Improving Patient-Centered Care for Underserved Older African American Patients With Cardiovascular Comorbidities

University of Alabama at Birmingham29 enrolled

Overview

This is formative evaluation trial guided by the Values Clarification Theory25 and the Cultural Values Theory26, with specific aims to: Aim 1. Develop a culturally appropriate version of the PPC Approach for older AAs with CVCs by assembling a community advisory group of 3 primary care clinicians, 3 older AA patients with CVCs, and 3 AA persons who care for AA patients with CVCs to solicit feedback on the PPC Approach. Aim 2. Determine the acceptability (e.g., program appraisal interviews) and feasibility (e.g., avg. length of program sessions, program participation rate, study completion rate) of the PPC Approach among a sample 20 of under-resourced older southern AA patients with CVCs receiving primary care at Cooper Green Mercy Health Services Authority. Aim 3. Examine the ability of participants to complete pre- and post-test (8 weeks post-baseline) measures of perception of care, treatment burden, shared decision-making, and patient-clinician communication exchange.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Cardiovascular Comorbidity Diabetes Inflammatory Joint Diseases Chronic Kidney Diease Chronic Obstructive Pulmonary Disease (COPD)

Eligibility

Sex: ALLMin age: 50 YearsMax age: 99 Years

Medical Language ↔ Plain English

Inclusion Criteria: * greater than or equal to 50 years old * at least one CVD (i.e., coronary artery disease, hypertension, heart failure, arrhythmias, cardiomyopathy, peripheral artery disease, stroke, and valvular heart disease) * at least one coexisting chronic condition (i.e., inflammatory joint disease, COPD/asthma, diabetes, chronic kidney disease, and cancer one-year post-treatment) * a caregiver of a participant, or a provider who serves this population. Exclusion Criteria: * Axis I psychiatric (schizophrenia, bipolar disorder), dementia, suicidal ideation, * active substance use disorder nursing home or assisted living facility residence.

Outcomes

Primary Outcomes

Older Patient Assessment of Chronic Illness Care (O-PACIC) Score

Patient experience with integrated care delivery and self-management support measured using the 10-item Older Patient Assessment of Chronic Illness Care (O-PACIC) questionnaire. Responses to the 10 items will be summed to calculate a total score ranging from 10 to 50. Higher scores indicate more positive perceptions of chronic illness care. Scores will be reported at baseline and 8 weeks post-baseline, along with the change from baseline.

Time frame: Baseline and eight weeks post- baseline.

Secondary Outcomes

Treatment Burden Questionnaire (TBQ) Score

Perceived treatment burden measured using the 13-item Treatment Burden Questionnaire (TBQ). Each item is rated from 0, indicating not a problem, to 10, indicating a big problem. Item scores will be summed to calculate a total score ranging from 0 to 130. Higher scores indicate greater perceived treatment burden. Scores will be reported at baseline and 8 weeks post-baseline, along with the change from baseline.

Time frame: Baseline and eight weeks post- baseline

Perceived Shared Clinical Decision-Making (CollaboRATE Score)

Patient perception of involvement in shared decision-making measured using the 3-item CollaboRATE questionnaire. Responses to the three items will be averaged to calculate an overall mean score ranging from 1 to 9. Higher scores indicate greater perceived involvement in shared decision-making. Scores will be assessed at baseline and 8 weeks post-baseline, and change from baseline will be evaluated.

Time frame: Baseline and eight week post- baseline