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5. Effects of a Family Intervention to Promote Mexican American Family Social Capital for Diabetes Management
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Nurs Outlook 65 (2017) 130e135
5. Effects of a Family Intervention to Promote Mexican American Family Social Capital for Diabetes Management Marylyn Morris McEwen PhD, MS, BSN, Professor, The University of Arizona College of Nursing; Alice Pasvogel PhD, MS, BSN, Assistant Research Scientist, The University of Arizona College of Nursing; Carolyn Murdaugh PhD, FAAN, Professor, The University of Arizona College of Nursing; Joseph Hepworth PhD, Clinical Assistant Professor, The University of Arizona College of Nursing Aims: Family social capital, a critical determinant of health, underpins family engagement in Type 2 diabetes (T2DM) management. A 3-month family-based T2DM self-management social support intervention on family social capital with Mexican American adults with T2DM and their family member was assessed. We hypothesized that the intervention would increase family social capital outcomes operationalized by social integration, social support, family efficacy, health literacy, and health care access. Methods: Using a randomized, two group experimental design, participants with T2DM and a family member (n¼87 dyads) completed questionnaires at baseline, immediately following the intervention, and at 6 months post intervention. Primary analyses were 2X3 ANOVAs with interaction contrasts. Results: Participants with T2DM ranged in age from 38 to 73 (M¼54, SD¼9); family members from 18 to 88 (mean¼48, SD¼16), most had less than a high school education (73% participant; 53% family member), family income was $20,000 or less (69% participant; 58% family member). The intervention significantly increased family self-efficacy (p¼.003) for the participants and family self-efficacy (p¼.016) and family support for physical activity (p¼.023) for family members. All effects were sustained for 6 months. Conclusions: The intervention increased family selfefficacy and family support for physical activity. Further research is needed to identify strategies to increase family social capital for other diabetes self-management behaviors such as healthy eating which benefits all family members. Our family intervention builds on family assets and relationships, the foundation for addressing a critical social determinant of health for diabetes self-management among Mexican American adults.
6. Does Independent NP Scope of Practice Improve Medication Adherence, Reduce Costs, and Reduce Prices for Primary Care Visits? Ulrike Muench RN, Assistant Professor, Social and Behavioral Sciences, UCSF School of Nursing; Joanne Spetz, Professor, Institute for Health Policy Studies
Aims: This study examines the effect of independent scope of practice (SOP) for nurse practitioners on medication adherence, costs of care, and prices for primary care visits. Methods: We used administrative claims from nearly 50 million individuals in the Health Care Cost Institute (HCCI) database, years 2008 e 2012. To capture primary care supply we obtained data on the number of NPs per state. Medication adherence rates were calculated annually for each patient. Cost of care was measured across the inpatient, outpatient, physician and pharmacy claims. Prices were calculated for primary care CPT codes. To estimate the effect of the law we employed the commonly used difference-in-difference approach. Results: An ordinary least squares regression with controls for patient demographic and plan information, out-of-pocket share, and state level covariates found no significant change in medication adherence when states introduced independent SOP. Results for costs of care showed significant increases for annual outpatient, physician, and prescription costs when states switched to independent SOP. Effects ranged from a $74 increase in prescription costs (p < .01) to a $155 increase in outpatient costs (p < .01), and a $289 increase in total costs (p < .01), or approximately 3% for all cost types. Prices on primary care visits dropped significantly on all CPT codes (p < .01), with a moderate effect size of $1-4 dollars, or roughly 2-4%. Conclusions: The findings of this study indicate that independent SOP can maintain prescribing outcomes and may lead to reduced prices. However, as access to care increases, savings in costs of care are unlikely to be a result of independent SOP.
7. Individual, System, and Program Interactions that Create Barriers to Participation in Diabetes Self-Management Education Stephanie D. Smith PhD, RN, Faculty, University of North Carolina Wilmington; Nancy Winterbauer PhD, Faculty, East Carolina University; Mary Bea Kolbe, Diabetes Education Recognition Program Coordinator, NC Division of Public Health Aims: Approximately 10% of NC adults have diabetes and African Americans are disproportionately affected. Diabetes Self-Management Education (DSME) can improve health outcomes, however participation is lower than expected. Our purpose was to identify 1) key barriers to DSME, and 2) opportunities to improve participation. We sought to examine determinants of participation. Methods: 10 focus groups (FGs) were conducted with persons with type II diabetes (T2D) and their family caregivers. FGs were audio-recorded and transcribed. Content analysis was used to code and classify
Nurs Outlook 65 (2017) 130e135
5. Effects of a Family Intervention to Promote Mexican American Family Social Capital for Diabetes Management Marylyn Morris McEwen PhD, MS, BSN, Professor, The University of Arizona College of Nursing; Alice Pasvogel PhD, MS, BSN, Assistant Research Scientist, The University of Arizona College of Nursing; Carolyn Murdaugh PhD, FAAN, Professor, The University of Arizona College of Nursing; Joseph Hepworth PhD, Clinical Assistant Professor, The University of Arizona College of Nursing Aims: Family social capital, a critical determinant of health, underpins family engagement in Type 2 diabetes (T2DM) management. A 3-month family-based T2DM self-management social support intervention on family social capital with Mexican American adults with T2DM and their family member was assessed. We hypothesized that the intervention would increase family social capital outcomes operationalized by social integration, social support, family efficacy, health literacy, and health care access. Methods: Using a randomized, two group experimental design, participants with T2DM and a family member (n¼87 dyads) completed questionnaires at baseline, immediately following the intervention, and at 6 months post intervention. Primary analyses were 2X3 ANOVAs with interaction contrasts. Results: Participants with T2DM ranged in age from 38 to 73 (M¼54, SD¼9); family members from 18 to 88 (mean¼48, SD¼16), most had less than a high school education (73% participant; 53% family member), family income was $20,000 or less (69% participant; 58% family member). The intervention significantly increased family self-efficacy (p¼.003) for the participants and family self-efficacy (p¼.016) and family support for physical activity (p¼.023) for family members. All effects were sustained for 6 months. Conclusions: The intervention increased family selfefficacy and family support for physical activity. Further research is needed to identify strategies to increase family social capital for other diabetes self-management behaviors such as healthy eating which benefits all family members. Our family intervention builds on family assets and relationships, the foundation for addressing a critical social determinant of health for diabetes self-management among Mexican American adults.
6. Does Independent NP Scope of Practice Improve Medication Adherence, Reduce Costs, and Reduce Prices for Primary Care Visits? Ulrike Muench RN, Assistant Professor, Social and Behavioral Sciences, UCSF School of Nursing; Joanne Spetz, Professor, Institute for Health Policy Studies
Aims: This study examines the effect of independent scope of practice (SOP) for nurse practitioners on medication adherence, costs of care, and prices for primary care visits. Methods: We used administrative claims from nearly 50 million individuals in the Health Care Cost Institute (HCCI) database, years 2008 e 2012. To capture primary care supply we obtained data on the number of NPs per state. Medication adherence rates were calculated annually for each patient. Cost of care was measured across the inpatient, outpatient, physician and pharmacy claims. Prices were calculated for primary care CPT codes. To estimate the effect of the law we employed the commonly used difference-in-difference approach. Results: An ordinary least squares regression with controls for patient demographic and plan information, out-of-pocket share, and state level covariates found no significant change in medication adherence when states introduced independent SOP. Results for costs of care showed significant increases for annual outpatient, physician, and prescription costs when states switched to independent SOP. Effects ranged from a $74 increase in prescription costs (p < .01) to a $155 increase in outpatient costs (p < .01), and a $289 increase in total costs (p < .01), or approximately 3% for all cost types. Prices on primary care visits dropped significantly on all CPT codes (p < .01), with a moderate effect size of $1-4 dollars, or roughly 2-4%. Conclusions: The findings of this study indicate that independent SOP can maintain prescribing outcomes and may lead to reduced prices. However, as access to care increases, savings in costs of care are unlikely to be a result of independent SOP.
7. Individual, System, and Program Interactions that Create Barriers to Participation in Diabetes Self-Management Education Stephanie D. Smith PhD, RN, Faculty, University of North Carolina Wilmington; Nancy Winterbauer PhD, Faculty, East Carolina University; Mary Bea Kolbe, Diabetes Education Recognition Program Coordinator, NC Division of Public Health Aims: Approximately 10% of NC adults have diabetes and African Americans are disproportionately affected. Diabetes Self-Management Education (DSME) can improve health outcomes, however participation is lower than expected. Our purpose was to identify 1) key barriers to DSME, and 2) opportunities to improve participation. We sought to examine determinants of participation. Methods: 10 focus groups (FGs) were conducted with persons with type II diabetes (T2D) and their family caregivers. FGs were audio-recorded and transcribed. Content analysis was used to code and classify