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Biomedical subjects

Lisa A Cooper

Publications and source records attributed to Lisa A Cooper.

At least 19 recordsLinked to original sources
PubMed2006

Attitudes and illness factors associated with low perceived need for depression treatment among young adults.

BACKGROUND: We do not yet fully understand how low perceived need for treatment leads many young adults to not seek care for their depression. METHODS: A cross-sectional study of 10,962 depressed young adults (ages 16-29) who visited a depression screening/education Internet website. Based on the Theory of Reasoned Action, we developed a multivariate model to determine the effects of beliefs and attitudes, social norms, past treatment behavior, and symptom severity on low perceived depression treatment need (i.e., not agreeing that one needs depression treatment). RESULTS: Negative beliefs and attitudes, social norms, and past treatment behavior predicted low perceived depression treatment need and explained more than half the model variance. Even after adjusting for depression severity and symptoms of other mental disorders, lacking confidence in either a biological or counseling based explanation or treatment approach for depression predicted low perceived depression treatment need. CONCLUSIONS: Lack of helpful treatment experiences and/or confidence in either of the currently practiced depression treatment models may prevent many young adults from seeking depression treatment.

Adolescent↗
PubMed2006

Are physicians' attitudes of respect accurately perceived by patients and associated with more positive communication behaviors?

OBJECTIVE: To explore the domain of physician-reported respect for individual patients by investigating the following questions: How variable is physician-reported respect for patients? What patient characteristics are associated with greater physician-reported respect? Do patients accurately perceive levels of physician respect? Are there specific communication behaviors associated with physician-reported respect for patients? METHODS: We audiotaped 215 patient-physician encounters with 30 different physicians in primary care. After each encounter, the physician rated the level of respect that s/he had for that patient using the following item: "Compared to other patients, I have a great deal of respect for this patient" on a five-point scale between strongly agree and strongly disagree. Patients completed a post-visit questionnaire that included a parallel respect item: "This doctor has a great deal of respect for me." Audiotapes of the patient visits were analyzed using the Roter Interaction Analysis System (RIAS) to characterize communication behaviors. Outcome variables included four physician communication behaviors: information-giving, rapport-building, global affect, and verbal dominance. A linear mixed effects modeling approach that accounts for clustering of patients within physicians was used to compare varying levels of physician-reported respect for patients with physician communication behaviors and patient perceptions of being respected. RESULTS: : Physician-reported respect varied across patients. Physicians strongly agreed that they had a great deal of respect for 73 patients (34%), agreed for 96 patients (45%) and were either neutral or disagreed for 46 patients (21%). Physicians reported higher levels of respect for older patients and for patients they knew well. The level of respect that physicians reported for individual patients was not significantly associated with that patient's gender, race, education, or health status; was not associated with the physician's gender, race, or number of years in practice; and was not associated with race concordance between patient and physician. While 45% of patients overestimated physician respect, 38% reported respect precisely as rated by the physician, and 16% underestimated physician respect (r=0.18, p=0.007). Those who were the least respected by their physician were the least likely to perceive themselves as being highly respected; only 36% of the least respected patients compared to 59% and 61% of the highly and moderately respected patients perceived themselves to be highly respected (p=0.012). Compared with the least-respected patients, physicians were more affectively positive with highly respected patients (p=0.034) and provided more information to highly and moderately respected patients (p=0.018). CONCLUSION: Physicians' ratings of respect vary across patients and are primarily associated with familiarity rather than sociodemographic characteristics. Patients are able to perceive when they are respected by their physicians, although when they are not accurate, they tend to overestimate physician respect. Physicians who are more respectful towards particular patients provide more information and express more positive affect in visits with those patients. PRACTICE IMPLICATIONS: Physician respectful attitudes may be important to target in improving communication with patients.

Adolescent↗
PubMed2006

Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions.

BACKGROUND: Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities. METHODS: We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities. RESULTS: Twenty-seven studies met criteria for review. Almost all (n = 26) took place in the primary care setting, and most (n = 19) focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive) reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable), provider education alone (2 of 2 studies favorable), use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable), and use of remote simultaneous translation (1 of 1 study favorable). Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these strategies, as only one study reported cost data. CONCLUSION: There are several promising strategies that may improve health care quality for racial/ethnic minorities, but a lack of studies specifically targeting disease areas and processes of care for which disparities have been previously documented. Further research and funding is needed to evaluate strategies designed to reduce disparities in health care quality for racial/ethnic minorities.

Ethnicity↗
PubMed2006

Depressive symptoms and health-related quality of life in early pregnancy.

OBJECTIVE: Depressive symptoms can be associated with lower health-related quality of life in late pregnancy. Few studies have quantified the effect of depressive symptoms in early pregnancy or among a racially and economically diverse group. Our goal was to estimate the independent association of depressive symptoms with health-related quality of life among a diverse group of women in early pregnancy. METHODS: We conducted a cross-sectional study of 175 pregnant women receiving prenatal care in a community and university-based setting. We related the presence of depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale score of 16 or more to health-related quality of life scores from the 8 Medical Outcomes Study Short Form domains: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. Quantile regression was used to measure the independent association of depressive symptoms with each of the 8 domains. RESULTS: The study sample was 49% African American, 38% white, and 11% Asian. Mean (+/- standard deviation) gestational age was 14 +/- 6 weeks. The prevalence of depressive symptoms was 15%. Women with depressive symptoms had significantly lower health-related quality of life scores in all domains except Physical Functioning. After adjustment for sociodemographic, clinical, and social support factors, depressive symptoms were associated with health-related quality of life scores that were 30 points lower in Role-Physical, 19 points lower in Bodily Pain, 10 points lower in General Health, and 56 points lower in Role-Emotional. CONCLUSION: Women in early pregnancy with depressive symptoms have poor health-related quality of life. Early identification and management of depressive symptoms in pregnant women may improve their sense of well-being. LEVEL OF EVIDENCE: II-2.

Adaptation, Psychological↗
PubMed2006

Maternal race, procedures, and infant birth weight in type 2 and gestational diabetes.

OBJECTIVE: To examine the relation between race and cesarean delivery, episiotomy, and low birth weight infants in pregnancies with type 2 and gestational diabetes mellitus and to identify factors that might explain racial differences. METHODS: Population-based, cross-sectional study of 1999-2004 Maryland hospital discharge data. Hospitalizations for delivery of pregnancies with type 2 and gestational diabetes mellitus were identified and matched to infants. The independent variable was maternal race. Dependent variables were cesarean delivery, episiotomy, and low infant birth weight. Stepwise logistic regression models were developed to estimate the independent effect of race on use of each procedure and infant birth weight, after adjusting for sociodemographic, hospital, and clinical factors. RESULTS: We examined 6,310 deliveries for pregnancies with type 2 (15%) and gestational (85%) diabetes. Before adjustment, black race was associated with a higher odds of cesarean delivery (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24-1.58) and low birth weight infants (OR 1.94, 95% CI 1.57-2.40) compared with white race. Adjustment for racial differences in preeclampsia and fetal heart rate abnormalities accounted for a modest degree of the racial variation in outcomes. With full adjustment, black race was still associated with a higher odds of cesarean delivery (OR 1.38, 95% CI 1.20-1.60) and low birth weight (OR 1.81, 95% CI 1.41-2.34) and a lower odds of episiotomy (OR 0.45, 95% CI 0.36-0.57). CONCLUSION: In pregnancies with diabetes, adjustment for sociodemographic, hospital, and clinical factors only partially explains racial differences in procedure use and infant low birth weight.

Adult↗
PubMed2006

Primary care patients' involvement in decision-making is associated with improvement in depression.

BACKGROUND: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. OBJECTIVE: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. DESIGN: Prospective cohort study. SETTING: Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care. SUBJECTS: Primary care patients with current symptoms and probable depressive disorder. MEASUREMENTS: Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors. RESULTS: For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P < 0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004). CONCLUSIONS: Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.

Adolescent↗
PubMed2006

Delving below the surface. Understanding how race and ethnicity influence relationships in health care.

There is increasing evidence that racial and ethnic minority patients receive lower quality interpersonal care than white patients. Therapeutic relationships constitute the interpersonal milieu in which patients are diagnosed, given treatment recommendations, and referred for tests, procedures, or care by consultants in the health care system. This paper provides a review and perspective on the literature that explores the role of relationships and social interactions across racial and ethnic differences in health care. First, we examine the social and historical context for examining differences in interpersonal treatment in health care along racial and ethnic lines. Second, we discuss selected studies that examine how race and ethnicity influence clinician-patient relationships. While less is known about how race and ethnicity influence clinician-community, clinician-clinician, and clinician-self relationships, we briefly examine the potential roles of these relationships in overcoming disparities in health care. Finally, we suggest directions for future research on racial and ethnic health care disparities that uses a relationship-centered paradigm.

Cultural Diversity↗
PubMed2005

The moral nature of patient-centeredness: is it "just the right thing to do"?

OBJECTIVE: Patient-centeredness is regarded as an important feature of high quality patient care, but little effort has been devoted to grounding patient-centeredness as an explicitly moral concept. We sought to describe the moral commitments that underlie patient-centered care. METHODS: We analyzed the key ideas that are commonly described in the literature on patient-centeredness in the context of three major schools of ethical thought. RESULTS: Consequentialist moral theories focus on the positive outcomes of providing patient-centered care. Deontological theories emphasize how patient-centered care reflects the ethical norms inherent in medicine, such as respect for persons and shared decision-making. Virtue-based theories highlight the importance of developing patient-centered attitudes and traits, which in turn influence physicians' behaviors toward their patients. CONCLUSION: Different ethical theories concentrate on different features of patient-centered care, but all can agree that patient-centeredness is morally valuable. PRACTICE IMPLICATIONS: In order to sustain patient-centeredness as a moral concept, practitioners and students ought to examine these ideas to determine what their own personal reasons are for or against adopting a patient-centered approach.

Attitude of Health Personnel↗
PubMed2005

A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals.

PURPOSE: To systematically examine the methodological rigor of studies using cultural competence training as a strategy to improve minority health care quality. To the authors' knowledge, no prior studies of this type have been conducted. METHOD: As part of a systematic review, the authors appraised the methodological rigor of studies published in English from 1980 to 2003 that evaluate cultural competence training, and determined whether selected study characteristics were associated with better study quality as defined by five domains (representativeness, intervention description, bias and confounding, outcome assessment, and analytic approach). RESULTS: Among 64 eligible articles, most studies (no. = 59) were published recently (1990-2003) in education (no. = 26) and nursing (no. = 14) journals. Targeted learners were mostly nurses (no. = 32) and physicians (no. = 19). Study designs included randomized or concurrent controlled trials (no. = 10), pretest/posttest (no. = 22), posttest only (no. = 27), and qualitative evaluation (no. = 5). Curricular content, teaching strategies, and evaluation methods varied. Most studies reported provider outcomes. Twenty-one articles adequately described provider representativeness, 21 completely described curricular interventions, eight had adequate comparison groups, 27 used objective evaluations, three blinded outcome assessors, 14 reported the number or reason for noninclusion of data, and 15 reported magnitude differences and variability indexes. Studies targeted at physicians more often described providers and interventions. Most trials completely described targeted providers, had adequate comparison groups, and reported objective evaluations. Study quality did not differ over time, by journal type, or by the presence or absence of reported funding. CONCLUSIONS: Lack of methodological rigor limits the evidence for the impact of cultural competence training on minority health care quality. More attention should be paid to the proper design, evaluation, and reporting of these training programs.

Cultural Diversity↗
PubMed2005

Cultural competence: a systematic review of health care provider educational interventions.

OBJECTIVE: We sought to synthesize the findings of studies evaluating interventions to improve the cultural competence of health professionals. DESIGN: This was a systematic literature review and analysis. METHODS: We performed electronic and hand searches from 1980 through June 2003 to identify studies that evaluated interventions designed to improve the cultural competence of health professionals. We abstracted and synthesized data from studies that had both a before- and an after-intervention evaluation or had a control group for comparison and graded the strength of the evidence as excellent, good, fair, or poor using predetermined criteria. MAIN OUTCOME MEASURES: We sought evidence of the effectiveness and costs of cultural competence training of health professionals. RESULTS: Thirty-four studies were included in our review. There is excellent evidence that cultural competence training improves the knowledge of health professionals (17 of 19 studies demonstrated a beneficial effect), and good evidence that cultural competence training improves the attitudes and skills of health professionals (21 of 25 studies evaluating attitudes demonstrated a beneficial effect and 14 of 14 studies evaluating skills demonstrated a beneficial effect). There is good evidence that cultural competence training impacts patient satisfaction (3 of 3 studies demonstrated a beneficial effect), poor evidence that cultural competence training impacts patient adherence (although the one study designed to do this demonstrated a beneficial effect), and no studies that have evaluated patient health status outcomes. There is poor evidence to determine the costs of cultural competence training (5 studies included incomplete estimates of costs). CONCLUSIONS: Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

Attitude of Health Personnel↗
PubMed2005

The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine.

BACKGROUND: Ethnic diversity among physicians may be linked to improved access and quality of care for minorities. Academic medical institutions are challenged to increase representation of ethnic minorities among health professionals. OBJECTIVES: To explore the perceptions of physician faculty regarding the following: (1) the institution's cultural diversity climate and (2) facilitators and barriers to success and professional satisfaction in academic medicine within this context. DESIGN: Qualitative study using focus groups and semi-structured interviews. PARTICIPANTS: Nontenured physicians in the tenure track at the Johns Hopkins University School of Medicine. APPROACH: Focus groups and interviews were audio-taped, transcribed verbatim, and reviewed for thematic content in a 3-stage independent review/adjudication process. RESULTS: Study participants included 29 faculty representing 9 clinical departments, 4 career tracks, and 4 ethnic groups. In defining cultural diversity, faculty noted visible (race/ethnicity, foreign-born status, gender) and invisible (religion, sexual orientation) dimensions. They believe visible dimensions provoke bias and cumulative advantages or disadvantages in the workplace. Minority and foreign-born faculty report ethnicity-based disparities in recruitment and subtle manifestations of bias in the promotion process. Minority and majority faculty agree that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, and qualifications for and subsequent recruitment to training programs and faculty positions. Minority faculty also describe structural barriers (poor retention efforts, lack of mentorship) that hinder their success and professional satisfaction after recruitment. To effectively manage the diversity climate, our faculty recommended 4 strategies for improving the psychological climate and structural diversity of the institution. CONCLUSIONS: Soliciting input from faculty provides tangible ideas regarding interventions to improve an institution's diversity climate.

Academic Medical Centers↗
PubMed2005

An assessment of the shared-decision model in parents of children with acute otitis media.

OBJECTIVE: Medicine is shifting from a doctor-centered approach to a model entailing more shared decision-making. Many organizations now recommend a shared-decision approach to treating children with acute otitis media (AOM). Our primary objectives in this study were to assess (1) which style of decision-making on the physician's part would most effectively reduce parents' proclivity to use antibiotics for treatment of their child's AOM and (2) parental satisfaction with different doctor-patient decision-making styles. METHODS: We conducted a cross-sectional survey to examine how parents respond to doctor-patient communication styles in 3 clinical vignettes that presented 2 versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were randomly assigned to receive 1 of 3 vignettes. The main predictor variable was the vignette assignment, and the main outcomes were (1) parent proclivity to use antibiotics and (2) parent ratings of care by the physician in the vignette. Using logistic regression, we adjusted for caregivers' age, gender, income, knowledge of antibiotics, decision-making preference, confidence in physician, and length of relationship with personal physician. RESULTS: Four hundred sixty-six parents met inclusion criteria, with a response rate of 94%. General characteristics were similar across vignette assignment groups. Parents who received the paternalistic-model vignettes were more likely to say that they would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9; 95% confidence interval: 2.3-10.6). This result remained statistically significant after adjustment for potential confounders. In addition, parents in the shared-decision groups were more satisfied (93% and 84%) than those in the paternalistic-model group (76%). CONCLUSIONS: To our knowledge, this is the first study to examine parent interest, acceptance, and satisfaction with the SDM. Our findings suggest that shared decision-making for AOM may lead to less antibiotic usage and higher levels of parental satisfaction. Although more studies are needed to examine how best to incorporate parents in the SDM, our study serves as an example of the potential benefit of this approach in pediatric medicine.

Adult↗
PubMed2005

Racial and socioeconomic differences in the weight-loss experiences of obese women.

Focus groups stratified by race and socioeconomic status were used to examine obese women's experiences with weight-loss methods. Six themes emerged: failure of weight maintenance, use of psychological and spiritual approaches, role of family influences and societal expectations, role of African American subculture, method affordability, and racial differences in weight-loss methods. Tailored weight-management interventions for women, particularly African Americans and those of low socioeconomic status, should account for features of African American subculture and address affordability concerns, include maintenance strategies that incorporate psychological and spiritual principles, and target family attitudes and behaviors.

Adult↗
PubMed2005

Changes in depressive symptoms and metabolic control over 3 years among African Americans with type 2 diabetes.

OBJECTIVE: It is established that individuals with diabetes have high rates of depression, but the longitudinal relationship between depression and glycemic control has not been well examined, particularly among African Americans. The objective of this study was to evaluate the longitudinal relationship between depressive symptoms and metabolic control. METHOD: We conducted an earlier cross-sectional study that demonstrated marginal and significant associations between depressive symptoms (using the Center for Epidemiologic Studies Depression Scale [CES-D]) and metabolic control (HbA1c, lipids, blood pressure) among 183 African Americans with type 2 diabetes. In this report, we present data on these individuals, followed for three years, and examine the relationship between change in depressive symptoms and change in metabolic control over that time period. RESULTS: Results showed that that there were no statistically significant associations between baseline or change in depressive symptoms and metabolic control over three years. Limited statistical power may explain this negative finding. CONCLUSIONS: This study provides insight into the relationship between depression and metabolic control. Prospective observational studies are needed to further evaluate this relationship.

Black or African American↗
PubMed2004

Whole body donation for medical science: a population-based study.

Although cadaveric whole-body donation for the purposes of medical science is extremely important for medical education, the number of persons who choose to donate remains low. We assessed persons' willingness to consider whole body donation in a standardized telephone survey of Maryland households, identified using random digit dialing. In multivariable analyses, we assessed the independent relation of sociodemographics and attitudinal factors to willingness to consider donation, and we determined the amount of variation in willingness to consider donation among the study population that could be explained by these factors. Of 385 participants (84% of randomized homes), 49% reported they would consider whole body donation. In bivariate analysis, younger age, African-American race/ethnicity, less education and income, greater number of dependents, marital status, and attitudes about religion/spirituality, trust in hospitals, and income, gender, and racial/ethnic discrimination in hospitals were statistically significantly associated with 40-70% less odds of willingness to consider donation. After adjustment, persons of African-American race/ethnicity, less education, and those agreeing with the statements, "Rich patients receive better care at hospitals than poor patients," and "White patients receive better care at hospitals than other racial or ethnic groups," had 40-60% less odds of willingness to consider donation when compared to their counterparts. Respondents' race/ethnicity and education contributed most to willingness to consider donation. We conclude that demographic and attitudinal factors are strongly related to willingness to consider whole body donation. Efforts to enhance donation should seek to identify ways in which potential barriers to donation can be addressed by health professionals.

Adolescent↗
PubMed2004

Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries.

BACKGROUND: This study assessed the relation of comorbid depressive syndrome with utilization of emergency department services and preventable inpatient hospitalizations among elderly individuals with chronic medical conditions. RESEARCH DESIGN: A cross-sectional study. SETTING: Individuals greater than or equal to 65 years of age living in the United States with Medicare part A and B fee-for-service coverage in 1999. SUBJECTS: A 5% random sample of elderly Medicare recipients (N = 1,238,895) of whom 60,382 (4.9%) met criteria for a depressive syndrome. MEASUREMENTS: Medicare beneficiaries were stratified based on the presence of at least 1 of the following medical conditions: coronary artery disease, diabetes mellitus, congestive heart failure, hypertension, prostate cancer, breast cancer, lung cancer, or colon cancer. For each stratum, we compared the odds of emergency department visits, all-cause hospitalization, and hospitalization for ambulatory care sensitive conditions (ACSC), conditions for which timely and effective medical care could decrease risk of hospitalization, for beneficiaries with and without a depressive syndrome. RESULTS: Compared with those without a depressive syndrome, beneficiaries with a depressive syndrome were more likely to be older, white, and female (P <0.001). For each of the 8 chronic medical conditions, elderly beneficiaries with a depressive syndrome were at least twice as likely to use emergency department services (range of adjusted odds ratios, 2.12-3.16; P <0.001); medical inpatient hospital services (range of adjusted odds ratios, 2.59-3.71; P <0.001); and medical inpatient hospital services associated with an ACSC (range of adjusted odds ratios, 1.72-2.68; P <0.001) as compared with those without a depressive syndrome. CONCLUSIONS: For elderly individuals with at least 1 chronic medical condition, the presence of a depressive syndrome increased the odds of acute medical service use, suggesting that improvements in clinical management, access to mental health services, and coordination of medical and mental health services could reduce utilization.

Aged↗