Publications by authors named "Woolson S"
Epigenetic measures of aging derived from DNA methylation are promising biomarkers associated with prospective morbidity and mortality, but require validation in real-world medical settings. Using data from 2,216 post-9/11 veterans, we examined whether accelerated DunedinPACE aging scores were associated with chronic disease morbidity, predicted healthcare costs, and mortality assessed over an average of 13.1 years of follow up in VA electronic health records.
View Article and Find Full Text PDFObjectives: Adults with dementia are frequently prescribed antipsychotic medications despite concerns that risks outweigh benefits. Understanding conditions where antipsychotics are initially prescribed, such as hospitalization, may offer insights into reducing inappropriate use.
Design, Setting, Participants: Retrospective cohort study of community-dwelling veterans with dementia aged ≥68 with VA hospitalizations in 2014, using Veterans Health Administration (VA) and Medicare data.
Background: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs.
View Article and Find Full Text PDFArticle Synopsis
- Psychological distress is a common yet often overlooked issue among veterans coping with lung cancer, significantly impacting their mental health and quality of life.
- In a study of 60 veterans with lung cancer, high levels of distress were noted, with 37% showing signs of depression, 35% experiencing anxiety, and 13% having cancer-related PTSD.
- Recommendations for future research include identifying veterans at risk for psychological distress and testing mental health interventions specifically targeting this vulnerable group.
Purpose: In 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement.
Methods: Survey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics.
Veterans living with HIV have up to twice the risk of atherosclerotic cardiovascular disease (ASCVD) compared to those without HIV. Our study seeks to test a non-physician led virtual self-management implementation strategy to reduce ASCVD risk among people living with HIV (PWH). We aim to conduct a randomized control trial among PWH ( = 300) with a diagnosis of hypertension (HTN) who are enrolled in Veterans Health Administration (VHA) clinics, on suppressive antiretroviral therapy (ART), randomized 1:1 to intervention education control for a 12-month duration.
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- The study aimed to understand medication adherence in veterans with glaucoma by analyzing interviews from participants in a trial comparing an intervention group to a usual care control group.
- Results showed that those in the intervention group had significantly better adherence rates (85% vs. 62%) over six months.
- Key findings identified common barriers, like a difficult schedule, and facilitators, such as using a smart bottle, influencing adherence across different levels of responders.
Article Synopsis
- Racial disparities in lung cancer screening (LCS) exist within the Veterans Affairs health care system, despite reduced barriers; a study at the Durham Veterans Affairs Health Care System aimed to investigate this issue in North Carolina.
- The study included veterans referred for LCS from 2013 to 2021, specifically looking at those who identified as White or Black and met eligibility criteria, excluding those who died early or screened before referral.
- Results showed that only 37.1% of veterans completed LCS, with significant disparities: Black veterans had a lower completion rate (30.5%) compared to White veterans (41.3%), and lower odds of completing screening even after accounting for demographic and socioeconomic factors.
Purpose: Rural Veterans are more likely than urban Veterans to qualify for community care (Veterans Health Administration [VHA]-paid care delivered outside of VHA) due to wait times ≥30 days and longer travel times for VHA care. For rural Veterans receiving both VHA and community care, suboptimal care coordination between VHA and community providers can result in poor follow-up and care fragmentation. We developed Telehealth-based Coordination of Non-VHA Care (TECNO Care) to address this problem.
View Article and Find Full Text PDFIntroduction: We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable.
Methods: The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops.
Purpose: To assess the relationship between glaucoma knowledge and disease severity.
Design: Substudy of a randomized controlled trial at a single Veterans Affairs (VA) eye clinic.
Participants: Veterans with medically treated open-angle glaucoma who self-reported poor medication adherence.
Introduction: Peer support is a well-established part of veteran care and a cost-effective way to support individuals pursuing health behavior change. Common models of peer support, peer coaching, and mutual peer support have limitations that could be minimized by building on the strengths of each to increase the overall reach and effectiveness. We conducted a 12-week, proof-of-concept study to test the acceptability and feasibility of a hybrid model of peer support which supplements dyadic mutual peer support with as-needed peer coaching.
View Article and Find Full Text PDFPurpose: To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence.
Design: Prospective cost-effectiveness analysis of randomized, controlled trial data.
Methods: The study setting was a Veterans Affairs (VA) eye clinic.
Article Synopsis
- High COVID-19 vaccination rates among health care employees are essential to prevent outbreaks, prompting a study to explore factors influencing vaccination intentions and decisions.
- The research involved a cross-sectional survey and semi-structured interviews with employees from a VA health care system, gathering data on vaccination intentions, decisions, and barriers before and after vaccine distribution.
- Results showed that 77% of employees initially wanted the vaccine, with five decision-making groups identified post-distribution, indicating varied levels of acceptance and hesitancy, particularly among Black and multi-racial employees.
Objectives: This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis).
Methods: The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response.
Purpose: To assess the relationship between health literacy and successful glaucoma drop administration.
Design: Substudy of a single-site interventional randomized controlled trial.
Participants: Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence.
Improved Glaucoma Medication Adherence in a Randomized Controlled Trial.
Ophthalmol Glaucoma
April 2022
Purpose: To test the effectiveness of an intervention designed to improve glaucoma medication adherence.
Design: Randomized, controlled trial at a Veterans Affairs (VA) eye clinic.
Participants: Veterans with medically treated glaucoma who reported poor adherence and their companions if applicable.
Background: Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention.
View Article and Find Full Text PDFBackground: Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs
Objective: To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA).
Design: Randomized controlled trial. (ClinicalTrials.
Article Synopsis
- The study examined cannabinoid and opioid use among total joint arthroplasty (TJA) patients over a six-year period, finding an increase in cannabinoid use and a decrease in opioid use.
- Pre-operative cannabinoid use rose from 9% to 15%, while opioid use dropped from 24% to 17% from 2012 to 2017, with cannabinoid users more likely to also use opioids.
- No significant association was found between cannabinoid use and postoperative complications such as readmission or infection, suggesting that cannabinoids may not negatively impact surgical outcomes.
Aims: To establish whether there was a consensus among the members of the Hip Society (HS) on the role of direct anterior approach (DAA) contemporary primary total hip arthroplasty (THA).
Methods: An online survey was sent to all 112 active and senior members of the HS, to which 71 members responded. The survey was constructed to determine whether they believed that evidence-based medicine proves, in modern clinical practice, that the DAA has significant benefits compared to risks when contrasted with other approaches.
Significance: Outpatient vision rehabilitation improves function in veterans with vision impairment, but the prevalence of cognitive impairment and the degree to which it may affect rehabilitation outcomes in the Veterans Affairs system are unknown.
Purpose: The purpose of this study was to determine the prevalence of cognitive impairment among veterans receiving outpatient vision rehabilitation in the Veterans Affairs system and compare the benefits of rehabilitation in veterans with and without cognitive impairment.
Methods: We conducted cognitive assessments and a nested longitudinal cohort study in veterans with eye disorders at two outpatient rehabilitation sites.
Objective: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs).
Research Design And Methods: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics.
Implementation of a group physical therapy program for Veterans with knee osteoarthritis.
BMC Musculoskelet Disord
February 2020
Background: A previous randomized clinical trial found that a Group Physical Therapy (PT) program for knee osteoarthritis yielded similar improvements in pain and function compared with traditional individual PT. Based on these findings the Group PT program was implemented in a Department of Veterans Affairs Health Care System. The objective of this study was to evaluate implementation metrics and changes in patient-level measures following implementation of the Group PT program.
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