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Sperber N.,Duke University | Hall K.S.,Geriatric Research | Allen K.,Durham Center for Health Services Research in Primary Care | DeVellis B.M.,Durham University | And 2 more authors.
Journal of Physical Activity and Health | Year: 2014

Background: Physical and psychological symptoms limit physical activity for people with arthritis. This study examined if self-efficacy mediated a relationship between symptom and physical activity (PA) frequency change. Methods: This was a secondary analysis of older adults with arthritis and joint pain in a trial of a lifestyle PA program (n = 339). Measures were depressive symptoms, pain, fatigue, arthritis self-efficacy, PA self-efficacy, and PA frequency. A panel model was used to analyze relationships at baseline and changes at 20 weeks. Results: The mean age was 68.8 years. At baseline, depression and fatigue were associated with arthritis self-efficacy (β = -.34 and -.24) and, in turn, PA self-efficacy (β = .63); PA self-efficacy was associated with PA (β = .15). Pain and depression changes were associated with arthritis self-efficacy change (β = -.20 and -.21) and, in turn, PA self-efficacy (β = .32) change; PA self-efficacy change was associated with PA change (β = .36). Conclusion: Change in symptom severity affected change in PA frequency. These relationships appeared to operate through self-efficacy. Over time, pain appeared to have a stronger relationship than fatigue with self-efficacy and PA. These findings support strategies to help people with arthritis strengthen their confidence for symptom coping and PA participation. © 2014 Human Kinetics, Inc.

Galanos A.N.,Duke University | Morris D.A.,Duke University | Pieper C.F.,Duke University | Poppe-Ries A.M.,Duke University | And 2 more authors.
American Journal of Hospice and Palliative Medicine | Year: 2012

Background: End-of-life care is deemed to be poor in the United States - particularly in large teaching hospitals. Via a brief survey, we examined satisfaction with end-of-life care for those patients who died in our academic medical center from provider and family perspectives. Methods: To assess the correlation between overall satisfaction between providers (attending, housestaff, and nurses) as well as family members for decedents who died in our hospital, we conducted a satisfaction survey regarding care in the last three days of life. The nine item survey was administered within 1 week of the patient s death to care providers and approximately 8 to 12 weeks to next of kin. Results: There were 166 deaths examined over the four month study period. Overall satisfaction with care was 3.02 out of 4.0, and differed by respondent group (p= 0.035). Correlation between respondents was very low (range 0.02 to 0.51). The least discordance was between residents and interns (0.5), who had the lowest level of satisfaction (2.72). Housestaff and attendings had the lowest overall correlation in mean satisfaction scores (0.05). Most providers knew their patients for 24 hours or less. Conclusions: Overall satisfaction was high, but there was discordance among different providers. Continuity of care was limited. Age and location of death alone did not significantly affect satisfaction with end-of-life care. Implications of this type of research for improving end of life care at academic centers are discussed. © SAGE Publications 2012.

Jacobs S.R.,University of North Carolina at Chapel Hill | Jacobs S.R.,Rti International | Weiner B.J.,University of North Carolina at Chapel Hill | Reeve B.B.,University of North Carolina at Chapel Hill | And 4 more authors.
Clinical Trials | Year: 2014

Background: Our purpose was to identify physicians' individual characteristics, attitudes, and organizational contextual factors associated with higher enrollment of patients in cancer clinical trials among physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). We hypothesized that physicians' individual characteristics, such as age, medical specialty, tenure, CCOP organizational factors (i.e. policies and procedures to encourage enrollment), and attitudes toward participating in CCOP would directly determine enrollment. We also hypothesized that physicians' characteristics and CCOP organizational factors would influence physicians' attitudes toward participating in CCOP, which in turn would predict enrollment. Methods: We evaluated enrollment in National Cancer Institute-sponsored cancer clinical trials in 2011 among 481 physician participants using Structural Equation Modeling. The data sources include CCOP Annual Progress Reports, two surveys of CCOP administrators and physician participants, and the American Medical Association Masterfile. Results: Physicians with more positive attitudes toward participating in CCOP enrolled more patients than physicians with less positive attitudes. In addition, physicians who practiced in CCOPs that had more supportive policies and practices in place to encourage enrollment (i.e. offered trainings, provided support to screen and enroll patients, gave incentives to enroll patients, instituted minimum accrual expectations) also significantly enrolled more patients. Physician status as CCOP Principal Investigator had a positive direct effect on enrollment, while physician age and non-oncology medical specialty had negative direct effects on enrollment. Neither physicians' characteristics nor CCOP organizational factors indirectly influenced enrollment through an effect on physician attitudes. Conclusion: We examined whether individual physicians' characteristics and attitudes, as well as CCOP organizational factors, influenced patient enrollment in cancer clinical trials among CCOP physicians. Physician attitudes and CCOP organizational factors had positive direct effects, but not indirect effects, on physician enrollment of patients. Our results could be used to develop physician-directed strategies aimed at increasing involvement in clinical research. For example, administrators may want to ensure physicians have access to support staff to help screen and enroll patients or institute minimum accrual expectations. Our results also highlight the importance of recruiting physicians for volunteer clinical research programs whose attitudes and values align with programmatic goals. Given that physician involvement is a key determinant of patient enrollment in clinical trials, these interventions could expand the overall number of patients involved in cancer research. These strategies will be increasingly important as the CCOP network continues to evolve. © The Author(s) 2014.

Vorderstrasse A.A.,Duke University | Cho A.,Duke University | Voils C.I.,Durham Center for Health Services Research in Primary Care | Orlando L.A.,Duke University | Ginsburg G.S.,Duke University
Personalized Medicine | Year: 2013

Genetic advances in Type 2 diabetes (T2D) have led to the discovery and validation of multiple markers for this complex disease. Despite low predictive value of current T2D markers beyond clinical risk factors and family history, researchers are exploring the clinical utility and outcomes of implementation in practice, and testing is available via direct-to-consumer markets. Clinical utility research demonstrates high hypothetical utility to patients for motivating behavior change and potentially reducing risk. However, trials to date have not demonstrated improvements in behavioral and clinical outcomes over and above counseling based on traditional risk factors. Ongoing research in T2D genetics and associated risk-prediction models is necessary to refine genetic risk pathways, algorithms for risk prediction and use of this information in clinical care. Further research is also needed to explore care models and support interventions that address the needs of personalized risk information and sustainable preventive behaviors to reduce the rising prevalence of T2D. © 2013 Future Medicine Ltd.

Myers V.H.,Klein Buendel, Inc. | McVay M.A.,Durham Center for Health Services Research in Primary Care | Brashear M.M.,The New School | Johnson W.D.,Louisiana State University | And 3 more authors.
American Journal of Health Promotion | Year: 2014

Purpose. The financial impact of intensive medical interventions for weight loss has not been fully studied. Design. A randomized pragmatic clinical trial. Setting. Seven primary care clinics and one research center in Louisiana. Subjects. Severely obese individuals (body mass index 40-60 kg/m2) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses. Intervention. Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Measures. Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs. Analysis. Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories. Results. Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p=.0125), and for antidiabetic agents (p=.0464), antihypertensives (p=.0075), and dyslipidemic subcategories (p = .0197). Conclusion. An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants. © 2014 by American Journal of Health Promotion, Inc.

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