Sarah C. Blake

Does social support help limited-literacy patients with medication adherence?: A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) Study

OBJECTIVE To explore whether social support helps patients with limited health literacy adhere to their medication regimens. METHODS We interviewed 275 pharmacy patients and assessed social supports influence on medication adherence for those with limited vs. adequate health literacy. We talked with patients (n=26) and pharmacists (n=7) to explore possible explanations for the quantitative findings. RESULTS Social support was associated with better medication adherence for patients with adequate health literacy but not those with limited health literacy (p<0.05). When individual subscales for social support were analyzed, having a trusted confidant was the only type of social support associated with better medication adherence for limited-literacy patients (p<0.05). Comments from patients and pharmacists suggest that limited-literacy patients were less likely to ask the pharmacists questions and infrequently brought relatives with them to the pharmacy. CONCLUSION Unless they have a trusted confidant, limited-literacy patients might be reluctant to ask others for the kind of help needed to take their medicines correctly. PRACTICE IMPLICATIONS Pharmacists need training to increase their awareness of limited health literacy and to communicate effectively with all patients, regardless of their literacy skills. To succeed, pharmacists also need the support of the health care systems where they work.

Facilitators and Barriers to 10 National Quality Forum Safe Practices

The objective of this study was to identify facilitators and barriers to the implementation of 10 National Quality Forum (NQF) medication processes and the culture of safety practices in Georgia hospitals. In-depth interviews with hospital administrators were conducted to identify facilitators and barriers to the implementation of programs that support the NQF safe practices. Hospitals identified significant as well as other key factors that resulted in the adoption and/or nonadoption of medication and culture of safety practices. Informants also identified strategies used to overcome barriers that were experienced. Facilitators to both practices include administrative leadership support and education and training. The resistance to change was the most significant barrier identified in both the safe medication process interviews and the culture of safety interviews. Implementing safety practices can be a difficult process, replete with organizational, financial, and professional barriers. Strategies identified by our informants to overcome these barriers may assist other hospitals currently facing this challenge.

A Qualitative Evaluation of a Health Literacy Intervention to Improve Medication Adherence for Underserved Pharmacy Patients

Objective. To evaluate the implementation of a health literacy intervention to improve medication adherence among patients in an inner-city health system. Methods. Interviews with pharmacists and focus groups with pharmacy patients were conducted one month and six months after beginning the intervention. Patients and pharmacists described their experiences with the intervention, consisting of an automated telephone call reminder system, an illustrated medication schedule, and pharmacist training in clear health communication. Results. Despite initial technical problems, patients and pharmacists reported positive experiences. Pharmacists thought the intervention made counseling easier. Patients appreciated the design and portability of the illustrated medication schedule and found the reminder calls helpful as well. Conclusion. Successful health literacy interventions require tools that are easy to comprehend, accessible, and personalized to the special needs and interests of the target population. Moreover, providers must be well-trained, and adequate resources must be provided to assure the fidelity of the interventions implementation.

Revisiting Safe Sleep Recommendations for African-American Infants: Why Current Counseling is Insufficient

The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.

A Two-Pronged Quality Improvement Training Program for Leaders and Frontline Staff

BACKGROUND A unique two-pronged QI training program was developed at Emory Healthcare (Atlanta), which encompasses five hospitals and a multispecialty physician practice. One two-day program, Leadership for Healthcare Improvement, is offered to leadership, and a four-month program, Practical Methods for Healthcare Improvement, is offered to frontline staff and middle managers. KNOWLEDGE ASSESSMENT: Participants in the leadership program completed self-assessments of QI competencies and pre- and postcourse QI knowledge tests. Semistructured interviews with selected participants in the practical methods program were performed to assess QI project sustainability and short-term outcomes. RESULTS More than 600 employees completed one of the training programs in 2008 and 2009. Leadership course participants significantly improved knowledge in all content areas, and self-assessments revealed high comfort levels with QI principles following the training. All practical methods participants were able to initiate and implement QI projects. Participants described significant challenges with team functionality, but a majority of the QI projects made progress toward achieving their aim statement goals. A review of completed projects shows that a significant number were sustained up to one year after program completion. Quality leaders continue to modify the program based on learner feedback and institutional goals. CONCLUSIONS This initiative shows the feasibility of implementing a broad-based in-house QI training program for multidisciplinary staff across an integrated health system. Initial assessment shows knowledge improvements and successful QI project implementations, with many projects active up to one year following the courses.

What New Mothers Need to Know: Perspectives from Women and Providers in Georgia

Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new mothers and identify opportunities to enhance healthcare providers’ current educational efforts. A two-part methodology was utilized to qualitatively explore the topic of parenting information needs for new mothers in Georgia. Data collection included information from 11 focus groups with 92 first-time, new mothers and 20 interviews with healthcare providers who serve new mothers. Discussions with both new mothers and providers clearly indicated that new mothers face a significant informational deficit, especially regarding very basic, daily infant care information and health literacy challenges. Educational materials already exist; however, mothers report difficulty accessing and understanding this information. For this reason, both the mothers and the providers stressed a focus on developing programs or interventions that allow in-person education and/or alternative modalities to access information, as opposed to development of new written materials solely. Information from the focus group and interviews provided important insight regarding what improvements need to be made to help new mothers and their families during the early stages of parenthood. By improving the education of new mothers and their families, it is proposed that maternal and infant health status could be improved.

Disaster Preparedness in Home Health and Personal-Care Agencies: Are They Ready?

Background: The use of home health care and personal-care agencies in the United States has increased by nearly 1,000% in less than 20 years. Despite the numerous advantages of keeping older and disabled people at home and fairly independent, new concerns have emerged about how to keep home health care and personal-care clients safe during emergencies and large-scale disasters. To date, little is known about the disaster preparedness activities of home health and personal-care agencies, including what oversight they have for their patients and what capabilities they sustain for preparing their clients for disasters. Objective: The purpose of this study was to explore the disaster preparedness policies and practices of these agencies and to identify opportunities for coordination with disaster preparedness officials. Methods: Semi-structured interviews were conducted by phone and in person with 21 home health and personal-care administrators across Georgia and Southern California. Transcripts from the interviews were analyzed for disaster preparedness themes. Results: We found that most agencies have very limited disaster plans and capabilities. Despite this, most stated either their intentions or outlined past experience which demonstrated their commitment to provide services to clients on a case-by-case basis throughout a large-scale emergency or disaster. Conclusion: The findings from our study help to contribute to the growing interest in disaster preparedness among home health and personal-care agencies and point to the fact that these agencies need assistance to properly lay out their disaster preparedness plans.

Influenza vaccination rates and beliefs about vaccination among nursing home employees

BACKGROUND Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states. METHODS Nursing home employees were surveyed at nursing homes in Florida, Georgia, and Wisconsin in 2011-2012. Completed surveys were received from a total of 1,965 employees. RESULTS Approximately 54% of the employees surveyed received the vaccination during the 2010-2011 and 2011-2012 influenza seasons. Nursing home-level staff vaccination rates varied widely, from 15%-97%. Black and younger employees were less likely to receive the vaccine. Employee vaccination rates in nursing homes that used incentives were 12 percentage points higher than those that did not use incentives (P = .08). CONCLUSION Low vaccination rates among nursing home workers may put residents at increased risk for influenza-related morbidity and mortality. The Centers for Medicare and Medicaid Services may consider employee vaccination rates as a quality indicator in addition to resident vaccination rates. Our findings support the use of a trial to test the use of incentives to increase employee vaccination rates.

Facilitators and Barriers to Cervical Cancer Screening, Diagnosis, and Enrollment in Medicaid: Experiences of Georgia’s Women’s Health Medicaid Program Enrollees

Although cervical cancer incidence and mortality rates have declined in the USA, African American women have a higher incidence rate of cervical cancer and a higher percentage of late-stage diagnosis than white women. Previous analyses by the authors showed that, even after adjusting for age, provider location, and availability, African American women were almost half as likely as white women to be diagnosed or enter Medicaid while at an early stage of their cervical cancer. To understand why these differences exist, we undertook a qualitative examination of the cervical cancer experiences of women enrolled in Georgia’s Women’s Health Medicaid Program (WHMP). Life history interviews were conducted with 24 WHMP enrollees to understand what factors shaped their cervical cancer experiences, from screening through enrollment in Medicaid. We also examined whether these factors differed by race in order to identify opportunities for increasing awareness of cervical cancer screening among underserved women. Results suggest that many women, especially African Americans, lacked understanding and recognition of early symptoms of cervical cancer, which prevented them from receiving a timely diagnosis. Additionally, participants responded positively to provider support and good communication but wished that their doctors explained their diagnosis more clearly. Finally, women were able to enroll in Medicaid without difficulty due largely to the assistance of clinical staff. These findings support the need to strengthen provider education and public health efforts to reach low-income and minority communities for screening and early detection of cervical cancer.

Caregiver measures for seizure control, efficacy, and tolerability of antiepileptic drugs for childhood epilepsy: Results of a preference survey

We sought to identify and quantify caregiver-defined characteristics of efficacy related to the perceived success of antiepileptic drug (AED) use. A 22-question survey was designed using physician input, focus groups, and clinical trial endpoints. Responses were pooled and analyzed with regard to seizure type and treatment, categorized as controlled (exposure to 1 AED), adjunctive (exposure to 2 AEDs), or refractory (exposure to ≥3 AEDs). Two hundred ninety-five surveys were completed: 109 (37%) controlled, 84 (28%) adjunctive, and 102 (35%) refractory. Seizure freedom and median seizure reduction >90% maintained for >1 year were reported as the most important indicators of medication efficacy by the majority of respondents. These measures were the same regardless of seizure type or treatment category. Our results demonstrate that current trial design may be inadequate to address the expectations of patients. Incorporating patient-defined AED efficacy measures may improve satisfaction and informed decision making regarding epilepsy treatment.