A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack

Sajatovic, Martha; Tatsuoka, Curtis; Welter, Elisabeth; Colón-Zimmermann, Kari; Blixen, Carol; Perzynski, Adam T.; Amato, Shelly; Cage, Jamie; Sams, Johnny; Moore, Shirley; Pundik, Svetlana; Sundararajan, Sophy; Modlin, Charles S.; Sila, Cathy A.

doi:10.1177/0890117117695218

Cited by 31 publications

(67 citation statements)

References 65 publications

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“…Targeted Training for Illness Management (TTIM) is an evidence-based, manualized, modular group intervention for the self-management of chronic illness, originally developed for people with severe mental illness. The evidence-based TTIM approach has been successfully adapted for a variety of chronic health conditions including epilepsy, stroke, Parkinson's disease, and diabetes [32][33][34][35][36]. TTIM was selected for this study by our stakeholders because it met the criteria for having both physical and mental health topics and had a version specific to diabetes.…”

Section: Curriculummentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

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Background: Shared medical appointments (SMAs) have been shown to be an efficient and effective strategy for providing diabetes self-management education and self-management support. SMA features vary and it is not known which features are most effective for different patients and practice settings. The Invested in Diabetes study tests the comparative effectiveness of SMAs with and without multidisciplinary care teams and patient topic choice for improving patient-centered and clinical outcomes related to diabetes. Methods: This study compares the effectiveness of two SMA approaches using the Targeted Training for Illness Management (TTIM) curriculum. Standardized SMAs are led by a health educator with a set order of TTIM topics. Patient-driven SMAs are delivered collaboratively by a multidisciplinary care team (health educator, medical provider, behavioral health provider, and a peer mentor); patients select the order and emphasis on TTIM topics. Invested in Diabetes is a cluster randomized pragmatic trial involving approximately 1440 adult patients with type 2 diabetes. Twenty primary care practices will be randomly assigned to either standardized or patient-driven SMAs. A mixed-methods evaluation will include quantitative (practice-and patient-level data) and qualitative (practice and patient interviews, observation) components. The primary patient-centered outcome is diabetes distress. Secondary outcomes include autonomy support, self-management behaviors, clinical outcomes, patient reach, and practicelevel value and sustainability. Discussion: Practice and patient stakeholder input guided protocol development for this pragmatic trial comparing SMA approaches. Implementation strategies from the enhanced Replicating Effective Programs framework will help ensure practices maintain fidelity to intervention protocols while tailoring workflows to their settings. Invested in Diabetes will contribute to the literature on chronic illness management and implementation science using the RE-AIM model.

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Section: Curriculummentioning

confidence: 99%

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Kwan

Dickinson

Glasgow

et al. 2020

Trials

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“…Cerebrovascular accident (CVA) is a syndrome which consists of the rapid development of focal clinical disorders of cerebral function, lasting more than 24 hours. Featuring a high morbidity, this is the main reason of disability and use of health resources in the United States (1) . In Europe, especially in Portugal, it remains the most significant cause of morbidity of potential lost of years of life (2) .…”

Section: Introductionmentioning

confidence: 99%

Functional capacity and social support to people affected by cerebrovascular accident

et al. 2019

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Objective: To investigate the functional capacity and its relationship with the level of social support to people affected by cerebrovascular accident. Methods: Cross-sectional and quantitative research, conducted with 108 individuals with sequelae of cerebrovascular accident in João Pessoa/PB. Data were collected through interviews, using a sociodemographic instrument – the Barthel Index and the Social Support Scale. Results: We observed the prevalence of functional dependency in 93.5%, and the mild dependency stood out in 40.7%. Medium social support was the most found, with 48.2%. The predominant dimensions of social support were the material dimension, followed by the emotional. There was a significant association (p ≤ 0.05) between very serious dependency and high social support. Conclusion: The results found allow us to reflect on the need for involvement of health professionals in strengthening the social support of patients with disabling diseases, such as the cerebrovascular accident.

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“…We would like to clarify that trying to recruit only non‐adherent patients is not the same as recruiting patients who suffer from medical or psychosocial risks that may or may not be related to non‐adherence. For example, focusing on patients with uncontrollable hypertension in behavioral intervention trials does not qualify as recruiting “only non‐adherent patients.” Increased or uncontrolled hypertension is a medical indicator of poor outcome, and it does not measure the behavior of adherence. While recruitment of patients who are “in trouble”—suffer an increased medical or psychosocial risk—has certainly been tried before in multiple settings, it has shortcomings.…”

Section: Discussionmentioning

confidence: 99%

“…Not all of those patients are non‐adherent (the poor outcomes can be related to other issues). In addition, waiting until the medical poor outcome already happened is not a desired selection criterion if one is trying to prevent medical complications rather than treat them after they have already happened. While choosing a “high‐risk pool” has been tried, we are not aware of any randomized controlled trials in adherence research in pediatric settings that had an inclusion criterion that specified that only non‐adherent patients would be targeted for intervention.…”

Section: Discussionmentioning

confidence: 99%

Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

Shemesh

Mitchell

Neighbors

et al. 2017

Pediatric Transplantation

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Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: it is very hard to recruit and retain nonadherent patients in research efforts. This manuscript presents recruitment strategies and results from the MALT (Medication Adherence in children who had a Liver Transplant) multisite prospective cohort study. MALT sites recruited 400 pediatric liver transplant patients who agreed to be followed for 2 years. The primary purpose was to determine whether a marker of adherence, the medication level variability index (MLVI), predicts rejection outcomes. The present manuscript describes methods used in MALT to ensure that a representative sample was recruited, and presents detailed recruitment results. MALT sites were able to recruit a nationally representative sample, as determined by a comparison between the MALT cohort and a national sample of transplant recipients. Strategies that helped ensure that the sample was representative included monitoring of the outcome measure in comparison with a national sample, drastically limiting patient burden, and specific recruitment methods. We discuss the importance of a representative sample in adherence research and recommend that future efforts to study adherence pay special attention to sample characteristics.

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A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack

Cited by 31 publications

References 65 publications

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

The Invested in Diabetes Study Protocol: a cluster randomized pragmatic trial comparing standardized and patient-driven diabetes shared medical appointments

Functional capacity and social support to people affected by cerebrovascular accident

Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

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