Introduction: Cardiovascular disease and not hyperglycemia is the major cause of mortality in patients with diabetes mellitus (DM). Hypertension is particularly burdensome in low income groups, where the prevalence of uncontrolled hypertension is higher than the general population. Federally Qualified Health Centers (FQHCs) provide care for low income and medically underserved populations (both immigrant and non-immigrant population). Objectives: 1) to determine the rate and predictors of Blood Pressure (BP) control in patients with diabetes and hypertension. 2) to identify differences by immigration status in BP control among patients attending FQHCs. Methods: The Office Guidelines Applied to Practice (Office-GAP) study is a cluster randomized trial designed to improve cardiovascular care for minority and low income populations in outpatient clinical settings. Office-GAP intervention included: provider training, patient education in a group visit, and use of Office-GAP checklist and patient decision aids during office visits. We describe baseline patient characteristics (prior to any intervention) in the FQHC sites. Retrospective review was performed of charts of all patients with hypertension, coronary artery disease and or, diabetes mellitus (DM) from September 2010 to December 2012. Hypertension was defined as Systolic BP>140 mmHg (>130 mm Hg in DM patients) and diastolic BP > 90 mmHg (>80 mm Hg in DM patients). A multivariable logistic regression was used to assess the effects of potential predicators on BP control. Results: Of 242 patients identified, 169 had DM, and 166 had hypertension. The mean age was 54.47 ± 11.91 years and 44.39 % were men (99 of 223). Of the total sample, 178 (73.55%, 178 of 242) were non-immigrants, 23.87 % (53 of 222) were covered by Medicaid, 40.99% (91 of 222) by Medicare, 39.19 % (87 of 222) by county outpatient insurance; 33.06% (70 of 242) were Black, 34.71 % (84 of 242) White and 32.23% (78 of 242) formed other races (Hispanics, Somalis, Nepalese). BP control was 36.73% (83 of 226) 95% CI = [30.44, 43.02] and 27.22% (46 of 169) 95% CI = [20.51, 33.93] in total sample and DM patients respectively. BP control among immigrants was 32.2% (19 of 59) 95% CI = [20.28, 44.12] vs. 38.32% (64 of 167) 95% CI = [30.95, 45.69] in non-immigrants. A logistic regression model identify the DM status as the sole significant predictor associated with BP control, with patients without DM having the best BP control (p-value<0.0001). This effect of DM on BP control remained significant even after adjusted for other predictors. Conclusions: We found that significant number of patients attending FQHCs do not have their BP controlled. Immigration status did not play any role in BP control; however BP control among patients with DM was substantially lower than the whole sample. This underscores the urgent need for strategies to improve BP control in FQHCs, particularly among diabetic patients.
Background: Cardiovascular disease (CVD) risk factor control is critical to reducing CVD risk and adverse outcomes. Recent studies from CDC revealed that American adults who smoke decreased from 20.9% in 2005 to 19.3% in 2010.In addition, prevalence of obesity appears to be slowing or leveling off. However,minority and low-income populations face barriers of literacy and poverty blocking access to the benefits of efficacious strategies to control these risk factors for CVD. Federally Qualified Health centers (FQHCs {Safety-Net Clinics}) provide care for low income and medically underserved populations. Objectives: 1) Determine if obese diabetic/ CVD patients in FQHCs have access to community resources for weight loss. 2) Determine smoking rates and accessibility to smoking cessation programs for these populations. Methods: This study is part of the Office- Guidelines Applied to Practice (Office-GAP) project, designed to improve secondary prevention of heart disease for diabetic and CVD patients in FQHCs in Michigan. We analyzed 242 patients that participated in Office-GAP group visits (September 2010-December 2012). Patients completed a health survey at baseline that included demographic characteristics, comorbidity, smoking status, weight, having access to weight loss programs and nutrition counseling, and access to smoking cessation programs. Chart abstraction was performed for relevant data by trained research assistants. Descriptive analysis was performed on the cross sectional data that was obtained. Results: Among the enrolled patients 53.71% (130 of 242) were obese (BMI > 30). Mean age=53.69; male=33.07% (43 of 130); white=47.69% (62 of 130). Analysis revealed that 55.85% (105 of 188) diabetics, 57.06% (109 of 191) hypertensives and 57.57% (19 of 33) MI patients were obese. Only 57.42% (58 of 101) and 62.5% (40 of 64) patients said they have access to weight loss programs and nutrition counseling respectively. Furthermore, 78.46% (102 of 130) and 61.54% (80 of 130) patients stated having a problem getting into weight loss and nutrition counseling programs respectively. Current smokers were 31.4% (76 of 242) with {(blacks=35.29% (30 of 85), whites=41.75% (38 of 91) and other races=12.12% (8 of 66)}. Further analysis revealed 63.64% (21 of 33) patients with history of myocardial infarction, 28.19% (53 of 188) diabetics and 48.65% (18 of 37) of asthmatics were smokers with 69.74% (53 of 76) stating they have problems accessing smoking cessation programs. Conclusion: Very high proportions of diabetic and CVD patients are obese in FQHCs. Many lack access to programs that can assist with weight loss. Smoking rates remain high, with many patients reporting difficulty in accessing smoking cessation programs in FQHCs. There is an urgent need for strategies to improve access to smoking cessation and weight loss programs in FQHCs to decrease cardiovascular risk, morbidity and mortality.
Background: Some research has been done into using mobile phones as a means of communication with patients. It has been shown to improve medication adherence among chronically ill patients. As of December 2012 , more than 89% of the US inhabitants have mobile broadband subscriptions .This opens up the potential for Smartphone applications and also patient portals, above and beyond text messaging for patient communication. Objectives: To assess the readiness, interest and barriers of low income minority patients with diabetes mellitus (DM) and cardiovascular disease (CVD) towards adopting 1) Text messaging , Smartphone applications , Patient portals as means of communication with providers. 2)Compare technology adoption in immigrant versus non-immigrant populations. Methods: This study is part of the Office- Guidelines Applied to Practice (Office-GAP) project, designed to improve secondary prevention of heart disease for DM and CVD patients in FQHCs (Federally Qualified Health Centers) in Michigan. We analyzed 119 out of the 242 patients that participated in Office-GAP group visits (June 2013-January 2014) and completed the questionnaire. The questionnaire evaluated their readiness , interest and barriers towards electronic means of communication . Chart abstraction was performed for relevant data by trained research assistants. Descriptive analysis was performed on the cross sectional data thus obtained. Results: Study population is 53 % (63 of 119) non-immigrant , 47% (56 of 119) immigrant. Mean age is 53.69 (33.07% males) and 57.1% (68 of 119) of our patient population has a cellphone with non-immigrants having higher access (74.6 vs 37.5%) compared to immigrants. Text messages can be sent and received by 37.8% (45 of 119) with 21.1% (25 of 118) having to pay extra charges for texts and 25.7% (30 of 117) want texts from the doctors office. A landline is available to 54% (64 of 119) and 48.2% (56 of 116) want voicemails. Out of our population with both a landline and cellphone 57 %(60 of 106) prefer landline. Only 10 % (12 of 119) of our population can use a computer very well and 55% (65 of 119) cannot use a computer at all , 35%(42 of 119) have access to internet and email and 52.3%(22 of 42) want emails from their doctors office. Seven percent (4 of 58) would like to have access to their medical information online by means of a patient portal. Three percent (2 of 58) have a smartphone and 1.7% (1 of 58) would like a Smartphone application for accessing their medical records. Conclusion: Minority and low-income patients with DM and CVD may eventually be ready for adopting more technology as a means of communication with their provider as technology gets cheaper and trivialized . Current readiness and interest to adoption is lower among immigrant compared to non immigrant population. More research is needed to determine the barriers to adopting technology for secondary prevention of heart disease.
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