Multimedia tools that incorporate videos may help patients better understand and manage their disease. Patient involvement in the development process is essential to ensure relevant content and usability.
This study explores how travel distance and other
Objective The present study was undertaken to evaluate the efficacy of 2 educational tools for patients with rheumatoid arthritis (RA) by comparing a newly developed video tool, including storylines and testimonials, combined with a written booklet to the same written booklet alone. Methods We conducted a randomized controlled trial. Our primary outcome was disease knowledge. Secondary outcomes were decisional conflict, self‐efficacy, effective health care management, and satisfaction. Outcomes were measured before and after reviewing the materials, and 3 and 6 months later. Linear mixed‐effects models were performed to evaluate changes over time. Results In total, 221 participants received an educational video and booklet (n = 111) or a booklet alone (n = 110). The mean age was 50.8 years, mean disease duration was 4.8 years, 85% were female, and 24% had limited health literacy levels. Within groups, most outcomes improved between baseline and follow‐up, but there were no statistically significant differences across groups. Patients receiving the video and booklet were more likely than those receiving the booklet alone to rate the presentation as excellent for providing information about the impact of RA, medication options, evidence about medications, benefits of medication, and self‐care options. Factors significantly associated with greater improvements in knowledge and decisional conflict from baseline to 6 months included limited health literacy, lower educational level, and shorter disease duration. Conclusion Regardless of the delivery method, outcomes were improved up to 6 months after educational materials were delivered. Our findings support the implementation of self‐administered educational materials in clinical settings, as they can result in sustained improvements in disease knowledge and decisional conflict.
This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.
Objective. To conduct a descriptive literature review on research studies investigating the association between chronic periodontitis (CP) and erectile dysfunction (ED).Methods. Cohort studies, case-control studies, cross-sectional studies, randomized control trials, and animal studies up to July 2015 that studied the relationship between CP and ED were reviewed and reported. Data sources included PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. The themes “periodontal disease” and “erectile dysfunction” and the role of periodontal therapy were identified and discussed throughout the narrative review.Results. After reviewing the literature, it was found that an association between CP and vasculogenic ED likely exists. Inflammation resulting from CP promotes endothelial dysfunction by increasing the systemic levels of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Periodontal therapy attempts to decrease the release of TNF-αand could act to restore endothelial function, particularly in the penile vasculature.Conclusion. Although the literature reported a positive association between CP and ED, the studies were few and possess several methodological limitations. Large-scale cohort studies and confounder analysis are recommended. Dentists and physicians should collaborate to manage patients with either CP or ED because of their potential association not only with each other but also with other serious systemic comorbidities.
Objective. To evaluate the association of preoperative psychosocial and demographic factors with total knee arthroplasty (TKA) outcomes and satisfaction in patients with osteoarthritis (OA) of the knee at 24 months after surgery. Methods. A prospective cohort study of patients undergoing TKA was conducted. Outcome measures included: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 (SF-36) scores at baseline and 24 months after surgery, and patient satisfaction with TKA at 24 months. Linear regression models were performed to evaluate the association of preoperative psychosocial determinants (ie, Medical Outcome Study Social Support Scale; Depression, Anxiety, and Stress Scale; Brief COPE inventory, The Life Orientation Test-Revised; Multidimensional Health Locus of Control; and Arthritis Self-Efficacy Scale) on outcomes. Results. We included 178 patients. Increasing WOMAC pain scores at 24 months were associated with increasing age and body mass index (BMI); low tangible social support and low optimism were associated with higher levels of pain (R 2 = 0.15). A decrease in WOMAC function scores was also associated with older age and higher BMI; low tangible support, increased stress, and low optimism were also associated with worse function (R 2 = 0.22). When evaluating quality of life, lower SF-36 physical functioning scores at 24 months were associated with age, high BMI, and comorbidity (R 2 = 0.34). Lower SF-36 mental functioning scores were associated with depression and low optimism (R 2 = 0.38). Having a dysfunctional style of coping was associated with lower satisfaction with surgery after 24 months (adjusted R 2 = 0.12). Conclusion. Psychosocial factors, such as tangible support, depression, dysfunctional coping, and optimism, were associated with pain, function, and satisfaction 2 years after TKA. Perioperative programs identifying and addressing psychosocial problems may result in improvements in pain and function after TKA.
Return to TOC Enhanced benefits, tier 2, include routine restorative services, root canals, non-emergent tooth extractions, and basic periodontal services. Enhanced plus benefits, tier 3, include crowns, bridges, and periodontal surgery. The DWP expects to establish a larger provider network than for adults with regular Medicaid dental coverage by offering higher reimbursement (approximately 50% higher) and reduced administrative burdens as compared with the traditional Medicaid program. Dentists are incentivized to conduct clinical risk assessments of their DWP patients. Member incentives Positive incentive-Members who return for a recall exam (regular dental checkup) every 6-12 months will earn access to additional services at no out-of-pocket cost to the enrollee. Negative incentive-Members who do not return for a recall exam every 6-12 months do not have access to the Enhanced or Enhanced Plus services. Provider incentives The State has developed a Provider Incentive Plan ("Bonus Pool") for dental providers. The Incentive Plan rewards general dentists based on the number of comprehensive and periodic exams performed for DWP members. Additional incentives to participate include generally higher reimbursement for fee-for-service care than they would normally receive for adult Iowa Medicaid members (about 50% higher) and reimbursement for conducting clinical risk assessments, a service not routinely covered by Medicaid or traditional dental insurance plans. Study populations This evaluation includes 3 major comparison groups, in addition to the DWP population, where comparisons are appropriate. Return to TOC Results Among respondents who reported utilizing specialist care since joining their dental plan, 55% (n=102) of DWP and 35% (n=13) of Medicaid members said they 'usually' or 'always' got an appointment with a specialist as soon as they wanted. Note: These results are the same as Measure 15-Care from a dental specialist. Hypothesis 7.34 Outreach will improve members' compliance with follow-up visits, including recall exams. Measure 39 Time to recall exams at 6-12 month intervals Time to recall exams at 6-12 month intervals when recall visits are defined as any visit that includes a comprehensive or periodic oral evaluation Definition Original measure Proposed Analytic Method Survival analyses for new members in DWP and MSP Variations from the Proposed Analytic Method Protocol is being developed for final report. Results Data for this measure are not available due to insufficient time passing since the beginning of the DWP.
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