Erica Phillips

A Practice-Based Trial of Motivational Interviewing and Adherence in Hypertensive African Americans

BACKGROUND Poor medication adherence is a significant problem in hypertensive African Americans. Although motivational interviewing (MINT) is effective for adoption and maintenance of health behaviors in patients with chronic diseases, its effect on medication adherence remains untested in this population. METHODS This randomized controlled trial tested the effect of a practice-based MINT counseling vs. usual care (UC) on medication adherence and blood pressure (BP) in 190 hypertensive African Americans (88% women; mean age 54 years). Patients were recruited from two community-based primary care practices in New York City. The primary outcome was adherence measured by electronic pill monitors; the secondary outcome was within-patient change in office BP from baseline to 12 months. RESULTS Baseline adherence was similar in both groups (56.2 and 56.6% for MINT and UC, respectively, P = 0.94). Based on intent-to-treat analysis using mixed-effects regression, a significant time x group interaction with model-predicted posttreatment adherence rates of 43 and 57% were found in the UC and MINT groups, respectively (P = 0.027), with a between-group difference of 14% (95% confidence interval, -0.2 to -27%). The between-group difference in systolic and diastolic BP was -6.1 mm Hg (P = 0.065) and -1.4 mm Hg (P = 0.465), respectively, in favor of the MINT group. CONCLUSIONS A practice-based MINT counseling led to steady maintenance of medication adherence over time, compared to significant decline in adherence for UC patients. This effect was associated with a modest, nonsignificant trend toward a net reduction in systolic BP in favor of the MINT group.

The Role of Community–Academic Partnerships: Implications for Medical Education, Research, and Patient Care

Problem: Despite several studies demonstrating the benefits of community–academic partnerships, their value to academic health centers (AHCs) is often viewed with skepticism by some in the academic community.Purpose: This paper examines the roles of community organizations and the mechanisms by which they can enhance the AHC missions of education, research, and patient care.Key Points: As lay educators, community organizations can contribute to medical education by exposing students to diverse cultural perspectives. As community advocates, they can facilitate the research process by helping to frame culturally relevant research questions, by ensuring that research survey instruments are culturally and linguistically appropriate, and that research findings are disseminated to community stakeholders. As lay health workers, they can facilitate health care delivery by providing a link to hard-to-reach populations through their outreach and referral initiatives.Conclusion: Forming partnerships between community organizations and AHCs can support the missions of AHCs and simultaneously develop and strengthen community capacity.

Social network characteristics associated with weight loss among black and hispanic adults.

To examine social network member characteristics associated with weight loss.

Where do we go from here? Moving from systems-based practice process measures to true competency via developmental milestones

For many educators it has been challenging to meet the Accreditation Council for Graduate Medical Educations requirements for teaching systems-based practice (SBP). An additional layer of complexity for educators is evaluating competency in SBP, despite milestones and entrustable professional activities (EPAs). In order to address this challenge, the authors present the results of a literature review for how SBP is currently being taught and a series of recommendations on how to achieve competency in SBP for graduate medical trainees with the use of milestones. The literature review included 29 articles and demonstrated that only 28% of the articles taught more than one of the six core principles of SBP in a meaningful way. Only 7% of the articles received the highest grade of A. The authors summarize four guiding principles for creating a competency-based curriculum that is in alignment with the Next Accreditation System (NAS): 1) the curriculum needs to include all of the core principles in that competency, 2) the objectives of the curriculum should be driven by clinical outcomes, 3) the teaching modalities need to be interactive and clinically relevant, and 4) the evaluation process should be able to measure competency and be directly reflective of pertinent milestones and/or EPAs. This literature review and the provided guiding principles can guide other residency educators in their development of competency-based curricula that meets the standards of the NAS.For many educators it has been challenging to meet the Accreditation Council for Graduate Medical Educations requirements for teaching systems-based practice (SBP). An additional layer of complexity for educators is evaluating competency in SBP, despite milestones and entrustable professional activities (EPAs). In order to address this challenge, the authors present the results of a literature review for how SBP is currently being taught and a series of recommendations on how to achieve competency in SBP for graduate medical trainees with the use of milestones. The literature review included 29 articles and demonstrated that only 28% of the articles taught more than one of the six core principles of SBP in a meaningful way. Only 7% of the articles received the highest grade of A. The authors summarize four guiding principles for creating a competency-based curriculum that is in alignment with the Next Accreditation System (NAS): 1) the curriculum needs to include all of the core principles in that competency, 2) the objectives of the curriculum should be driven by clinical outcomes, 3) the teaching modalities need to be interactive and clinically relevant, and 4) the evaluation process should be able to measure competency and be directly reflective of pertinent milestones and/or EPAs. This literature review and the provided guiding principles can guide other residency educators in their development of competency-based curricula that meets the standards of the NAS.

Innovative approaches to weight loss in a high-risk population: The small changes and lasting effects (SCALE) trial

To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self‐affirmation (PA/SA) component on weight loss at 12 months.

Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs

BackgroundWhile there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern.ObjectivesThe 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country.DesignNationwide survey.ParticipantsAll internal medicine program directors registered with APDIM.Main MeasuresDescriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs.Key ResultsOf the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year–End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff.ConclusionsMost internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

Understanding of Cardiovascular Disease Risk Factors Among Bangladeshi Immigrants in New York City.

ABSTRACT Objectives: Among all South Asians, Bangladeshis have the highest prevalence of cardiovascular disease (CVD). The purpose of our study was to compare the understanding of CVD risk factors among Bangladeshi immigrants to the general Caucasian population in the U.S. Design: We surveyed Bangladeshi immigrants in Queens, New York using a CVD risk factor knowledge instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess awareness of risk factors. Using multivariate regression modeling, we compared scores on the knowledge instrument between Bangladeshis we surveyed and Caucasians from the CARDIA study, controlling for potential confounders. We subsequently examined the frequency of mentioning each risk factor to understand what was driving the difference in the overall score. Results: The proportion of Bangladeshis scoring low on the knowledge assessment was 0.53, where as the proportion of whites scoring low in the CARDIA study was 0.32 (p value < .001). Whites were 34% more likely to score high than Bangladeshis (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.19–1.52). Bangladeshis were more likely to mention diet and cholesterol as risk factors and less likely to mention lack of exercise, being overweight, and smoking as risk factors. Conclusion: Understanding of cardiovascular disease risk factors was lower among Bangladeshis than whites. This was driven by Bangladeshis having less awareness regarding how exercise and being overweight contribute to CVD. Community based interventions and community health partnerships should target these behavioral risk factors in the Bangladeshi population.

Social network characteristics associated with weight loss among black and hispanic adults: Social Network Characteristics and Weight Loss

To examine social network member characteristics associated with weight loss.

Social Network Characteristics Associated with Weight Loss among Black and Hispanic Adults with Overweight and Obesity

To examine social network member characteristics associated with weight loss.