Measurement in Veterans Affairs Health Services Research: Veterans as a Special Population

Morgan, Robert O.; Teal, Cayla R.; Reddy, Siddharta G.; Ford, Marvella E.; Ashton, Carol M.

doi:10.1111/j.1475-6773.2005.00448.x

Cited by 98 publications

(78 citation statements)

References 3 publications

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“…VA patients are more likely to be male (especially the older patients), of lower SES, and sicker, compared with the US population as a whole (Morgan et al, 2005). They may, however, be similar to other indigent patient populations such as Medicaid recipients.…”

Section: Discussionmentioning

confidence: 85%

Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

Copeland¹,

Zeber²,

Salloum³

et al. 2008

Journal of Nervous &Amp; Mental Disease

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Insight into the perceived value of psychotherapy and pharmacological treatment may improve adherence to medication regimens among patients with bipolar disorder, because patients are more likely to take medication they believe will make them better. We conducted a cross-sectional survey of patients recruited into the Continuous Improvement for Veterans in Care-Mood Disorders (CIVIC-MD; July 2004-July 2006), assessing therapeutic insight and 2 measures of medication adherence: the Morisky scale of intrapersonal barriers and missing any doses the previous 4 days. Among 435 patients with bipolar disorder, 27% had poor adherence based on missed dose and 46% had poor adherence based on the Morisky. In multivariable models, greater insight into medication was negatively associated with both measures of poor adherence. Odds of poor adherence increased for women, African Americans, mania, and hazardous drinking. The association of mutable factors-hazardous drinking, manic symptoms, and insight-could represent an opportunity to improve adherence.

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Section: Discussionmentioning

confidence: 85%

Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

Copeland¹,

Zeber²,

Salloum³

et al. 2008

Journal of Nervous &Amp; Mental Disease

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“…Limitations of the study include restriction to VA patients, a population known to be generally poorer and sicker than US non-institutionalized residents [31], and mostly male. Therefore, results may not be as generalizable to women or higher socio-economic strata.…”

Section: Discussionmentioning

confidence: 99%

Cancer rates, medical comorbidities, and treatment modalities in the oldest patients

Zeber¹,

Copeland²,

Hosek³

et al. 2008

Critical Reviews in Oncology/Hematology

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“…However, the potential for new delivery systems further integrating provider organizations (eg, Accountable Care Organizations) 22 and the effort to move all US health care to EHRs may extend the generalizability of studies like ours. Reflecting the VA population, 23 trial participants were mostly men and had lower socioeconomic status Confidence intervals (CIs) for the differences in expenditures between arms were derived from model estimates using the delta method. HINTS indicates Hypertension Intervention Nurse Telemedicine Study.…”

Section: Discussionmentioning

confidence: 99%

Do the Benefits of Participation in a Hypertension Self-Management Trial Persist After Patients Resume Usual Care?

Maciejewski

Bosworth

Olsen

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Interventions that combine self-management (SM) support and individualized medical management theoretically represent a potentially sustainable intervention for patients with hypertension if they retain and apply skills learned in such interventions after returning to usual care. The longer-term clinical and economic benefits of SM interventions remain largely untested because only 5 prior studies tracked clinical outcomes after completion of SM trials in patients with hypertension. Results from the United Kingdom Prospective Diabetes Study (UKPDS) 1 found that the clinical benefits of tight blood pressure (BP) control were not sustained ≤10 years after trial completion. Editorial see p 205The Steno-2 2 follow-up study of patients with diabetes mellitus and microalbuminuria and 3 follow-up studies of pharmacist interventions for patients with hypertension suggested that SM interventions had long-lasting effects.3-5 These long-term clinical benefits may translate into reductions in healthcare utilization and costs, but no prior trial has reported long-term economic outcomes once patients return to usual care.The purpose of this article is to examine clinical and economic outcomes 18 months after completion of an 18-month Background-Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longerterm economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after completion of a hypertension self-management trial. Methods and Results-This study is a follow-up analysis of an 18-month, 4-arm, hypertension self-management trial of 591 veterans with hypertension who were randomized to usual care or 1 of 3 interventions. Clinic-derived systolic blood pressure obtained before, during, and after the trial were estimated using linear mixed models. Inpatient admissions, outpatient expenditures, and total expenditures were estimated using generalized estimating equations. The 3 telephonebased interventions were nurse-administered health behavior promotion, provider-administered medication adjustments based on hypertension treatment guidelines, or a combination of both. Intervention calls were triggered by home BP values transmitted via telemonitoring devices. Clinical and economic outcomes were examined 12 months before, 18 months during, and 18 months after trial completion. Compared with usual care, patients randomized to the combined arm had greater improvement in proportion of BP control during and after the 18-month trial and estimated proportion of BP control improved 18 months after trial completion for patients in the behavioral and medication management arms. Among the patients with inadequate baseline BP control, estimated mean systolic BP was significantly lower in the combined arm as compared with usual care during and after the 18-month trial. Utilization and expenditure trends were similar for patients in all 4 arms. Conclusions-Behavioral and medication management can generate systolic BP improvements ...

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Measurement in Veterans Affairs Health Services Research: Veterans as a Special Population

Cited by 98 publications

References 3 publications

Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

Treatment Adherence and Illness Insight in Veterans With Bipolar Disorder

Cancer rates, medical comorbidities, and treatment modalities in the oldest patients

Do the Benefits of Participation in a Hypertension Self-Management Trial Persist After Patients Resume Usual Care?

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