Background-Low-income African American adults in Chicago have disproportionately high asthma morbidity and mortality rates. Interventions that improve asthma self-efficacy for appropriate self-management behaviors may ultimately improve asthma control in this population.
UCCESS IN THE CONTROL OF THEheart failure epidemic has come from advances in understanding effective, evidence-based medical therapies. 1 Challenges remain, however, in the delivery of these therapies to patients. Patient nonadherence to heart failure drugs ranges from 30% to 60% and nonadherence to lifestyle recommendations from 50% to 80%, with higher rates occurring in more socioeconomically disadvantaged subgroups. 2 To meet the challenge of delivering evidence-based therapies to patients with heart failure, research has turned to the evaluation of disease management, remote monitoring, and patient self-management programs. [3][4][5][6][7][8] Disease management programs extend medical care in the outpatient setting but keep patients in a passive role and, as For editorial comment see p 1383.
Higher rates of primary and repeat amputation for African American patients at study hospitals, which all have significant vascular surgery capacity and an aggressive policy of limb salvage, suggest that these rates may be even higher at less well equipped institutions. Improving access to primary and preventive care for lower-income patients could reduce amputation rates among African Americans.
Poorer lower extremity functioning in African Americans was largely explained by differences in leg symptoms and, to a somewhat lesser degree, lower ABI levels and poorer education in African Americans than in whites. Further study is needed to determine whether these findings affect racial treatment disparities and poorer outcomes previously reported in African Americans than in whites with PAD.
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