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Persell SD Keating NL Landrum MB Landon BE Ayanian JZ Borbas C Guadagnoli E 《Preventive medicine》2004,39(4):746-752
BACKGROUND: Educational interventions increase diabetes patients' knowledge and self-care activities, but their impact on the use of health services to prevent diabetes complications is unclear. We sought to determine the relationship of patients' diabetes-specific knowledge with self-management behaviors, use of ambulatory preventive care, and metabolic outcomes. METHODS: We surveyed 670 adults with diabetes from three managed care plans to assess diabetes knowledge (using an eight-item scale) and self-management activities. With chart review, we assessed five processes of care--retinal and foot examinations, low-density lipoprotein cholesterol (LDL-C) testing, hemoglobin A1c (HbA1c) testing, and urine microalbumin testing--and three metabolic outcomes--HbA1c < or = 9.5%, LDL-C <130 mg/dL (3.36 mmol/L), and last blood pressure <140/90 mm Hg. RESULTS: In adjusted analyses, a one-point increase on the knowledge scale was associated with following a diabetes diet (OR 1.23, 95% CI 1.10-1.38), blood glucose self-measurement (OR 1.29, 95% CI 1.13-1.48), and regular exercise (OR 1.15, 95% CI 1.03-1.28) but not with processes of care or metabolic outcomes. CONCLUSIONS: Knowledgeable patients were more likely to perform self-management activities but not to receive recommended ambulatory care or reach metabolic outcome goals. Providing patient education about diabetes care processes should be tested as a means of increasing ambulatory care to prevent diabetes complications. 相似文献
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Persell SD Osborn CY Richard R Skripkauskas S Wolf MS 《Journal of general internal medicine》2007,22(11):1523-1526
Background Limited health literacy may influence patients’ ability to identify medications taken; a serious concern for ambulatory safety
and quality.
Objective To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between
patient self-report and the medical record.
Design In-person interviews, literacy assessment, medical records abstraction.
Participants Adults with hypertension at three community health centers.
Measurement We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the
medications they took for blood pressure. Their responses were compared with the medical record.
Results Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name
any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p = 0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR] = 2.9, 95% confidence interval
[95%CI] = 1.3–6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with
inadequate and 37.8% with adequate literacy had no medications common to both lists.
Conclusions Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate
how this may impact safety and hypertension control.
Presented in part at the American Medical Association/AMA Foundation Health Literacy and Patient Safety Conference, November
16, 2006, Chicago. IL. 相似文献
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Prehypertension is a designation used by the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure to describe untreated adults with blood pressure of 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic.
As the term implies, prehypertension frequently progresses to hypertension, though weight loss, exercise, and dietary changes
can lower blood pressure and reduce the chance of progression to hypertension. Prehypertension often occurs along with other
cardiovascular risk factors, such as dyslipidemia and impaired glucose metabolism. Prehypertension also carries independent
cardiovascular risk. Recent clinical trials indicate that drug therapy should be considered for stable patients with prehypertension
at high risk for cardiovascular disease or stroke. Whether using antihypertensive medication in lower risk persons with prehypertension
is advantageous is not known. 相似文献
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BACKGROUND: Despite high cardiovascular risk among adults with diabetes mellitus, aspirin use has been low. METHODS: To assess recent self-reported regular aspirin use among adults 35 years or older with diabetes, we used statewide telephone surveys conducted in 7 states in 1997 and 20 states in 1999 and 2001 including 875, 3205, and 4272 subjects in 1997, 1999, and 2001, respectively. RESULTS: Aspirin use increased from 37.5% in 1997 to 48.7% in 2001. In 2001, 74.2% (95% confidence interval [CI], 70.9%-77.5%) of diabetic adults with cardiovascular disease, but only 37.9% (95% CI, 35.1%-40.7%) of those without cardiovascular disease, used aspirin regularly, including less than 40% with diagnosed hypertension or hypercholesterolemia or who smoked. After adjusting for cardiac risk factors and socioeconomic characteristics, among those without cardiovascular disease, aspirin use was less common in women aged 35 to 49 years (adjusted rate ratio [RR], 0.35; 95% CI, 0.24-0.51) and 50 to 64 years (RR, 0.69; 95% CI, 0.53-0.88) and in men aged 35 to 49 years (RR, 0.62; 95% CI, 0.43-0.85) compared with men 65 years and older. For those with diagnosed cardiovascular disease, aspirin use was lower among women (RR, 0.81 compared with men; 95% CI, 0.70-0.90) and adults younger than 50 years (RR compared with those >/=65 years, 0.81; 95% CI, 0.61-0.98). The disparity in aspirin use between men and women appeared between 1997 and 2001. CONCLUSIONS: Aspirin use among adults with diabetes has increased. However, many high-risk individuals, especially women and those younger than 50 years, do not use this effective and inexpensive therapy. 相似文献
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Stephen D. Persell Stacy Cooper Bailey Joyce Tang Terry C. Davis Michael S. Wolf 《The American journal of medicine》2010,123(2):1361-1470