Transitions of care: Medication-related barriers identified by low socioeconomic patients of a federally qualified health center following hospital discharge

Cope, Rebecca; Jonkman, Lauren J.; Quach, Karen; Ahlborg, J; Connor, Sharon E.

doi:10.1016/j.sapharm.2016.12.007

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…Other studies, however, suggest that the observed disparities are less related to access but that a lack of familiarity with data retrieval (eg, electronic health literacy) helps explain the lower portal usage among these disparate groups [22]. Among hospitalized patients with low socioeconomic status, inadequate communication between patients and providers during discharge and posthospital transition periods has also been cited as a potential barrier to medication access and adherence [23]. A patient portal has the potential to overcome barriers in patient-provider communication, but little is known about potential disparities in portal usage among kidney and liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study

Wedd¹,

Basu²,

Curtis³

et al. 2019

J Med Internet Res

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Background Kidney and liver transplant recipients must manage a complex care regimen after kidney transplant. Although the use of Web-based patient portals is known to improve patient-provider communication and health outcomes in chronic disease populations by helping patients manage posttransplant care, disparities in access to and use of portals have been reported. Little is known about portal usage and disparities among kidney and liver transplant recipients. Objective The aim of this study was to examine patient racial/ethnic, socioeconomic, and clinical characteristics associated with portal usage among kidney and liver transplant recipients. Methods The study included all adult kidney and liver transplant recipients (n=710) at a large academic transplant center in the Southeastern United States between March 2014 and November 2016. Electronic medical record data were linked with Cerner portal usage data. Patient portal use was defined as any portal activity (vs no activity) recorded in the Cerner Web-based portal, including viewing of health records, lab results, medication lists, and the use of secure messaging. Multivariable log-binomial regression was used to determine the patient demographic, clinical, and socioeconomic characteristics associated with portal usage, stratified by organ. Results Among 710 transplant recipients (n=455 kidney, n=255 liver), 55.4% (252/455) of kidney recipients and 48.2% (123/255) of liver recipients used the patient portal. Black patients were less likely to use the portal versus white patients among both kidney (57% black vs 74% white) and liver (28% black vs 55% white) transplant recipients. In adjusted multivariable analyses, kidney transplant recipients were more likely to use the portal if they had higher education; among liver recipients, patients who were white versus black and had higher education were more likely to use the portal. Conclusions Despite studies showing that patient portals have the potential to benefit transplant recipients as a tool for health management, racial and socioeconomic disparities should be considered before widespread implementation. Transplant centers should include portal training and support to all patients to encourage use, given its potential to improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study

Wedd¹,

Basu²,

Curtis³

et al. 2019

J Med Internet Res

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“…There was also a notable discrepancy between the number of self-reported BP meds and the number prescribed per EMR, suggesting participants may not have adhered to prescribed therapies. Findings in low-SES populations indicate that inadequate communication and literacy may be barriers to medication adherence [ 45 ]. Additionally, although dual therapy with calcium channel blockers and diuretics is recommended for African Americans [ 46 ], it was not predominantly prescribed in our sample.…”

Section: Discussionmentioning

confidence: 99%

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Avegno

Roberson

Onsomu

et al. 2023

IJERPH

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Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

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“…Collaborations between federally qualified health centers and clinicians from academic health centers have included health education and coaching programs, 66,67 but there are opportunities to expand these partnerships, including transition-of-care clinics to address insufficient information sharing between inpatient and community clinicians, building the workforce pipeline through shared training programs, and investing in federally qualified health center-based research infrastructure. [68][69][70] Partnerships between community and academic medical centers can be enhanced with increased diversity in health care clinicians and staff. This is true for collaborations between federally qualified health centers and academic medical centers as well.…”

Section: Overlapping Boundaries Between Clinical and Community Settingsmentioning

confidence: 99%

Section: Community Engagement In Preventive Cardiovascular Carementioning

confidence: 99%

Implementation of Prevention Science to Eliminate Health Care Inequities in Achieving Cardiovascular Health: A Scientific Statement From the American Heart Association

Agarwala,

Patel,

Stephens

et al. 2023

Circulation

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Prevention of cardiovascular and related diseases is foundational to attaining ideal cardiovascular health to improve the overall health and well-being of individuals and communities. Social determinants of health and health care inequities adversely affect ideal cardiovascular health and prevention of disease. Achieving optimal cardiovascular health in an effective and equitable manner requires a coordinated multidisciplinary and multilayered approach. In this scientific statement, we examine barriers to ideal cardiovascular health and its related conditions in the context of leveraging existing resources to reduce health care inequities and to optimize the delivery of preventive cardiovascular care. We systematically discuss (1) interventions across health care environments involving direct patient care, (2) leveraging health care technology, (3) optimizing multispecialty/multiprofession collaborations and interventions, (4) engaging local communities, and (5) improving the community environment through health-related government policies, all with a focus on making ideal cardiovascular health equitable for all individuals.

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Transitions of care: Medication-related barriers identified by low socioeconomic patients of a federally qualified health center following hospital discharge

Cited by 6 publications

References 32 publications

Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study

Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Implementation of Prevention Science to Eliminate Health Care Inequities in Achieving Cardiovascular Health: A Scientific Statement From the American Heart Association

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