Biomedical subjects
C Willey
Publications and source records attributed to C Willey.
Patient education provided to asthmatic children: a historical cohort study of the implementation of NIH recommendations.
NIH guidelines for treatment of childhood asthma emphasize educating both patients and family about avoiding triggers and providing information to support self-management of asthma. To determine the extent to which primary care providers had implemented these recommendations, we examined the patient education provided to a cohort of asthmatic children (n = 331) between January and December 1994. During 1994 education of any type was documented for less than half the children. Provision of education was associated with asthma severity: An action plan for exacerbations was discussed with the majority with moderate or severe asthma (61%). Avoiding triggers (aOR: 2.38, 95% CI: 1.37-4.12) and treatment goals (aOR: 3.14, 95% CI: 1.46-6.75), were more likely to be discussed with children who were prescribed inhaled anti-inflammatory medication, after adjustment for asthma severity and age. Limited implementation of the NIH recommendations by primary care providers in our study may have reduced their impact on the management of childhood asthma.
Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure.
BACKGROUND: The stages-of-change (SOC) model has been used to explain and predict how behavior change occurs, but it is new as an approach to understanding why patients fail to take their medications as prescribed. OBJECTIVE: This study validated a 2-item measure of SOC for adherence with medication regimens in 2 groups of patients prescribed pharmacologic therapy for chronic conditions. METHODS: Two cross-sectional studies of attitudes toward medication adherence included the same measure of SOC for medication adherence. One was a sample of 161 HIV-positive patients in the United States, and the other was an international sample of 731 patients with hypertension. The validity of the measure of SOC for medication adherence was examined in both convenience samples using previously validated self-reported measures of adherence (the Medication Adherence Scale and a measure of adherence from the Medical Outcomes Study), and in the HIV sample using electronic monitoring of adherence behavior in 85 patients. RESULTS: Construct validity was demonstrated in both samples by associations between SOC and the previously validated measures of adherence (P < 0.001), and predictive validity was supported by significant associations between SOC for medication adherence and electronically monitored medication-taking behavior during the next 30 days (P < 0.03). CONCLUSIONS: Behavior-change theory suggests that stage-tailored communication strategies are more effective than uniform health-promotion messages. Our results provide a foundation for the development of interventions for medication adherence that are tailored to patients' readiness for change. Our validated 2-item measure of SOC for medication adherence can be used to match communication strategies to individual motivation and readiness for adherence with chronic disease medication regimens.
Behavior-changing methods for improving adherence to medication.
Long-term adherence to antihypertensive drug therapy is poor, and new strategies to predict and improve adherence to prescribed drug regimens are needed. The literature on behavior change is reviewed, and a new perspective on medication adherence is presented. Successfully adopting and continuing with a long-term medication regimen requires behavior change, and behavior change principles can be used to accelerate the adoption of adherence to medication- taking behavior. The efficacy of behavior-changing interventions, which are tailored to each patient's stage of change, has been demonstrated in several health behavior areas. Rewards, monitoring devices, and reminder techniques are most useful for individuals in later stages of behavior change, but individuals in earlier stages need consciousness-raising interventions that focus upon awareness of the benefits of therapy. Recent research has yielded reliable ways to measure the stage of change for medication adherence, providing the foundation for the application of behavior- changing principles to the pharmacologic management of hypertension.
Public health and the science of behavior change.
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Changing nurses' pain assessment practice: a collaborative research utilization approach.
It is not uncommon for a decade to pass between the time a research problem is identified and the time that research-based solutions are translated into standards for care. This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research-based knowledge (pain assessment) into practice for the purpose of helping to solve pain management problems. At the same time, nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model.
Stages of change for reducing dietary fat to 30% of energy or less.
OBJECTIVE: To develop an algorithm that defines a person's stage of change for fat intake < or = 30% of energy. The Stages of Change Model describes when and how people change problem behaviors; change is defined as a dynamic variable with five discrete stages. DESIGN: A stage of change algorithm for determining dietary fat intake < or = 30% of energy was developed using one sample and was validated using a second sample. SUBJECTS: Sample 1 was a random sample of 614 adults who responded to mailed questionnaires. Sample 2 was a convenience sample of 130 faculty, staff, and graduate students. STATISTICS: Subjects in sample 1 were initially classified in a stage of change using an algorithm based on their behavior related to avoiding high-fat foods. Dietary markers were selected for a Behavioral algorithm using logistic regression analyses. Sensitivity, specificity, and predictive value of the Behavioral algorithm were determined, then compared between samples using the Z test. RESULTS: The following dietary markers predicted intake < or = 30% of fat (chi 2 = 131; P < .0001): low-fat cheese, breads without added fat, chicken without skin, low-calorie salad dressing, and vegetables for snacks. The specificity of the Behavioral algorithm was validated; the algorithm classified subjects consuming > 30% of energy from fat with 93% specificity in sample 1 and 87% in sample 2 (Z = 1.36; P > .05). Predictive value was also validated; 64% and 58% of subjects meeting the behavioral criteria had fat intakes < or = 30% of energy (Z = 1.1; P > .05). The algorithm was not sensitive, however; most subjects with fat intakes < or = 30% of energy from fat failed to meet the behavioral criteria. The sensitivity differed between samples 1 and 2 (44% and 27%, respectively; Z = 3.84; P < .0001). APPLICATIONS: The Behavioral algorithm determines stage of change for fat reduction to < or = 30% of energy in populations with high fat intakes. The algorithm could be used in dietary counseling to tailor interventions to a patient's stage of change.
Distinguishing between the fit and frail elderly, and optimising pharmacotherapy.
Frail older patients are at risk for adverse consequences from medications or other external stresses. No single marker, such as age or physical disability, or laboratory test can identify this group of patients. As a result, screening questionnaires have been developed and successfully used by nurses to help identify frail older patients upon admission to a hospital. A very short, 7-item screen with questions concerning cognitive ability, physical mobility, nutrition, number of medications used and hospitalisation within the previous month, was able to identify those patients who were more likely to be discharged to a nursing home, die, or incur a large hospitalisation cost for the institution. While the number of medications used was not an independent predictor of the outcome measures studied (e.g. discharge to a nursing home), data from the literature show that the number of medications prescribed is related to iatrogenic complications in older patients, and specific impairments in mobility and cognition. The proper choice and prescribed dose of a medication is extremely important in frail older patients who, for instance, are at increased risk from hip fracture with some benzodiazepines, and who have markedly diminished clearance of some drugs. A systematic approach is suggested for the prescription of medications in frail older persons which will help achieve optimal pharmacotherapy by using a limited number of medications, thoughtfully selecting medications which will not impair function, and prescribing an appropriate dose based on pharmacodynamic and pharmacokinetic changes that occur with age.
Compliance-related problems in the ambulatory population.
When prescription drugs are taken in the correct dose and the correct manner, they have great potential for improving the quality of medical care, but inappropriate and incorrect administration of these drugs can lead to severe health problems. Risk factors for problems related to prescription drug compliance were examined in a cross-sectional retrospective study (n = 1017) of ambulatory individuals who had undergone a Brown Bag Prescription Evaluation Program consultation. A pharmacist interviewer assessed drug-related problems such as duplication of drug product, overutilization and underutilization of medication, drug interactions, and side effects. Associations between specific medication-related problems and patient characteristics (demographics, medical history, and insurance status) were studied. Factors that appear to be associated with compliance problems include a patient's level of understanding of both medication instructions and the drug therapy, length of time since last physician visit, length of time on medication, total number of medications, and number of drug allergies. The class of medication taken was also found to be a significant predictor of excess risk. The age and sex of an individual appear to have little association with the development of compliance-related problems. The study reinforces the need for frequent patient contact with a health care professional and the value of educating the patient about the medication regimen.
Risk of functional decline among well elders.
Active lifestyles may delay the onset of the functional consequences of chronic disease, potentially increasing active life expectancy. We analyzed the Longitudinal Study of Aging (LSOA) to test the hypothesis that elders participation in an active lifestyle prevents loss of function. Focusing on the cohort aged 70-74 who reported being able to carry 25 lb, walk 1/4 mile, climb 10 steps and do heavy housework without help and without difficulty at baseline, decline was defined as no longer being able to perform these tasks independently and without difficulty 2 years later. Using multivariate logistic regression, results reveal that those who did not report regularly exercising or walking a mile were 1.5 times more likely to decline than those who did, controlling for reported medical conditions and demographic factors. Similar findings (with different models) were observed for both men and women. Findings suggest the potential value of programs oriented toward the primary prevention of functional decline.
Rhode Island women's awareness of breast cancer detection techniques: implications for the Rhode Island clinician. Mammography in Rhode Island is vastly underutilized.
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Tobacco withdrawal in CCU patients.
This project examined the hypothesis that smokers, undergoing forced abstinence from tobacco in the Cardiac Care Unit (CCU) setting, would have higher anxiety and more withdrawal symptoms than nonsmoking patients. The investigators found that anxiety was not higher in smokers than in nonsmokers, but that smokers did have more psychological withdrawal symptoms on the first day after admission. This article provides the critical care nurse with guidelines to assess patients for nicotine withdrawal symptoms, and offers suggestions for nursing care of these patients.