Family and friend participation in primary care visits of patients with diabetes or heart failure: patient and physician determinants and experiences.

Background: Professional and patient groups have called for increased participation of patients' informal support networks in chronic disease care, as a means to improve clinical care and self-management. Little is known about the current level of participation of family and friends in the physician visits of adults with chronic illnesses or how that participation affects the experience of patients and physicians.

Methods: Written survey of 439 functionally independent adults with diabetes or heart failure and 88 of their primary care physicians (PCPs).

The role of imams in American Muslim health: perspectives of Muslim community leaders in Southeast Michigan.

American Muslims are a diverse and growing population, numbering nearly 200,000 in Southeast Michigan. Little empirical work exists on the influence of Islam upon the healthcare behaviors of American Muslims, and there is to date limited research on the roles that imams, Muslim religious leaders, play in the health of this community. Utilizing a community-based participatory research (CBPR) model through collaboration with four key community organizations, we conducted semi-structured interviews with 12 community leaders and explored their perceptions about the roles imams play in community health.

Diabetes control with reciprocal peer support versus nurse care management: a randomized trial.

Background: Resource barriers complicate diabetes care management. Support from peers may help patients manage their diabetes.

Objective: To compare a reciprocal peer-support (RPS) program with nurse care management (NCM).

Study protocol: the Adherence and Intensification of Medications (AIM) study--a cluster randomized controlled effectiveness study.

Background: Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen.

Multicenter cluster-randomized trial of a multifactorial intervention to improve antihypertensive medication adherence and blood pressure control among patients at high cardiovascular risk (the COM99 study).

Background: Medication nonadherence is common and results in preventable disease complications. This study assessed the effectiveness of a multifactorial intervention to improve both medication adherence and blood pressure control and to reduce cardiovascular events.

Methods And Results: In this multicenter, cluster-randomized trial, physicians from hospital-based hypertension clinics and primary care centers across Spain were randomized to receive and provide the intervention to their high-risk patients.

Telephone-based mutual peer support for depression: a pilot study.

Objectives: To evaluate the acceptability, feasibility and depression-related outcomes of a telephone-based mutual peer support intervention for individuals with continued depressive symptoms in specialty mental health treatment.

Methods: Participants were depressed patients with continued symptoms or functional impairment treated at one of the three outpatient mental health clinics. Participants were partnered with another patient, provided with basic communication skills training, and asked to call their partner at least once a week using a telephone platform that recorded call initiation, frequency and duration.

Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?

Objectives: Among functionally independent patients with diabetes or heart failure, we examined family member support and family-related barriers to self-care. We then identified patient characteristics associated with family support and family barriers and how each was associated with self-management adherence.

Methods: Cross-sectional survey of 439 patients with diabetes or heart failure (74% response rate).

Physician views on barriers to primary care for young adults with childhood-onset chronic disease.

Objective: Growing numbers of children with severe chronic illnesses are surviving to adulthood. Little is known about what primary care physicians perceive as the resources for and barriers to providing primary care services for young adults who transfer care from pediatric to adult medicine practitioners. The objective of this study was to describe primary care physicians' resources for and barriers to caring for young adults with childhood-onset chronic diseases.

Physicians' perceptions of barriers to cardiovascular disease risk factor control among patients with diabetes: results from the translating research into action for diabetes (TRIAD) study.

Introduction: Many patients with diabetes have poorly controlled blood glucose, lipid, or blood pressure levels, increasing their risk for cardiovascular disease (CVD) and other complications. Relatively little is known about what physicians perceive to be barriers to good CVD risk factor control or their own role in helping patients achieve good control.

Methods: We interviewed 34 primary care physicians in 4 states to assess their perceptions of patients' barriers to CVD risk factor control.

Beliefs about prescription medications among patients with diabetes: variation across racial groups and influences on cost-related medication underuse.

Objectives: This study sought to understand differences across racial groups in diabetes patients' medication-related beliefs and adherence problems due to cost concerns.

Research Design And Methods: We surveyed 806 African American and White diabetes patients about their beliefs regarding medications, cost-related adherence problems, socioeconomic status and communication about treatments with their clinicians.

Results: Many patients endorsed statements such as "Most prescription medications are addictive" (35%) and "Insurance plans push generics to save themselves money at the expense of my health" (65%).

Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients.

Background: Many patients with diabetes have multiple other chronic conditions, but little is known about whether these patients and their primary care providers agree on the relative importance that they assign these comorbidities.

Objective: To understand patterns of patient-provider concordance in the prioritization of health conditions in patients with multimorbidity.

Design: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with elevated clinic triage blood pressure (> or = 140/90) at nine Midwest VA facilities.

Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach.

Objective: Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

Methods: We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity.

Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis.

Context: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths.

Objective: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost.

The association of perceived abuse and discrimination after September 11, 2001, with psychological distress, level of happiness, and health status among Arab Americans.

Objectives: We assessed the prevalence of perceived abuse and discrimination among Arab American adults after September 11, 2001, and associations between abuse or discrimination and psychological distress, level of happiness, and health status.

Methods: We gathered data from a face-to-face survey administered in 2003 to a representative, population-based sample of Arab American adults residing in the greater Detroit area.

Results: Overall, 25% of the respondents reported post-September 11 personal or familial abuse, and 15% reported that they personally had a bad experience related to their ethnicity, with higher rates among Muslims than Christians.

Participants' assessments of the effects of a community health worker intervention on their diabetes self-management and interactions with healthcare providers.

Background: The specific ways in which community health worker (CHW) programs affect participants' healthcare behaviors and interactions with their healthcare providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. A qualitative descriptive study of participants in a successful CHW diabetes self-management program was designed to examine: (1) what gaps in diabetes care, with a focus on patient-doctor interactions, participants identify; (2) how the program influences participants' diabetes care and interactions with healthcare providers, and what gaps, if any, it addresses.

Methods: From November 2005 to December 2006, semi-structured interviews with 40 African- American and Latino adults were conducted and analyzed.

Children's roles in parents' diabetes self-management.

Background: Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents' diabetes self-management, diet, and exercise.

Cost-related nonadherence to medications among patients with diabetes and chronic pain: factors beyond finances.

Objective: In the face of financial constraints, diabetic patients may forgo prescribed medications, causing negative health effects. This study examined how cost and noncost factors are associated with patterns of cost-related nonadherence to medications (CRN).

Research Design And Methods: This was a cross-sectional survey of patients using medications for both diabetes and chronic pain (n = 245).

Association between cognitive function and social support with glycemic control in adults with diabetes mellitus.

Objectives: To examine whether cognitive impairment in adults with diabetes mellitus is associated with worse glycemic control and to assess whether level of social support for diabetes mellitus care modifies this relationship.

Design: Cross-sectional analysis.

Setting: The 2003 Health and Retirement Study (HRS) Mail Survey on Diabetes and the 2004 wave of the HRS.

Experience and management of chronic pain among patients with other complex chronic conditions.

Objective: Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF).

Methods: We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users.

Reducing the health risks of diabetes: how self-determination theory may help improve medication adherence and quality of life.

Purpose: The purpose of this study is to apply the self-determination theory (SDT) model of health behavior to predict medication adherence, quality of life, and physiological outcomes among patients with diabetes.

Methods: Patients with diabetes (N = 2973) receiving care from an integrated health care delivery system in 2003 and 2004 were identified from automated databases and invited to participate in this study. In 2005, patients responded to a mixed telephone-and-mail survey assessing perceived autonomy support from health care providers, autonomous self-regulation for medication use, perceived competence for diabetes self-management, medication adherence, and quality of life.

Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research.

Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management.

The role of peer support in diabetes care and self-management.

In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems.

Strangers in a strange land: health care experiences for recent Latino immigrants in Midwest communities.

Unlabelled: Latino immigrants in recent years are moving to U.S. communities that have little experience with immigration from Latin America.

When is social support important? The association of family support and professional support with specific diabetes self-management behaviors.

Background: Social support is associated with better diabetes self-management behavior (SMB), yet interventions to increase family and friend support (FF support) have had inconsistent effects on SMB.

Objective: To test whether FF support differentially affects specific SMBs and compare the influence of support from health professionals and psychological factors on specific SMBs to that of FF support.

Design: Cross-sectional survey of people with diabetes recruited for a self-management intervention

Participants And Setting: One hundred sixty-four African-American and Latino adults with diabetes living in inner-city Detroit

Measurements And Main Results: For every unit increase in FF support for glucose monitoring, the adjusted odds ratio (AOR) of completing testing as recommended was 1.