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  1. Article ; Online: Predictors and outcomes of early adherence to the use of a home telehealth device by older veterans with heart failure.

    Guzman-Clark, Jenice Ria S / van Servellen, Gwen / Chang, Betty / Mentes, Janet / Hahn, Theodore J

    Telemedicine journal and e-health : the official journal of the American Telemedicine Association

    2012  Volume 19, Issue 3, Page(s) 217–223

    Abstract: Objectives: The present study examined home telehealth (HT) adherence, and its potential predictors and outcomes, in older Veterans with heart failure (HF) using the Health Buddy (Bosch Healthcare, Palo Alto, CA) device.: Subjects and methods: This ... ...

    Abstract Objectives: The present study examined home telehealth (HT) adherence, and its potential predictors and outcomes, in older Veterans with heart failure (HF) using the Health Buddy (Bosch Healthcare, Palo Alto, CA) device.
    Subjects and methods: This was a retrospective study using secondary data from the Department of Veterans Affairs (VA) databases, describing adherence rates and patterns in the first 90 days after enrollment in 248 older Veterans with HF enrolled in the VA HT Programs using the Health Buddy at five medical centers in Southern California and Nevada, between June 1, 2006 and June 1, 2008. Adherence to the use of Health Buddy was defined as the number of days the patient completed an HT session over different time frames during the study period.
    Results: Significant differences occurred between average adherence across all three 30-day time frame increments, with adherence decreasing over time. Despite the use of standardized VA HT protocols and equipment, the department in which the HT program was embedded was a consistent significant predictor of patient adherence in all time frames, with odds ratios of 2.2-4.0 for the department with the consistent best adherence versus that with the worse adherence (confidence intervals varying with the time frame, p<0.03). Increased co-morbidity burden was associated with decreased adherence only in the first 30 days after enrollment. In this short-term study, no relationship was found between adherence to the use of the Health Buddy and outcomes.
    Conclusions: Program and patient characteristics warrant further study as potential predictors of HT device adherence. Additional research is also needed to further examine the relationships between HT device adherence and various outcomes.
    MeSH term(s) Aged ; Aged, 80 and over ; Comorbidity ; Female ; Health Services/statistics & numerical data ; Health Status ; Heart Failure/therapy ; Humans ; Male ; Mental Health ; Patient Compliance/statistics & numerical data ; Patient Satisfaction ; Retrospective Studies ; Telemedicine/organization & administration ; Telemedicine/statistics & numerical data ; Time Factors ; United States ; Veterans
    Language English
    Publishing date 2012-12-26
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2035659-6
    ISSN 1556-3669 ; 1530-5627
    ISSN (online) 1556-3669
    ISSN 1530-5627
    DOI 10.1089/tmj.2012.0096
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Barriers in the management of glucocorticoid-induced osteoporosis.

    Guzman-Clark, Jenice Ria S / Fang, Meika A / Sehl, Mary E / Traylor, Laural / Hahn, Theodore J

    Arthritis and rheumatism

    2007  Volume 57, Issue 1, Page(s) 140–146

    Abstract: Objective: To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers ... ...

    Abstract Objective: To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers and interventions in the management of GIOP.
    Methods: To characterize current management of GIOP in an academic veterans administration medical center, we conducted a retrospective chart review of 100 patients who were prescribed a 90-day supply of prednisone. To assess clinicians' knowledge of GIOP clinical guidelines and perceptions of GIOP management, primary care clinicians and subspecialists completed a questionnaire and participated in focus groups.
    Results: Chart review revealed that only 32 of 100 patients receiving long-term glucocorticoid treatment underwent bone mineral density testing, and only 32 patients were prescribed the recommended calcium supplements. Of the 23 providers who completed the questionnaire and participated in the focus groups, 4 correctly identified both the dose and duration of glucocorticoid use at which GIOP prevention measures should be instituted. Common GIOP management barriers cited by participants were lack of knowledge, having limited time during the clinic visit to address all problems, patient nonadherence, and system problems. The most commonly mentioned potential interventions were the use of computerized clinical reminders and patient education.
    Conclusion: Clinicians frequently do not follow recommended guidelines for the management of GIOP. Improving the management of GIOP will likely require a fundamental redesigning of care processes for this disorder in order to overcome provider, patient-related, and system barriers.
    MeSH term(s) Aged ; Aged, 80 and over ; Arthritis, Rheumatoid/drug therapy ; Calcium, Dietary/therapeutic use ; Clinical Competence ; Female ; Focus Groups ; Glucocorticoids/adverse effects ; Glucocorticoids/therapeutic use ; Guideline Adherence ; Health Surveys ; Hospitals, Veterans ; Humans ; Male ; Middle Aged ; Osteoporosis/chemically induced ; Osteoporosis/drug therapy ; Osteoporosis/prevention & control ; Patient Education as Topic ; Prednisone/adverse effects ; Prednisone/therapeutic use ; Retrospective Studies ; Risk Factors
    Chemical Substances Calcium, Dietary ; Glucocorticoids ; Prednisone (VB0R961HZT)
    Language English
    Publishing date 2007-02-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 127294-9
    ISSN 1529-0131 ; 0004-3591 ; 2326-5191
    ISSN (online) 1529-0131
    ISSN 0004-3591 ; 2326-5191
    DOI 10.1002/art.22462
    Database MEDical Literature Analysis and Retrieval System OnLINE

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