Jonell Hudson

Community-Driven Research Agenda to Reduce Health Disparities.

This paper describes how a new regional campus of an academic health center engaged in a community‐based participatory research (CBPR) process to set a community‐driven research agenda to address health disparities. The campus is situated among growing Marshallese and Hispanic populations that face significant health disparities. In 2013, with support from the Translational Research Institute, the University of Arkansas for Medical Sciences Northwest began building its research capacity in the region with the goal of developing a community‐driven research agenda for the campus. While many researchers engage in some form of community‐engaged research, using a CBPR process to set the research agenda for an entire campus is unique. Utilizing multiple levels of engagement, three research areas were chosen by the community: (1) chronic disease management and prevention; (2) obesity and physical activity; and (3) access to culturally appropriate healthcare. In only 18 months, the CBPR collaboration had dramatic results. Ten grants and five scholarly articles were collaboratively written and 25 community publications and presentations were disseminated. Nine research projects and health programs were initiated. In addition, many interprofessional educational and service learning objectives were aligned with the community‐driven agenda resulting in practical action to address the needs identified.

Family Model of Diabetes Education With a Pacific Islander Community

Purpose The purpose of the study was to use a community-based participatory research approach to pilot-test a family model of diabetes education conducted in participants’ homes with extended family members. Methods The pilot test included 6 families (27 participants) who took part in a family model of diabetes self-management education (DSME) using an intervention-driven pre- and posttest design with the aim of improving glycemic control as measured by A1C. Questionnaires and additional biometric data were also collected. Researchers systematically documented elements of feasibility using participant observations and research field reports. Results More than three-fourths (78%) of participants were retained in the study. Posttest results indicated a 5% reduction in A1C across all participants and a 7% reduction among those with type 2 diabetes. Feasibility of an in-home model with extended family members was documented, along with observations and recommendations for further DSME adaptations related to blood glucose monitoring, physical activity, nutrition, and medication adherence. Conclusions The information gained from this pilot helps to bridge the gap between knowledge of an evidence-based intervention and its actual implementation within a unique minority population with especially high rates of type 2 diabetes and significant health disparities. Building on the emerging literature of family models of DSME, this study shows that the family model delivered in the home had high acceptance and that the intervention was more accessible for this hard-to-reach population.

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

BackgroundThe Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.MethodsUsing a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team.ResultsFour hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.DiscussionThis project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

Effects of pharmacy resident led education on resident physician prescribing habits associated with stress ulcer prophylaxis in non-intensive care unit patients

OBJECTIVE Overutilization of stress ulcer prophylaxis in both critically and noncritically ill patients poses significant health risks and increases healthcare costs. The purpose of this study was to assess the impact of education for appropriate stress ulcer prophylaxis prescribing by Family Medicine Resident Physicians. METHODS The study evaluated the SUP prescribing and continuation or discontinuation of acid suppressive therapy upon discharge. Patients admitted to the Family Medicine Residency team at Washington Regional Medical Center were retrospectively assessed from September through November 2011. In January 2012, an educational seminar describing appropriate stress ulcer prophylaxis indications, the associated risks and costs of acid suppressive therapy, and initial findings was provided. After the educational intervention, patients admitted to the Family Medicine Residency team were retrospectively followed from February through April 2012 to assess the impact of the educational intervention. RESULTS Post education analysis demonstrated a decrease in inappropriate stress ulcer prophylaxis prescribing from 55.5% to 30.5% (p < 0.0001). There was no statistically significant difference between the pre-intervention (5.5%) and post-intervention (8.3%) groups in regards to patients discharged on AST inappropriately (p = 0.627). CONCLUSION Pharmacist led educational sessions improved appropriateness of stress ulcer prophylaxis prescribing by Family Practice Resident Physicians, leading to patient risk avoidance and cost savings..

Cultural Adaptation of Diabetes Self-Management Education for Marshallese Residing in the United States: Lessons Learned in Curriculum Development

Abstract: Background: Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity. Objectives: We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese. Methods: Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts. Lessons Learned: Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality. Conclusions: We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others’ work with Pacific Islanders.

Cost-related Nonadherence to Medication Treatment Plans

Background: Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. Objective: Examine factors related to CRN to medication treatment plans within an understudied population. Research Design: Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults. Bonferroni-adjusted Wald test and multivariable logistic regression were performed to examine associations among financial burden-related factors, CD status, and CRN. Results: Across CD status, NHPI engaged in CRN behaviors had, on an average, increased levels of perceived financial stress, financial insecurity with health care, and food insecurity compared with adults in the total NHPI population. Regression analysis indicated perceived financial stress [adjusted odds ratio (AOR)=1.16; 95% confidence intervals (CI), 1.10–1.22], financial insecurity with health care (AOR=1.96; 95% CI, 1.32–2.90), and food insecurity (AOR=1.30; 95% CI, 1.06–1.61) all increase the odds of CRN among those with CD. We also found significant associations between perceived financial stress (AOR=1.15; 95% CI, 1.09–1.20), financial insecurity with health care (AOR=1.59; 95% CI, 1.19–2.12), and food insecurity (AOR=1.31; 95% CI, 1.04–1.65) and request for lower cost medication. Conclusions: This study demonstrated health-related and non–health-related financial burdens can influence CRN behaviors. It is important for health care providers to collect and use data about the social determinants of health to better inform their conversations about medication adherence and prevent CRN.

Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas

Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.

Screening for diabetes in patients receiving second-generation atypical antipsychotics

PURPOSE Results of a study to assess adherence with a consensus statement for diabetes screening in patients receiving atypical antipsychotics and to evaluate the role of pharmacists in a patient-centered medical home in improving guideline adherence are presented. SUMMARY For patients prescribed atypical antipsychotics, records were reviewed for glycosylated hemoglobin (HbA1c) testing within the past 12 months. If no HbA1c results were found within that time frame, physicians were sent an alert in the patients electronic medical record requesting an HbA1c order. Patient medical records were reviewed to analyze the number of HbA1c orders before and after pharmacist intervention. Prior to pharmacist intervention, 17 of 120 (14%) patients were screened with HbA1c. As a result of pharmacist intervention, 86 alerts were sent to physicians to order an HbA1c level, 24 (28%) of which included an order for an HbA1c level. Eleven of 24 (46%) HbA1c test results were collected during study follow-up, and one prediabetic patient was identified. CONCLUSION After pharmacist intervention, a greater number of patients receiving atypical antipsychotic medications had HbA1c levels monitored for evidence of type 2 diabetes.