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Biomedical subjects

Betsy Sleath

Publications and source records attributed to Betsy Sleath.

At least 19 recordsLinked to original sources
PubMed2006

Patient-reported behavior and problems in using glaucoma medications.

OBJECTIVE: The objectives of the current study were to describe the different types of problems patients receiving adjunctive therapy reported having when taking their glaucoma medications and to examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: A survey was distributed to glaucoma patients in 4 geographically distinct ophthalmology practices. We excluded patients using only 1 glaucoma medication. The survey was completed by 324 patients. METHODS: For each patient, average percent adherence to his or her glaucoma medication regimen was calculated. Logistic regression was used to examine how patient characteristics and problems in using glaucoma medications were related to reported adherence. MAIN OUTCOME MEASURE: Whether patients were less than 100% adherent in the previous week. RESULTS: We found that 60% of patients reported 1 or more problems with taking their glaucoma medications. Fourteen percent of patients reported being less than 100% adherent to their glaucoma regimen medications during the previous week. Patients who had difficulty remembering to take their glaucoma medications and those who reported that they had other problems or concerns with their glaucoma medications were significantly less likely to be 100% adherent. CONCLUSIONS: Patient adherence to a glaucoma medication regimen could be improved among patients receiving adjunctive therapy. Ophthalmologists and their clinical colleagues should make sure to discuss the problems and concerns that patients may have in taking their glaucoma medications in an effort to improve adherence.

Adult↗
PubMed2005

Ethnicity and prenatal depression: women's experiences and perspectives on communicating about their emotions and feelings during pregnancy.

The purpose of the study was to examine the relationship between ethnicity, the presence of moderate to severe symptoms of depression, and communication about emotions and feelings during prenatal visits. The purpose was also to describe women's perceptions of the barriers to communicating with providers, family, and friends about their emotions or feelings and how to overcome these barriers. Seventy-three women were recruited and interviewed by a bilingual research assistant between June and September 2002 after a prenatal visit occurring between 12- and 32-week gestation. Nineteen percent of women screened as having moderate to severe symptoms of depression. Quality of social relationships had a significant negative relationship with whether women had moderate to severe symptoms of depression. Almost 29% of women reported discussing their emotions or feelings with their providers and this did not differ significantly by ethnicity. Women who discussed their emotions or feelings with their providers did have significantly higher scores on the Beck Depression Inventory-II (BDI-II) than those who did not. Thirty-four percent of women stated that there were barriers to expectant or new mothers communicating with their providers. Women who felt that there were barriers to expectant or new mothers discussing their emotions with their providers did have significantly higher BDI-II scores than those women who did not. Thirty-seven percent of women believed that there were barriers to expectant or new mothers communicating with their family about their emotions. Women felt that providers and families could try to develop trust with them and try to make them feel more comfortable discussing their feelings.

Adolescent↗
PubMed2005

Physician use of a participatory decision-making style with children with ADHD and their parents.

The purpose of this study was to examine the extent to which physicians reported using a participatory decision-making (PDM) style with children and their parents during attention-deficit/hyperactivity disorder visits and the physician characteristics that were related to physician use of a PDM style. The survey was sent to a stratified random sample of 250 pediatricians and 250 family practitioners that were licensed and actively practicing in North Carolina. A second mailing of the survey was sent to non-responders approximately 3 weeks after the first mailing was sent. Approximately 47% of the physicians responded. Physicians were significantly more likely to rate themselves as more participatory with parents than with children. Younger physicians were more likely to use a participatory style with attention-deficit/hyperactivity disorder (ADHD) children. Physicians who rated themselves as using a more participatory style with parents, also rated themselves as being more participatory with children. Pediatricians and younger physicians were more likely to use a participatory style with parents of ADHD children. The majority of physicians believed that ADHD children could begin to contribute to decisions about the diagnosis and treatment of ADHD during medical visits from age 7 to 11 years.

Adult↗
PubMed2005

Ethnicity and depression treatment preferences of pregnant women.

African American, Hispanic, and White women between 12 and 32 weeks gestation were recruited to examine their depression treatment preferences. The 73 women who participated were interviewed after their prenatal visit. Nineteen percent of women had symptoms of moderate or severe depression. Women with moderate or severe symptoms of depression were more likely to believe that antidepressants were an acceptable treatment than those without symptoms or with only minor depression symptoms. There were only small differences among the three ethnic groups for antidepressant use preference but most women found them to be unacceptable. In contrast, approximately half of the White women felt that herbal medicines were acceptable compared with 16 and 22 percent for African Americans and Hispanics, respectively. Only 44 percent of African American women felt that counseling from a mental health professional was an acceptable treatment for depression compared to 68 percent for White and 61 percent for Hispanic women. Similarly, African American women were less likely to believe that waiting and getting over depression symptoms naturally was acceptable compared to Hispanic and White women.

Adolescent↗
PubMed2005

Patients' perceptions of primary care physicians' participatory decision-making style and communication about complementary and alternative medicine for arthritis.

OBJECTIVE: The purpose of this study was to examine: (1) which patient demographics were related to whether patients rated their family physicians as using a participatory decision-making style, and (2) whether arthritis patients who reported using complementary and alternative medicine (CAM) were more likely to report discussing CAM use with their providers if they saw family physicians rated with participatory decision-making styles. METHODS: A survey that asked about health status, demographics, physician use of a participatory decision-making style, and medical skepticism was sent to 2178 patients with arthritis who attended 16 different family practice sites that were part of a research network in rural and urban North Carolina. Generalized estimating equations were used to analyze the data. RESULTS: Younger and more educated patients were more likely to rate their family physicians as using participatory styles. In all, 71% of patients who reported having used one or more CAM strategy reported having discussed it with their physicians. Patients who rated their health as worse, reported using more categories of CAM, and rated their physicians as being using participatory styles were more likely to tell their physicians about their CAM use. CONCLUSION: Our findings suggest that if providers use more participatory styles with patients and involve them when making treatment decisions; patients will tell providers more about what they are doing for their health.

Adult↗
PubMed2005

African-American and white caregivers of older adults with dementia: differences in depressive symptomatology and psychotropic drug use.

OBJECTIVES: To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial differences on predisposing, enabling, and need factors associated with use of these agents was also examined. DESIGN: National survey. SETTING: Community-based population of informal caregivers of elderly male U.S. veterans with dementia living throughout the 48 contiguous states and Puerto Rico. PARTICIPANTS: Two thousand thirty-two African-American and white female caregivers of elderly male veterans diagnosed with probable Alzheimer's disease or vascular dementia. MEASUREMENTS: Depressive symptoms were measured using a modified version of the Center for Epidemiological Studies Depression Scale. Antidepressant, antianxiety, and sedative/hypnotic agents were indexed using the Veterans Affairs medication classification system. RESULTS: Of caregivers with depressive symptoms, 19% used antidepressants, 23% antianxiety agents, and 2% sedative/hypnotics. African-American caregivers with depressive symptoms were significantly less likely than whites with depressive symptoms to be using antidepressants and antianxiety medications. Caregivers who reported higher levels of social support and more physician visits during the previous 6 months were significantly more likely than others to be taking antidepressants. CONCLUSION: This study found that 81% of caregivers with depressive symptoms were not taking antidepressant medication and that African-American caregivers were less likely than whites to be taking antidepressants. Results suggest that routine screening for depression in dementia caregivers may identify unmet needs for antidepressant therapy. Particular care should be taken to ensure that African-American caregivers are made aware of the potential benefits of such therapy.

Activities of Daily Living↗
PubMed2005

The influence of physicians' guideline compliance on patients' statin adherence: a retrospective cohort study.

BACKGROUND: National cholesterol management guidelines recommend regular follow-up of patients and annual lipid evaluations to promote adherence to statin therapy. OBJECTIVE: This study examined the relationship between primary care physicians' (PCPs') compliance with primary care guidelines and patients' adherence to statin therapy. METHODS: A retrospective cohort study was conducted among statin users aged > or = 50 years who had an assigned PCP at a Veterans Affairs Medical Center. The dependent variable was statin adherence by patients over 24 months. Computerized pharmacy, laboratory, and medical records were used to measure PCPs' compliance with 4 recommendations in national cholesterol management guidelines: (1) lipid-lowering drug (LLD) initiation; (2) 8-week follow-up visit after an initial LLD prescription; (3) 6- or 12-month follow-up visit for established LLD users; and (4) annual lipid evaluation. Multilevel, multivariable regression models were used to estimate the effects of PCPs' guideline compliance on patients' adherence while controlling for patients' demographic characteristics, comorbid conditions, and pharmacotherapy factors. RESULTS: The sample included 82 PCPs caring for 4707 patients. The mean statin adherence rate was 83.9%. An increase in the annual lipid evaluation rate resulted in an increase in patients' adherence (P = 0.037). Black race and higher statin dose negatively influenced patients' adherence (both, P < 0.001). The effects of PCPs' compliance rates were not homogeneous across race. Specifically, the 8-week follow-up visit rate after initial LLD prescription was significantly associated with improved statin adherence among the black subpopulation only. CONCLUSIONS: Patients' adherence to statin therapy was influenced by their PCPs' compliance with cholesterol management guidelines. Efforts should be made to align PCPs' practice with published guidelines for optimal statin therapy, especially for vulnerable subpopulations of patients.

Aged↗
PubMed2004

Restricting patients' medication supply to one month: saving or wasting money?

PURPOSE: A state Medicaid program's pharmacy expenditures associated with dispensing one- and three-month supplies of drugs were examined. METHODS: We simulated the effect of a policy change from a maximum of a 100-day supply of prescription medication to one where only a 34-day supply was allowed. All North Carolina prescription claims from Medicaid enrollees who filled a prescription for at least one of six medication categories during fiscal years 1999 and 2000 were included. The six categories were angiotensin-converting-enzyme inhibitors, antiulcers, antipsychotics, nonsteroidal antiinflammatory drugs, selective serotonin-reuptake inhibitors, and sulfonylureas. The dollar value of the medication wasted, the amount of medication wastage diverted after a change to a shorter prescription length, and the total costs incurred by the increases in prescription refills were calculated. RESULTS: For each therapeutic category, 255,000-783,000 prescription drug claims were analyzed. No valid drug claims were excluded for any reason. Although 5-14% of total drug wastage, attributed to switches of drug therapy, could be saved by dispensing a 34-day supply, this saving could not make up for a larger increase in dispensing costs, as consumers would fill prescriptions more often. In addition, reducing the amount of drug dispensed each time may be costly to consumers through increased transportation and other expenses. CONCLUSION: Simulated calculation showed that the cost of drug therapy to North Carolina's Medicaid program would probably increase if 34-day rather than 100-day supplies of medications are dispensed to patients.

Cost Savings↗
PubMed2004

Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior.

The purpose of this study is to examine the association of ethnicity and language concordance with physician-patient agreement about physicians' recommendations for patient health behavior in the following areas: diet, exercise, medication, smoking, stress, and weight. Twenty-seven resident physicians at the University of New Mexico's internal medicine and family practice clinics and 427 of their patients participated. Random effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior. Ethnicity concordance was not significantly associated with physician-patient agreement. Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications. The lowest percentage of agreement occurred in the area of medication regimens (60%). The results from this study indicate that language is an important barrier to physician-patient agreement, while ethnicity concordance has no effect. However, the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research.

Adolescent↗
PubMed2004

Medication use among black and white caregivers of older male veterans with dementia.

BACKGROUND: Few studies have examined racial differences in medication use among informal caregivers of elderly individuals with progressive dementia. It is important to identify racial disparities in medication use so that these differences can be corrected. OBJECTIVE: The purpose of the current study was (1) to evaluate whether black caregivers were less likely to be taking medication than white caregivers after controlling for specific factors and (2) to examine the relationship between caregiver race and other predisposing, enabling, and need factors, and the use of specific categories of medications. METHODS: A secondary analysis of data was conducted from a national survey of 2032 black and white female caregivers of elderly male US veterans with a diagnosis of Alzheimer's disease or vascular dementia. Caregiver use of specific medications was classified according to the Veterans Affairs medication classification system. The Andersen Behavioral Model of Health Services Use provided a framework for multivariate models predicting racial differences in any medication use and use of specific categories of medications. RESULTS: Black caregivers were significantly less likely to use any medication than white caregivers (adjusted odds ratio [OR]=0.42; 95% CI=0.31-0.57). These differences persisted even after controlling for other predisposing, enabling, and need factors, and for outpatient doctor visits. Black caregivers were significantly less likely than white caregivers to be taking endocrine/metabolic medications (adjusted OR=0.57; 95% CI=0.42-0.77) and central nervous system medications (adjusted OR=0.57; 95% CI=0.39-0.83). CONCLUSION: The results of this analysis suggest that significant racial differences in medication use exist among informal caregivers providing care for elderly male US veterans with progressive dementia.

Black or African American↗
PubMed2003

The influence of Hispanic ethnicity on patients' expression of complaints about and problems with adherence to antidepressant therapy.

BACKGROUND: Although Hispanics constitute the most rapidly growing ethnic group in the United States, few studies have examined the relationship between Hispanic ethnicity and patients' experiences with the use of antidepressant medications. OBJECTIVE: The purpose of this study was to examine the influence of Hispanic ethnicity on patients' expression of complaints about and problems of adherence with antidepressant medications and physicians' reactions to these complaints and adherence problems. METHODS: Data were collected as part of a larger cross-sectional study of physician-patient communication conducted during 1995 in the general medicine and family practice clinics of the University of New Mexico. Between March and December 1995, patients' medical visits were recorded on audiotape, patients were interviewed after each visit, and patients' medical records were reviewed. The present analysis focused on patients who received a prescription for an antidepressant on the day of the audiotaped visit. Because this was a cross-sectional study, only 1 visit was recorded for each patient. RESULTS: Ninety-eight patients were identified who received a new or refill prescription for an antidepressant on the day of the audiotaped visit. Twenty-eight (28.6%) patients expressed a complaint about their antidepressant therapy. Younger patients and non-Hispanic white patients were more likely to express such a complaint than were older patients and Hispanic patients. Ten (10.2%) patients reported an adherence problem. Patients who rated their physical health as better were more likely to express adherence problems with antidepressant therapy than were patients who rated their physical health was worse. Physicians were generally responsive to patients' expression of complaints and adherence problems. CONCLUSIONS: Patients' ethnicity was related to their expression of complaints about antidepressant therapy but not to their expression of adherence problems or to physicians' reactions on patients' expression of either. Because many patients express complaints about and adherence problems with antidepressant therapy, providers should be prepared to educate patients about their prescribed therapy or change the antidepressant regimen.

Adult↗
PubMed2003

Sociological influences on antidepressant prescribing.

This study examined how patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient influenced whether patients with a depression diagnosis received an antidepressant prescription and whether they received a SSRI antidepressant, a non-SSRI antidepressant, or both. The 1998 National Ambulatory Medical Care Survey (NAMCS), in the USA, was used for the analysis. Logistic regression was used to examine what characteristics influenced whether a patient with a depression diagnosis received an antidepressant prescription. Next, a multinomial logistic regression model was applied to examine the relative risk of using one type of antidepressant versus another among antidepressant users while correcting for possible sample selections using the Heckman selection model. Sixty-seven percent of patients with a depression diagnosis received an antidepressant. Patients who were seeing providers who were not primary care physicians or psychiatrists, self-paying patients, and patients with neurotic depression were significantly less likely to receive an antidepressant prescription. Patients with depression listed as their first diagnosis were significantly more likely to receive an antidepressant prescription. Patients seeing a psychiatrist were more likely than patients seeing a primary care physician to receive a non-SSRI antidepressant than a SSRI antidepressant. Patients belonging to an HMO that had capitated visits were over four times more likely to receive non-SSRI antidepressants than SSRI antidepressants. Patients with major depression were significantly more likely to receive a non-SSRI antidepressant. Patients with depression as their primary diagnosis and patients who saw psychiatrists were significantly more likely to receive both SSRI and non-SSRI antidepressants rather than just SSRI antidepressants. Patient characteristics, physician characteristics, the physician's interaction with the health care system, and the physician's interaction with the patient all influenced antidepressant prescribing. An especially important finding was that insurance status influenced whether patients received an antidepressant. Health care providers need to take the time to help patients without insurance obtain antidepressant medication if it is needed.

Adolescent↗
PubMed2003

Drug information sources and antidepressant adherence.

The purpose of the study was to examine how patient sources of antidepressant information were related to antidepressant adherence. Eight community pharmacies in central North Carolina participated in the study. A research assistant interviewed eighty-one English-speaking patients who were picking up antidepressant refill prescriptions. Patients most frequently reported receiving antidepressant information from: pharmacists (58%), primary care physicians (50.6%), mental health specialists (40.7%), friends or family members (32.1%), and the Internet (18.5%). Patients experiencing more side effects were significantly less adherent to their antidepressants. Patients who received antidepressant information from more sources were significantly more adherent to their regimen than patients who received information from fewer sources.

Adult↗
PubMed2002

Gender, ethnicity, and physician-patient communication about depression and anxiety in primary care.

The purpose of this study was to describe the influence of patient gender and ethnicity on physician-patient communication about depression and anxiety. A data set comprised of audiotapes and transcripts of 383 patients' primary care visits was analyzed. Depression was brought up during 25% of medical visits. Depression was more likely to be brought up during the visits of patients who rated their emotional health poorly. Female patients and more educated patients were more likely to initiate the discussion. Anxiety was brought up during 29.5% of medical visits. Anxiety was more likely to be brought up during family practice visits and during visits with Asian physicians. Physicians were more likely to ask male patients and patients who had fewer previous visits closed-ended questions about anxiety. Physicians were more likely to ask Hispanic patients and patients who rated their emotional health poorly one or more open-ended questions about anxiety. Female physicians were more likely to counsel patients than male physicians.

Adolescent↗
PubMedDate not supplied

Hispanic ethnicity, physician-patient communication, and antidepressant adherence.

The purpose of the study was to examine how Hispanic ethnicity influenced physician-patient communication about antidepressants and antidepressant adherence using a data set of audiotapes and transcripts of 98 medical visits and medical and pharmacy records. The data were collected in 1995 at the University of New Mexico's general medicine and family practice clinics. Physicians were more likely to state antidepressant information to non-Hispanic white patients than to Hispanic patients. Physicians were more likely to state information to patients who were prescribed new antidepressants. Physicians asked approximately one of five patients on continued therapy how well their antidepressants were working and only one of 10 patients if they were experiencing any side effects. Non-Hispanic white patients were significantly more likely to state information about their antidepressants than Hispanic patients. Younger patients and patients who were prescribed new antidepressants were more likely to ask questions about antidepressants. Hispanic patients and patients who were prescribed new antidepressants were significantly less adherent to their antidepressant therapy during the one hundred day period after their audio-taped visits than non-Hispanic white patients and patients on continued therapy.

Adult↗
PubMedDate not supplied

Validation of the Patient Perception of Migraine Questionnaire.

OBJECTIVE: The purpose of this study was to assess the psychometric properties of the Patient Perception of Migraine Questionnaire (PPMQ), which measures patient satisfaction with migraine therapy. METHODS AND DATA: The PPMQ was administered to 940 patients as part of a 3-month, multinational, open-label, clinical trial comparing the effects of oral naratriptan 2.5 mg with the patient's customary therapy for the treatment of migraine. Psychometric properties of the PPMQ were evaluated in terms of its latent factor structure, validity, reliability, sensitivity, and development of a scoring method. Classical Test theory and Item Response theory (IRT) modeling were both used to measure reliability. RESULTS: The PPMQ was able to detect treatment differences (P >.001), and all items significantly correlated with diary ratings of headache pain (r =.18-.51, p >.0001) and the Medical Outcomes Short Form-36 pain scale (r =.27, p >.0001). A principal components factor analysis revealed that the items on the PPMQ were psychometrically distinct and unidimensional (loadings, 0.74-0.91), with the exclusion of two items. The reliability (i.e., internal item consistency) of the PPMQ post-trial was high in both treatment groups (Cronbach's alpha = 0.96). An IRT analysis also ensured the formation of homogenous items, which were stable on repeat administration. Items did not require weighting and can be simply summed to yield a total score. CONCLUSION: Based on the data from this one clinical trial, the 15-item PPMQ was shown to be a valid and reliable instrument that seems to efficiently and comprehensively measure patient perception of drug attributes in relation to the treatment of symptoms associated with migraine headaches.

Adult↗
PubMedDate not supplied

Examining knowledge, attitudes, and beliefs about depression among Latino adults with type 2 diabetes.

PURPOSE: The purpose of this study was to explore knowledge, attitudes, and beliefs about depression among Latinos with type 2 diabetes. METHODS: Eight 90-minute focus groups were conducted, each moderated by a bilingual, bicultural woman. Participants included 45 self-identified Latino adults with diabetes. Discussion topics included diabetes management, perceived control, emotional barriers, conceptualization of depression, and help-seeking behavior. Themes pertinent to depression and emotional health were identified using a combined deductive/inductive approach and an iterative process of consensus coding. RESULTS: Participants' mean age was 40 years, 44% were male, and most were born in Mexico. The mean time with diabetes was 6.5 years. The primary theme identified was the bidirectional relationship between emotional health and diabetes. Diagnosis of diabetes led to feelings of hopelessness and upset, while difficulty with diabetes management led to feelings of anxiety and depression. Participants felt that being "stressed out" or sad directly affected their blood sugar. Participants described factors that influence the relationship between emotions and diabetes, including family and societal stressors, and they reported little discussion of depression with providers. Depression and emotional health are closely associated with diabetes in the minds of these Latino adults. It is important to ask patients with diabetes about their emotional health, to screen for depression, and to elicit preferences about treatment when indicated.

Adult↗