Background One strategy that has had the greatest effect on improving blood pressure (BP) includes team-based care. The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists. Methods A Medline search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by two reviewers who independently abstracted data and classified the different intervention components. Results Thirty-seven papers met the inclusion criteria. Education on BP medications was significantly associated with improved BP (−8.75/−3.60 mm Hg). Other strategies that had large effect sizes on SBP included: pharmacist made treatment recommendation (−9.30 mm Hg), nurse did the intervention (−4.80 mm Hg), and a treatment algorithm was used (−4.00 mm Hg). The odds ratio (OR) and 95% confidence interval (CI) for controlled BP were: nurses OR=1.69 (CI = 1.48, 1.93), pharmacists within primary care clinics OR=2.17 (CI = 1.75, 2.68) and community pharmacists OR=2.89 (CI = 1.83, 4.55), Mean reductions in SBP were: nursing studies = 5.84 ± 8.05 mm Hg, pharmacists in clinics = 7.76 ± 7.81 mm Hg and community pharmacists = 9.31 ± 5.00 mm Hg but there was no significant differences between the nursing and pharmacy studies (p≥0.19). Conclusion Team-based care was associated with improved BP control and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in the health-care organizational structure to include important components of team-based care.

The purpose of this study was to explore through interviews of healthcare professionals their perspectives on elder abuse to achieve a better understanding of the problems of reporting and generate ideas for improving the process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed and thematic analysis was used to identify the following core themes: professional orientation, assessment, interpretation, systems, and knowledge and education. The impact by healthcare professionals in recognizing and reporting elder abuse and obtaining resources for those mistreated can be profound. Nurses tended to perceive elder abuse as uncommon and generally did not feel it was their role nor did they have time to assess patients for potential abuse. Physicians felt that other patient care issues, time limitations and maintaining trust in the clinician-patient relationship outweighed the importance of detecting and pursuing suspected cases of elder abuse. Social workers, although having the most knowledge and experience related to elder abuse, relied on nurses and physicians to detect potential abusive situations and to work with them in making appropriate referrals. The three disciplines acknowledged the need for more and better education about elder abuse detection and reporting. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.

Objectives: Patient self-care behaviors, including taking medication, following a meal plan, exercising regularly, and testing blood glucose, influence diabetes control. The purpose of this research was to identify (1) which barriers to diabetes management are associated with problem behaviors and (2) which patient behaviors and barriers are associated with diabetes control.Methods: This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes. A randomly selected sample of 800 clinic patients was mailed an investigator-developed survey. The study sample consisted of 253 (55%) individuals who had measured glycosylated hemoglobin (HbA1c) within 3 months of the survey date.Results: The barriers to each diabetes self-care behavior differed. Cost was the most common barrier to the 4 self-care behaviors. In a multivariable regression model, the belief that type 2 diabetes is a serious problem and depression were strongly associated with higher HbA1c levels. Lower HbA1c levels were significantly associated with being married and greater self-reported adherence-satisfaction with taking medication and testing blood glucose.Conclusion: This study expanded earlier research by focusing on 4 specific self-care behaviors, their barriers, and their association with HbA1c. Barriers that were significantly associated with HbA1c were specific to the behavior and varied across behaviors. Although the importance of glycemic control is well established, 1 it is often not achieved. 2 Factors contributing to poor control include inadequacies in patient self-care behaviors, medical management, or both. [3][4][5][6][7] Physicians know that patient self-care behaviors influence diabetes control but may lack training for and interest in motivating their patients to improve these behaviors. 8 Contributing to poor control is a paucity of information available about the frequency of problem behaviors, barriers to appropriate care behaviors, or the relationship of specific patient self-care behaviors to glycemic control. 9,10 Our conceptual model for this study is shown in Figure 1, adapted from the works of Glasgow. 11Factors that influence diabetes adherence in our model include personal factors, such as type and duration of diabetes, illness, and other health conditions and psychosocial factors. Glasgow's model places primary emphasis on the variables of the patient-health care provider interactions, compliance, and outcomes. The patient-provider interactions are composed of the patient's perspective and participation, appropriateness of prescriptions, and clarity and specificity of recommendations. The social/environmental influences included barriers to adherence, community resources, social support, and economic factors. The primary emphases of this study were the performance of 4 primary self-care behaviors and specific barriers to these behaviors: (1) medication use, (2) meal plans, (3) exercise, and (4) home glucose testing. In addition, our model attempts to include many ...

A systematic review of elder abuse research has not been conducted across disciplines. The purpose of this research was to provide a systematic review of and assign an evidence grade to the research articles on elder abuse. Sixteen healthcare and criminal justice literature databases were searched. The literature review was of English-language publications reporting research on abuse of people aged 55 years and older, from any country. Titles, abstracts, and publications were retrieved from 16 databases and were reviewed by at least 2 independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria. Omitting duplicates from the 1,700 publications, 590 publications were annotated and graded. No elder abuse research publication was given an A grade. Fourteen publications were given a B grade (controlled trials), 483 were given a C grade (observational studies), and 93 were given a D grade (opinion or multiple case reports). Of the 590 publications, 492 were quantitative studies, 78 were qualitative studies, and 20 were case studies. Little evidence is available that supports any intervention to prevent elder abuse. Financial support for elder abuse research is needed along with more rigorous research trials.

Introduction: Only about half of all eligible Americans have been screened for colorectal cancer (CRC). The objective of this study was to test whether mailed educational materials and a fecal immunochemical test (FIT), with or without a scripted telephone reminder, led to FIT testing. In addition, we compared changes in attitudes toward, readiness for, and barriers to screening from baseline to follow-up after education about screening.Methods: Subjects due for CRC screening were recruited from 16 Iowa Research Network family physician offices. Half of the subjects were randomized to receive mailed written and DVD educational materials, along with a FIT, either with or without a telephone call designed to encourage screening and address barriers. Subjects completed surveys regarding their attitudes and readiness for CRC screening at baseline and after education about screening. The main outcome was whether the subject completed FIT testing.Results: A total of 373 individuals received educational materials (including a FIT) and 231 (62%) returned a posteducation survey. The mean age was 61.2 years; 52% were women, 99% were white, 39% had a high school education or less, 39% had a total family income of less than $40,000, and 7% had no insurance. The written materials were read by 82%, understood by 91% (of those who read them), and 82% felt their knowledge was increased. The DVD was viewed by 67%, understood by 94% of those who viewed it, and 86% felt the DVD increased their knowledge. Compared with baseline, individuals reported being significantly more likely to bring up CRC screening at their next doctor's visit (P < .0001) and being more likely to be tested for CRC in the next 6 months (P < .0001). Comparing baseline with follow-up, summary attitude scores improved (P < .0001), readiness scores improved (P < .0001), and there were fewer barriers (P ‫؍‬ .034, Wilcoxon signed rank). The FIT return rate increased from 0% to 45.2% in the education alone group and from 0% to 48.7% for the group receiving education plus the telephone call (P < .0001 for each group individually and overall when compared with Medicare beneficiaries in Iowa).Conclusions: Mailing FIT kits with easy-to-understand educational materials improved attitudes toward screening and dramatically increased CRC screening rates among patients who were due for screening in a practice-based research network. A telephone call addressing barriers to screening did not result in increased FIT testing compared with mailed education alone. (J Am Board Fam Med 2012;25:73-82.)

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BackgroundIn average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests.MethodsThe study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model.ResultsIn the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients’ preferences were significantly different before and after provision of detailed information on test features (p < 0.0001).ConclusionsAHP analysis showed that patients slightly preferred FIT over colonoscopy. The information provided to patients strongly affected patient preference. Patients’ test preferences should be considered when ordering a colorectal cancer screening test.