Implementation of I-PASS has been associated with substantial improvements in patient safety and can be applied to a variety of disciplines and types of patient handoffs. Widespread implementation of I-PASS has the potential to substantially improve patient safety in the United States and beyond.
Background: Hypertension (HTN) in people with diabetes doubles the
risk of cardiovascular disease. Prior patient activation studies largely show
improved communication but little impact on behavior or health outcomes. We
sought to 1) assess the impact of Office-Based Guidelines Applied to Practice
(Office-GAP) Program on blood pressure (BP) control; 2) determine the rate and
predictors of BP control in patients with HTN and/or diabetes mellitus (DM) in
federally qualified health centers. Methods: Sample: Patients with
coronary heart disease (CHD) and/or DM with history of HTN; analyzed patients
with DM and HTN compared to HTN without DM. Intervention: Office-GAP included
physician training, patient activation, and an Office-GAP decision checklist.
Two-site intervention/control design; data collection at baseline and after 3,
6, and 12 months. Logistic regression with propensity scoring assessed impact on
BP control over time. Results: Of 243 patients, HTN was present in
75% at baseline; 32% had BP controlled. Consistent trend showed Office-GAP
slightly improved the rate of BP control across time, while the control arm
showed a nonsignificant decrease in the rate of BP control across time, compared
to baseline. BP improved at 6 months at the intervention site compared to
control site (odds ratio = 2.92; 95% confidence interval = 1.11–7.69).
Conclusion: BP control was better at the intervention site
compared to the control site at 6 months. Office-GAP shows promise to implement
guidelines-based patient-centered care that improves BP.
Contrary to our hypothesis, the results of this study suggest that pregnant women with OSA have higher antioxidant capacity and lower oxidative and carbonyl stress markers compared to controls, suggesting a possible protective effect of intermittent hypoxia. Whether OSA in pregnancy impacts oxidative stress differently than OSA in the general population remains to be confirmed.
The aim of this qualitative analysis was to identify obstructive sleep apnea (OSA) patients' preferences, partner experiences, barriers and facilitators to positive airway pressure (PAP) adherence, and to assess understanding of the educational content delivered and satisfaction with the multidimensionally structured intervention. Methods: A qualitative analysis was conducted on 28 interventional arm patients with a new diagnosis of OSA. They received a one-on-two semistructured motivational interview as the last part of a 60-to 90-minute in-person educational group intervention. The 10-to 15-minute interview with the patient and caregiver was patient-centered and focused on obtaining the personal and emotional history and providing support. We also assessed understanding of the OSA training plan, their commitment to it, and their goals for it. Results: We identified four themes: OSA symptom and diagnosis, using the PAP machine, perceptions about the group visit, and factors that determine adherence to PAP. Patients experienced positive, negative, or mixed emotions during the journey from symptoms of OSA to PAP adherence. Conclusions: Our findings suggest that patients' and caregivers' positive experiences of PAP could be enhanced by a patient-centered interaction and that it was important to explicitly address their fears and concerns to further enhance use of PAP. Not only could caregiver support play a role in improving PAP adherence but also the peer coaching session has the potential of providing a socially supportive environment in motivating adherence to PAP treatment.
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