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Objectives: Our principal objectives were to identify the level of adherence and identify the attitudes, beliefs, and behaviors that influence adherence to antihypertensive treatment among Vietnamese patients in New Orleans, Louisiana.Methods: By partnering with a community health center serving the Vietnamese community in New Orleans, we conducted reviews of 250 medical records of hypertensive patients receiving care there, 3 provider interviews, and 8 patient interviews. Descriptive and thematic analyses were used. Results:The level of treatment nonadherence in our sample population was 20.40%. Findings highlighted several key factors that may contribute to adherence, including easy access to providers, who are culturally competent and have used several strategies to help increase adherence, and the social support network of patients within a close-knit community. Other sociodemographic factors, such as age, sex, and tobacco and alcohol use also may play a role in adherence.Conclusions: Adherence to antihypertensive treatment among Vietnamese patients in New Orleans was relatively high compared with other ethnic and racial groups in the United States. Further assessment of the characteristics of patients, providers, and the community may improve adherence to other chronic conditions in this population and patients of other ethnicities and races.

The authors examined the relationship between patency after thrombectomy of clotted dialysis grafts and intraoperative measurements of flow (Q), pressure gradient (PGR), and longitudinal resistance (RL). Eighteen thrombosed arteriovenous (AV) grafts underwent 21 thrombectomies. Pressures at arterial (P1) and venous (P2) ends of the AV grafts were determined with 22-gauge catheters and standard transducers; flow was measured with transit-time probes; arithmetic averaging of waveforms was used to compute mean Q, PGR, and RL. Kaplan-Meier patency curves were analyzed by using log rank methods. Mean patency for all grafts was 164 +/-152 days. For each variable, the 21 measurements were split and the patency curve for the grafts with the 11 lowest value grafts was compared to the curve representing the 10 highest value grafts. The difference between high RL versus low RL patency curves was significant with high-resistance grafts having a median patency of 55 days and low-resistance grafts having a median patency greater than 151 days (p = 0.0089). In contrast, the high Q group median patency was 151 days versus 174 days for the low Q group (p = 0.86). Median patency for the low PGR group was 115 days compared to 62 days for the high PGR group (p = 0.162). Longitudinal resistance within AV grafts, but not flow or pressure gradient, showed a significant correlation with patency after thrombectomy. Increased resistance to flow within AV grafts appears to be an important factor affecting the propensity of dialysis grafts to thrombose.

Background: Medical adherence is one of the most effective ways of controlling hypertension among those under treatment. Vietnamese Americans have a high prevalence of hypertension and low rates of adherence to treatment. Yet there is a minimal body of literature that addresses this condition among Vietnamese Americans. Objectives: Our principle objectives are: 1) identify the level of adherence and 2) identify the attitudes, beliefs, and behaviors that influence adherence to antihypertensive treatment among Vietnamese in New Orleans. Methods: The first phase of the study examined 250 randomly selected medical records of Vietnamese hypertensive patients from a local community clinic to determine the adherence rate. Semi-structured interviews were conducted with four providers that work at the same clinic who treat these patients. Providers were asked about their perceptions of factors that influence antihypertensive treatment adherence in Vietnamese patients, and potential points of interventions. A thematic analysis of the semi-structured interviews was conducted. Results: The medical record review identified 20.4% (51 out of 250) of patients were non-adherent to antihypertensive treatment. The common theme that emerged from the interviews was health illiteracy, particularly limited access to knowledge in the native language was a major factor to non-adherence. Patients preferred to seek information from loved ones and to utilize therapies outside of Western medicine. Factors that increased adherence included having patients track blood pressure measurements and establishing trusting provider-patient relationships. Discussion/Conclusions: Patient education is a critical component to adherence to antihypertensive treatment in Vietnamese patients. Language barriers and limited knowledge about the disease are significant problems that need to be addressed to improve the rate of adherence. The interview data will guide the remainder of the study where we will interview patients to better understand what influences adherence, and what approaches to improving adherence might be appropriate for Vietnamese patients.

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