Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study.

BACKGROUND: The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters. AIMS: To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices. METHOD: Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ±â€¯8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices. RESULTS: 66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (ß = 0.359, p = 0.004) as the strongest determinant, followed by attitude (ß = 0.195, p = 0.093), and perceived behavioral control (PBC) (ß = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (ß = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (ß = 0.636, p < 0.001) on future PPP implementations. DISCUSSION: This study demonstrates utility of the TPB in predicting implementation of PPPs. CONCLUSIONS: Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.

Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes.

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

Identification, Treatment, and Prevention of Calcium-Alkali Syndrome in Elderly Patients.

OBJECTIVE: To guide pharmacists in identifying geriatric patients at risk, and providing education on the prevention and monitoring of calcium-alkali syndrome. DATA SOURCES: Searches of MEDLINE and Google Scholar (1990-February 2014). Search terms included milk-alkali syndrome, calcium-alkali syndrome, hypercalcemia, calcium carbonate, geriatric patients, and elderly patients. STUDY SELECTION: Published articles and case reports were chosen for inclusion to provide evidence-based treatment and management of calcium-alkali syndrome in elderly patients. DATA SYNTHESIS: There are not many observational, prospective, and randomized studies focusing on treating calcium-alkali syndrome in geriatric patients. Information was extrapolated from four case-based studies focusing on geriatric individuals affected by calcium-alkali syndrome. CONCLUSION: Conventional treatments used in the case studies were shown to be effective in treating geriatric patients affected by calcium-alkali syndrome. Use of case studies affects generalization and specific treatment and prevention strategies in the geriatric patient population. While more robust studies are still required to display definite treatments for geriatric patients, the case studies demonstrated resolution in health outcomes with conventional treatments. The use of optimized adult treatments and prevention strategies effectively improves health conditions in geriatric patients affected or susceptible to calcium-alkali syndrome.