Antihypertensive medication prescription dispensation among pregnant women in the United States: A cohort study.

Importance: Hypertension is increasingly common in pregnancy capable individuals, yet there is limited data on antihypertensive medication dispensation in peripartum individuals.

Objective: To describe antihypertensive medication dispensation from preconception through the first year postpartum.

Design, Setting, And Participants: This retrospective cohort study used the Truven Health Market Scan administrative data from 2008 to 2014 to identify women in the United States with commercial or government health insurance, aged 15-54, free from heart disease, who experienced a pregnancy and filled at least 1 prescription for an antihypertensive medication between 3 months prior to conception and 12 months after the end of the pregnancy.

A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention.

Introduction: Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.

A Pharmacologic Update: New Treatments for Patients with Cardiovascular Disease.

Pharmacologic agents are a key part of the medical armamentarium aimed at reducing the significant morbidity and mortality caused by cardiovascular disease (CVD). In recent years, the landscape of CVD treatment has evolved with the development of new medication classes and the repurposing of existing medications for new indications. This article provides nurses with a pharmacologic update on new and emerging therapies for the treatment of hypertrophic cardiomyopathy, familial hypercholesterolemia, and heart failure.

Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations.

Oral contraceptive pills (OCPs) have been used as effective and popular forms of contraception since the middle of the last century. By 2019, over 150 million reproductive-aged individuals were using OCPs to prevent unintended pregnancies worldwide. Safety concerns regarding the effects of OCPs on blood pressure were reported soon after these pills gained approval.

Behavioural Economics to Improve Antihypertensive Therapy Adherence (BETA): protocol for a pilot randomised controlled trial in Los Angeles.

Introduction: Non-adherence to antihypertensive therapy is one of the major barriers to reducing the risk of cardiovascular disease. Several interventions have targeted higher medication adherence, yet most do not result in sustained adherence. Routinisation has emerged as a potential method for mitigating this problem, but requires high motivation during the relatively long habit formation phase.

Variability independent of mean blood pressure as a real-world measure of cardiovascular risk.

Background: Individual-level blood pressure (BP) variability, independent of mean BP levels, has been associated with increased risk for cardiovascular events in cohort studies and clinical trials using standardized BP measurements. The extent to which BP variability relates to cardiovascular risk in the real-world clinical practice setting is unclear. We sought to determine if BP variability in clinical practice is associated with adverse cardiovascular outcomes using clinically generated data from the electronic health record (EHR).

Improving Efficiency of the Barbershop Model of Hypertension Care for Black Men With Virtual Visits.

Background The LABBPS (Los Angeles Barbershop Blood Pressure Study) developed a new model of hypertension care for non-Hispanic Black men that links health promotion by barbers to medication management by pharmacists. Barriers to scaling the model include inefficiencies that contribute to the cost of the intervention, most notably, pharmacist travel time. To address this, we tested whether virtual visits could be substituted for in-person visits after blood pressure (BP) control was achieved.

Cost-Effectiveness of Hypertension Treatment by Pharmacists in Black Barbershops.

Background: In LABBPS (Los Angeles Barbershop Blood Pressure Study), pharmacist-led hypertension care in Los Angeles County Black-owned barbershops significantly improved blood pressure control in non-Hispanic Black men with uncontrolled hypertension at baseline. In this analysis, 10-year health outcomes and health care costs of 1 year of the LABBPS intervention versus control are projected.

Methods: A discrete event simulation of hypertension care processes projected blood pressure, medication-related adverse events, fatal and nonfatal cardiovascular disease events, and noncardiovascular disease death in LABBPS participants.

Supporting business owners with psychiatric disabilities: An exploratory analysis of challenges and supports.

Objective: Self-employed individuals with psychiatric disabilities may face unique challenges to running small businesses. This study aims to identify business-related challenges and examine whether supports designed to alleviate those challenges are associated with positive business milestones and self-employment satisfaction.

Methods: Data were collected via a survey of 60 participants with a history of psychiatric disability who were operating a U.

Barbershop Management of Hypertension in the African American Population: Pitfalls and Opportunities for Extension to Other Underserved Communities.

Purpose Of Review: This review summarizes the results of recent barbershop-based studies focusing on the diagnosis and management of hypertension (HTN) in black adults. The pitfalls of prior attempts and opportunities for the development of future programs to address health disparities on a larger scale are also reviewed.

Recent Findings: While barbershop health outreach has become a commonplace in recent years, the quality of the evidence on the effectiveness of such programs has been weak, until the Los Angeles Barbershop Blood Pressure Study (LABBPS), a rigorously carried out cluster-randomized trial, demonstrated a - 21 mmHg greater reduction in BP among black hypertensive men who were assigned to a pharmacist-led HTN intervention when compared with usual care.

It's Time for a Haircut: a Perspective on Barbershop Health Interventions Serving Black Men.

Black men in the USA experience disproportionate cardiovascular disease mortality compared to their white counterparts, in part due to an excess of uncontrolled hypertension. A promising intervention to address these disparities involves the direct pharmacologic management of hypertension by clinical pharmacists in Black male patrons of barbershops, as demonstrated in the Los Angeles Barbershop Blood Pressure Study (LABBPS). Despite the observed reduction in systolic blood pressure of > 20 mmHg after 1 year, the feasibility of scaling up such an intervention to a regional or national platform remains uncertain.

Long-Term Follow-Up of a Randomized Trial of Supported Employment for SSDI Beneficiaries With Mental Illness.

Objective: In this study, the authors assessed the long-term impact of the Mental Health Treatment Study (MHTS), a randomized controlled trial testing the effects of providing 2 years of employment services based on the evidence-based individualized placement and support model to Social Security Disability Insurance (SSDI) recipients with serious mental illness. Treatment recipients also received systematic medication management, supplemental health care supports, and short-term relief from medical continuing disability review by the Social Security Administration (SSA).

Methods: MHTS site data for 2,160 participants were linked to SSA administrative data from 2011 to 2015, 1 to 5 years after the original study concluded.

Sustainability of blood pressure reduction in black barbershops.

Purpose Of Review: The prevalence of hypertension (HTN) among non-Hispanic blacks increased from 41 to 55% with the release of the new 2017 ACC/AHA guidelines - the highest among any racial group. Non-Hispanic black men have less physician interaction and lower blood pressure (BP) treatment and control rates when compared with their female counterparts, necessitating community outreach. Here, we review the Los Angeles Barbershop Blood Pressure Study (LABBPS) which demonstrated a community-based approach involving pharmacists, physicians, and barbers could improve BP control rates among black men.

Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years.

Background Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure ( BP ) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia.

Sustainability of Blood Pressure Reduction in Black Barbershops.

Background: We developed a new model of hypertension care for non-Hispanic black men that links health promotion by barbers to medication management by American Society of Hypertension-certified pharmacists and demonstrated efficacy in a 6-month cluster-randomized trial. The marked reduction in systolic blood pressure (BP) seen at 6 months warranted continuing the trial through 12 months to test sustainability, a necessary precondition for implementation research.

Methods: We enrolled a cohort of 319 black male patrons with systolic BP ≥140 mm Hg at baseline.

The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization.

Objective: This study assessed whether peer-staffed crisis respite centers implemented in New York City in 2013 as an alternative to hospitalization reduced emergency department (ED) visits, hospitalizations, and Medicaid expenditures for individuals enrolled in Medicaid.

Methods: This study used Medicaid claims and enrollment data for January 2009 through April 2016 to estimate impacts on ED visits, hospitalizations, and total Medicaid expenditures by using a difference-in-differences model with a matched comparison group. The study sample included 401 respite center clients and 1,796 members of the comparison group.

Care Coordinators in Integrated Care: Burnout Risk, Perceived Supports, and Job Satisfaction.

Introduction: This study examined burnout risk and job satisfaction reported by care coordinators in three programs integrating physical and behavioral health care; it also assessed the relationship between job support and burnout and the organizational supports helpful to care coordinators.

Methods: As part of an evaluation of the Centers for Medicare & Medicaid Services' Health Care Innovation Awards, the research team performed secondary data analysis of interviews conducted with staff (including care coordinators) in three integrated behavioral health models in 2014 and 2015 (n=88, n=69); focus groups with care coordinators in 2015 (n=3); and a survey of care coordinators in 2015 (n=231) that included the Maslach Burnout Inventory.

Results: Analysis of survey data completed in 2017 indicated that although care coordinators felt stressed, they also experienced high levels of job satisfaction, perceived job support, and personal accomplishment, and low levels of disconnection from participants; as a result, risk of burnout was low.

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops.

Background: Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings.

Methods: We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months.

The application and importance of disability policy research to the mental health field.

This editorial provides an introduction to this unique special issue of the Rather than focusing on a particular type of rehabilitative services, it more broadly addresses the subject, methods, and results of disability policy research. This special issue is meant to start a conversation about the role of psychiatric rehabilitation researchers, professionals, and consumers in shaping future policies affecting and affected by mental illness. In particular, this issue focuses on the application of rigorous research methodologies to answer policy-relevant questions to help ensure that decisions affecting our field are evidence-based and address the issues that matter most in the lives of consumers.

Preventing unemployment and disability benefit receipt among people with mental illness: Evidence review and policy significance.

Objective: We identify effective services to assist 3 groups of people with mental illnesses become or remain employed and prevent dependence on disability cash benefits: (a) individuals, including youth, who are experiencing an initial episode of psychosis; (b) employed individuals at risk of losing jobs due to mental illness; and (c) individuals who are or may become long-term clients of mental health services and are likely to apply for disability benefits.

Method: We searched for articles published between 1992 and 2015 using key word terminology related to employment support services and each subgroup, and prioritized articles by study design.

Results: The individual placement and support model of supported employment is more effective than traditional vocational programs in helping people with serious mental illnesses who are engaged in treatment or receiving disability benefits obtain competitive employment.

Supported employment outcomes for transition age youth and young adults.

Topic: Supported Employment (SE) can help transition age youth and young adults to obtain employment and develop meaningful careers and financial security.

Purpose: The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importance of employment to the quality of life of young people in establishing work histories and starting careers, it is important to have a better understanding of what client and program characteristics result in better employment outcomes.

Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

Objective: Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model.

Methods: As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living.