim of this study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer- and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors. METHODS: In the longitudinal NIH-AARP Study, we analyzed data from healthy participants, ages 50-71 years at study baseline (1995-1996). Deaths (n = 33831) were identified through December 2005. Information on census tracts was obtained from the 2000 US Census. Cox models estimated hazard …

Likelihood Of Missed And Recurrent Adenomas In The Proximal Versus The Distal Colon, Adeyinka Laiyemo, Chyke Doubeni, Andrew Sanderson, Paul Pinsky, Dilhana Badurdeen, V. Doria-Rose, Pamela Marcus, Robert Schoen, Elaine Lanza, Arthur Schatzkin, Amanda Cross

Chyke A. Doubeni

BACKGROUND: Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon.

OBJECTIVE: To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas.

DESIGN: Prospective.

SETTING: Polyp Prevention Trial.

PARTICIPANTS: A total of 1864 patients with an adenoma at baseline underwent a follow-up colonoscopy 4 years later (adenoma recurrence). Of these, 1731 underwent a clearing colonoscopy 1 year after the baseline examination (missed adenoma).

MAIN OUTCOME MEASUREMENTS: Association …

Racial And Ethnic Trends Of Colorectal Cancer Screening Among Medicare Enrollees, Chyke Doubeni, Adeyinka Laiyemo, Carrie Klabunde, Angela Higgins, Terry Field, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Colorectal cancer (CRC) screening rates have remained lower than the Healthy People 2010 goal, particularly among minority populations. PURPOSE: This study aimed to examine the racial-ethnic trends in CRC screening and the continued impact of healthcare access indicators on screening differences after Medicare expanded coverage. METHODS: The study used data from the Medicare Current Beneficiary Survey for 2000, 2003, and 2005. The sample was restricted to non-Hispanic whites, non-Hispanic blacks, and Hispanics. The primary outcome was the proportion of enrollees who underwent lower-gastrointestinal endoscopy within 5 years and/or home fecal occult blood test within 1 year. RESULTS: Over the …

A 25-Year Perspective Into The Changing Landscape Of Patients Hospitalized With Acute Myocardial Infarction (The Worcester Heart Attack Study), Robert Goldberg, Frederick Spencer, Jorge Yarzebski, Darleen Lessard, Joel Gore, Joseph Alpert, James Dalen

Jorge L. Yarzebski

Over the past several decades, significant advances have been made in the primary and secondary prevention of coronary artery disease. However, effects of changing lifestyle and treatment practices on demographic and clinical profiles and on hospital outcomes of patients who present with acute myocardial infarction (AMI) have not been well characterized. We carried out a prospective population-based investigation of >25-year trends (1975 to 2001) in demographic and clinical characteristics, treatment practices, and hospital outcomes of patients who had been hospitalized with AMI. Residents of a metropolitan area (Worcester, Massachusetts) who had been hospitalized with validated AMI (n = 10,440) in …

The Importance Of Examining Movements Within The Us Health Caresystem: Sequential Logit Modeling, Chioun Lee, Stephanie L L. Ayers, Jennie Jacobs Kronenfeld, Jemima A. Frimpong, Patrick A. Rivers, Sam S. Kim

Dartmouth Scholarship

Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., …

Effect Of Elevated Leukocyte Count On In-Hospital Mortality Following Acute Myocardial Infarction, Mark Furman, Richard Becker, Jorge Yarzebski, Judith Savageau, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

The peripheral white blood cell count on presentation with acute myocardial infarction directly correlates with short-term in-hospital mortality. This association is independent of other prognostic factors, including extent and size of the acute myocardial infarction.

Age-Related Trends (1986-1993) In The Use Of Thrombolytic Agents In Patients With Acute Myocardial Infarction. The Worcester Heart Attack Study, Harish Chandra, Jorge Yarzebski, Robert Goldberg, Judith Savageau, Colleen Singleton, Jerry Gurwitz, Joel Gore

Jorge L. Yarzebski

OBJECTIVE: To examine age-related differences and temporal trends in the use of thrombolytic therapy in a community-wide study of patients hospitalized with acute myocardial infarction (AMI) between 1986 and 1993. METHODS: All hospitals in the Worcester, Mass, metropolitan area (1990 census population, 4370000) were included. A total of 3824 patients with validated AMI categorized according to age comprised the study sample: younger than 55 years (n = 577), 55 to 64 years (n = 758), 65 to 74 years (n = 1143), and 75 years or older (n = 1346). RESULTS: Use of thrombolytic therapy increased during the period under …

Health Insurance Coverage And Outcome Following Acute Myocardial Infarction. A Community-Wide Perspective, Silvia Kreindel, Ronald Rosetti, Robert Goldberg, Judith Savageau, Jorge Yarzebski, Joel Gore, Arthur Russo, Carol Bigelow

Jorge L. Yarzebski

BACKGROUND: Several studies have suggested that type of medical insurance coverage is associated with hospital utilization rates and receipt of selected diagnostic or treatment approaches. To our knowledge no studies, however, have examined the relation between medical insurance coverage and short-term outcomes following acute myocardial infarction (AMI) from a multihospital, community-wide perspective. OBJECTIVE: To examine the association between medical insurance coverage and in-hospital case-fatality rates as well as length of hospital stay following AMI. METHODS: The study sample consisted of 3735 residents of the Worcester, Mass, metropolitan area hospitalized with validated AMI during 1986, 1988, 1990, 1991, and 1993 at …