College of Public Health

College publishes on cardiovascular disease in central Appalachia

Dr. Hadii Mamudu, Professor in East Tennessee State University College of Public Health’s Department of Health Services Management and Policy, is lead author of an article in the Journal of Health Care for the Poor and Underserved.  The article, Perceptions and Understanding of Patients with Cardiovascular Disease and Non-Licensed Caregivers about Patient-Centered Care: An Exploratory Study in Central Appalachia, explored knowledge, understanding, and perceptions of patient-centered care among patients with cardiovascular diseases and their non-licensed caregivers in Central Appalachia, a medically underserved rural environment.

Kristy Gagnon, doctoral student, and Dr. Mary Ann Littleton, Professor Emerita, in the Department of Community and Behavioral Health were co-authors along with Amy Poole and Cynthia Blair, Project Coordinators in the Department of Health Services Management and Policy.  Additional co-authors included Ginny Kidwell, Executive Director of the Tennessee Institute of Public Health, Rob Gregory, Vice President, Karing Hearts Cardiology, and Timir Paul, Program Director for Cardiology Fellowship at University of Tennessee at Nashville.

The Mended Hearts program is a national peer-support program for patients who have cardiovascular disease, their caregivers and their families.  Lynn Frierson and Carl Voigt, members of Mended Hearts, were also co-authors.

Cardiovascular diseases remain the leading cause of death in the United States, accounting for one in three deaths annually.  Disparities in CVD outcomes and risk factors exist across demographic groups, socioeconomic strata, and geographic areas with places such as Central Appalachia having disproportionately high burdens. One national public health goal is to reduce/eliminate these disparities at both individual and population levels.  

Patient-centered care is a model of health care delivery for improving both physician/patient outcomes and quality of care that has been heavily promoted over the past decades because of the potential to contribute to these efforts to reduce/eliminate health disparities.  Evidence indicates that patient-centered care improves disease outcomes and quality of life and may be critical to addressing racial, ethnic, and socioeconomic disparities in health care and health outcomes.

The present study is a qualitative exploratory study designed to uncover important themes on the topic of patient-centered care among patients with cardiovascular disease and non-licensed caregivers  in Central Appalachia. Seven focus group discussions involving 78 patients and caregivers were conducted across the six states of the region.   The importance of developing strong interpersonal patient/provider relationships was the overarching theme of all seven groups, aligning with the literature explicating patient-centered care tenets and best practices and this study's conceptual model. Thus, it is vital for providers  to understand the role that communication plays in creating positive patient perceptions of health care.

Without effective reciprocal communication, participants felt disempowered both as patients and as people. Models of care that actively engage both patients and non-licensed caregivers in health care are needed. The participants in this study advocated for such a change, to a situation where they are a full member of their health care team and treated as a "person with cardiovascular disease," not a "patient with cardiovascular disease."