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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1027 — Using an Illness Web to Understand the Role of Co-Occurring Illnesses in Veterans’ Self-Management of Hypertension

Fix GM (Center for Health Quality, Outcomes & Economic Research (CHQOER), ENRM VA Medical Center), Solomon JL (CHQOER), Cohn EC (Sargent College of Health and Rehabilitation Sciences), Mueller N (CHQOER), Cortés DE (The Cambridge Health Alliance, Cambridge Hospital), Elwy AR (CHQOER), Kressin NR (CHQOER), Haidet PM (Pennsylvania State University), Borzecki AM (CHQOER), Bokhour BG (CHQOER)

Objectives:
Uncontrolled hypertension (HTN) is a major risk factor for stroke and heart attack. Our previous work has shown that patient explanatory models (EM) of HTN may drive self-management behaviors. Researchers have focused on EMs to gain insight into how patients understand an illness’s etiology, symptoms, pathophysiology, course, and treatment. EMs traditionally focus on one condition. However, HTN does not occur in isolation; 70% of those with HTN have another chronic condition. We examined patient EMs of HTN in relation to other conditions to understand barriers to self-management.

Methods:
In-depth, qualitative interviews about HTN self-management were conducted at two large VA medical centers with 48 veterans with uncontrolled HTN. Interviews focused on EMs of HTN, beliefs about treatment, and daily living experiences of managing HTN. Verbatim transcripts were analyzed by a multidisciplinary team using methods from grounded theory. We iteratively coded for themes until consensus was reached.

Results:
Co-occurring illnesses interfered with HTN self-management in the following ways: 1) Integrating information: Veterans had trouble interpreting and integrating clinical information. Specifically, disentangling symptoms of and treatments for HTN in relation to other conditions was confusing. Understanding medical information was particularly difficult when conditions were discussed in unfamiliar terms, such as the values assigned to HTN and glucose levels. 2) Conflicting regimens: Veterans had trouble with complex or seemingly conflicting regimens. They struggled with health recommendations they perceived as incompatible for someone with limitations in lung function or mobility. 3) Medication management: Medication practices were confusing or worrisome. Veterans expressed confusion about taking numerous medications at varying times throughout the day, and also worried about potentially harmful interactions.

Implications:
HTN self-management is complicated by veterans’ understandings of other conditions in relation to HTN. Veterans incorporate HTN self-management into complex EMs, creating what we called an illness web. Illness webs are patient-centered EMs that integrate co-occurring illness experiences. They may inform researchers and clinicians about how best to address clinically salient concerns.

Impacts:
Illness webs can provide a framework for understanding how veterans prioritize self-management behaviors, and may better inform the management of co-occurring illnesses in the context of PACTs.


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