Effect of Patient Navigation on Enrollment in Cardiac Rehabilitation

Scott, Lisa Benz; Gravely, Shannon; Sexton, Thomas R.; Brzostek, Sabrina; Brown, David L.

doi:10.1001/2013.jamainternmed.1042

Cited by 15 publications

(6 citation statements)

References 7 publications

(6 reference statements)

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“…Whereas technical advances in recent years have resulted in the crystal structure determination of dozens of different GPCRs, , solution-state NMR studies have been mostly on the β 2 -AR, − with several other studies on thermostabilized Turkey β 1 -AR, , A 2A -adenosine, − μ-opioid receptor, , κ-opioid receptor, and chemokine receptor CXCR4. , These studies include protein-observed NMR, where spectra of isotopically labeled GPCR samples are acquired in the presence of various ligands, and ligand-observed NMR, where changes in the NMR spectra of ligands are monitored in the presence of an unobservable receptor.…”

mentioning

confidence: 99%

Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

et al. 2018

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α- and α-adrenoceptors (α-AR and α-AR) are closely related G protein-coupled receptors (GPCRs) that modulate the cardiovascular and nervous systems in response to binding epinephrine and norepinephrine. The GPCR gene superfamily is made up of numerous subfamilies that, like α-AR and α-AR, are activated by the same endogenous agonists but may modulate different physiological processes. A major challenge in GPCR research and drug discovery is determining how compounds interact with receptors at the molecular level, especially to assist in the optimization of drug leads. Nuclear magnetic resonance spectroscopy (NMR) can provide great insight into ligand-binding epitopes, modes, and kinetics. Ideally, ligand-based NMR methods require purified, well-behaved protein samples. The instability of GPCRs upon purification in detergents, however, makes the application of NMR to study ligand binding challenging. Here, stabilized α-AR and α-AR variants were engineered using Cellular High-throughput Encapsulation, Solubilization, and Screening (CHESS), allowing the analysis of ligand binding with Saturation Transfer Difference NMR (STD NMR). STD NMR was used to map the binding epitopes of epinephrine and A-61603 to both receptors, revealing the molecular determinants for the selectivity of A-61603 for α-AR over α-AR. The use of stabilized GPCRs for ligand-observed NMR experiments will lead to a deeper understanding of binding processes and assist structure-based drug design.

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confidence: 99%

Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

et al. 2018

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“…The peer navigation intervention was based on the approach previously tested in the USA by Benz Scott et al , 15 16 with modifications to accommodate the local healthcare context. As the University Health Network hospitals had an eReferral system in place as part of usual care, the primary focus of the current intervention was to increase CR enrolment.…”

Section: Methodsmentioning

confidence: 99%

“… 14 To minimise costs associated with the referral process, our institution recently established electronic CR referral (eReferral), such that referral to CR appears as an option in the electronic discharge summary for all indicated cardiac patients ( figure 1 ). To assess the potential added effect of patient education regarding CR at the bedside, in accordance with a recent successful trial of peer navigation, 15 16 our institution recently expanded and augmented a peer-visiting programme for patients of coronary artery bypass graft surgery to all wards treating patients indicated for CR.…”

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confidence: 99%

“… 18 It has been implemented and tested in a variety of healthcare populations, 19–21 including cardiac. 15 16 Prior reviews of peer navigation interventions provide evidence that it may reduce health system barriers, 22–26 such as those experienced by patients eligible for CR. Indeed, it has been recommended as an approach to overcoming barriers to CR use.…”

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confidence: 99%

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Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

et al. 2016

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ObjectivesTo describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment.Setting3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre.ParticipantsCR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants.InterventionThe PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers.Outcome measuresThe primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction.ResultsThose who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24).ConclusionsThere is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest to their home.Trial registration numberNCT02204449; Results.

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“…Health system navigation, particularly in the post-discharge time period, is a formidable barrier for many patients attempting to participate in CR, particularly those with low SES [ 74 ]. Patient navigators and inpatient liaisons improve the uptake of CR after discharge [ 75 ]. Among African Americans, health system navigation with the assistance of trained community health workers (CHWs) can potentially improve engagement with the health system [ 76 ].…”

Section: Reduce Barriers To Accessmentioning

confidence: 99%

Disparities in the Use of Cardiac Rehabilitation in African Americans

Mathews

Akhiwu

Mukherjee

et al. 2022

Curr Cardiovasc Risk Rep

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Purpose of review Cardiac rehabilitation (CR) is a comprehensive outpatient program that reduces the risk of mortality and recurrent events and improves functional status and quality of life for patients recovering from acute cardiovascular disease (CVD) events. Among individuals with established CVD, African Americans have a higher risk of major cardiac events, which underscores the importance of CR use among African Americans. However, despite their high likelihood of adverse outcomes, CR is poorly utilized in African Americans with CVD. We review data on CR utilization among African Americans, barriers to participation, and the implications for policy and practice. Recent findings Although established as a highly effective secondary prevention strategy, CR is underutilized in general, but especially by African Americans. Notwithstanding efforts to increase CR participation among all groups, participation rates remain low for African Americans and other minorities compared to Non-Hispanic Whites. The low CR participation rates by African Americans can be attributed to an array of factors including differential referral patterns, access to care, and socioeconomic factors. There are several promising strategies to improve CR participation which include promoting evidence-based guidelines, reducing barriers to access, novel CR delivery modalities, including more African Americans in CR clinical research, and increasing diversity in the CR workforce. Summary African Americans with CVD events are less likely to be referred to, enroll in, and complete CR than Non-Hispanic Whites. There are many factors that impact CR participation by African Americans. Initiatives at the health policy, health system, individual, and community level will be needed to reduce these disparities in CR use.

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Effect of Patient Navigation on Enrollment in Cardiac Rehabilitation

Cited by 15 publications

References 7 publications

Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

Disparities in the Use of Cardiac Rehabilitation in African Americans

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Effect of Patient Navigation on Enrollment in Cardiac Rehabilitation

Cited by 15 publications

References 7 publications

Determinants of Ligand Subtype-Selectivity at α1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

Determinants of Ligand Subtype-Selectivity at α1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

Disparities in the Use of Cardiac Rehabilitation in African Americans

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Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR

Determinants of Ligand Subtype-Selectivity at α_1A-Adrenoceptor Revealed Using Saturation Transfer Difference (STD) NMR