Copyright 2014 American Medical Association. All rights reserved.
Letters
Table
2.
Reported
Health
Behaviors
by
Medical
Conspiracism
Respondents Who Regularly
Engage
in the Behavior, %
(N = 1351)
No. of Medical Conspiracy
Theories Agreed With
Behavior
Total
0
1 or 2
≥3
Take
herbal
supplements
20
13
22
35
Buy
local/farm
stand
food
23
14
30
37
Prioritize
organic
21
18
22
24
food
consumption
Take
vitamins
57
54
61
58
Get
annual
physical
45
48
46
37
examination
Get
influenza
shot
35
39
36
25
Visit
dentist
41
44
39
33
Use
sunscreen
35
38
34
30
recognize that most individuals who endorse these narra-
tives are otherwise “normal” and that conspiracism arises from
common attribution processes.
2
Medical conspiracism may also
be a diagnostic tool for health practitioners because conspira-
cists are
less willing to follow traditional medical advice, such
as using sunscreens or vaccines, and are more
likely to use al-
ternative treatments.
J.
Eric
Oliver,
PhD
Thomas
Wood,
MA
Author
Affiliations:
Department
of
Political
Science,
University
of
Chicago,
Chicago,
Illinois
(Oliver,
Wood).
Corresponding
Author:
J.
Eric
Oliver,
PhD,
Department
of
Political
Science,
University
of
Chicago,
518
Pick
Hall,
5828
S
University
Ave,
Chicago,
IL
60637
(eoliver@uchicago.edu).
Published
Online:
March
17,
2014.
doi:10.1001/jamainternmed.2014.190.
Author
Contributions:
Dr
Oliver
had
full
access
to
all
of
the
data
in
the
study
and
takes
responsibility
for
the
integrity
of
the
data
and
the
accuracy
of
the
data
analysis.
Study
concept
and
design:
Both
authors.
Acquisition
of
data:
Oliver.
Analysis
and
interpretation
of
data:
Both
authors.
Drafting
of
the
manuscript:
Oliver.
Critical
revision
of
the
manuscript
for
important
intellectual
content:
Both
authors.
Statistical
analysis:
Both
authors.
Obtained
funding:
Oliver.
Conflict
of
Interest
Disclosures:
None
reported.
1
.
Ansolabehere
S,
Schaffner
BF.
Does
survey
mode
still
matter?
findings
from
a
2010
multi-mode
comparison.
Social
Science
Research
Network
website.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1868229.
Published
2011.
Accessed
February
6,
2014.
2
. Oliver
JE,
Wood
T.
Conspiracy
theories
and
the
paranoid
style(s)
of
mass
opinion.
Am
J
Pol
Sci
. In press.
Depression
and
Clinical
Inertia
in
Patients
With
Uncontrolled
Hypertension
Depression
is a known risk factor for poor prognosis among pa-
tients with cardiovascular disease.
1
Numerous biological and
behavioral mechanisms have been proposed.
2
However, few
studies have investigated the association between depres-
sion and “clinical
inertia,” or
lack of treatment
intensification
in individuals not at evidence-based goals for care.
3
To ad-
dress this gap, we assessed whether a diagnosis of depression
is associated with clinical inertia in patients with uncon-
trolled hypertension.
Methods
|
From February 2011 through September 2013, we en-
rolled a convenience sample of 28 nontrainee primary care pro-
viders (PCPs) (27 physicians and 1 nurse practitioner) and 158
patients with uncontrolled
hypertension
from 2
inner-
Editor's
Note
page
819
city, academic hospital–
based primary care clinics.
TheinstitutionalreviewboardofColumbiaUniversityMedi-
calCenterapprovedtheprotocol.Participantsprovidedwrit-
ten
informed
consent.
Patients were
eligible
if
they were
at
least
18
years
old, were prescribed
1
or more
blood pressure
(BP) medi-
cations, and had a BP measurement of at
least
140/90 mm Hg
(or ≥130/80 mm Hg
for patients with diabetes mellitus
[DM] or
with
chronic
kidney disease) on
at
least
2
consecutively
sched-
uled
visits with
their PCP. Exclusion
criteria were
age
older
than
80
years
and dementia. Clinical
inertia was defined
as
a
lack of
medication
intensification, hypertension
specialist
referral, or
workup
for
identifiable hypertension despite uncontrolled BP.
Depression
status was
based
on
PCP documentation
in
the
elec-
tronic medical
record.
We assessed established predictors of clinical
inertia,
4
in-
cluding age, sex, systolic blood pressure (SBP) measured at the
current visit, SBP at the prior visit, number of BP medica-
tions, number of medical problems addressed during the visit,
DM status, and medication adherence (Morisky Medication Ad-
herence Scale). All measures were either abstracted from the
medical record by a physician or,
in the case of medication ad-
herence, by
interviewing patients following the clinic visit. Mul-
tilevel analysis to account for clustering within PCP was used
to determine whether depression diagnosis was associated with
clinical
inertia after adjusting for established predictors of clini-
cal inertia. Sensitivity analyses were performed in which we
(1)
excluded 36 patients with clinician uncertainty regarding
BP control status (ie, documentation of
≥
1
BP
measurement
at home or at the current visit that was controlled),
5
(2) ad-
justed for PCP documentation of adherence assessment, and
(3)
excluded patients with DM who had an SBP between 130
and 140 mm Hg. We used SAS statistical software (version 9.3;
SAS Institute Inc) for all statistical analyses.
Results
|
The mean (SD) age of patients was 64.5 (8.8) years;
74.1% were women, 79.1% were Hispanic, 44.9% were diag-
nosed as having depression, and 61.2% had DM. On average,
participants had a prior visit SBP of 158.7 (15.7) mm Hg, cur-
rent visit SBP of 154.6 (16.7) mm Hg, were taking 2.5 (1.1) BP
medications, and had 5.3 (2.3) problems addressed during the
visit. Clinical
inertia was more common among depressed than
nondepressed patients (70% vs 51%;
P
= .02). Depression di-
agnosis was associated with clinical inertia in both the ad-
justed and unadjusted multilevel analyses (relative risk [RR],
1.40; 95% CI, 1.11-1.74;
P
= .004; adjusted relative risk [ARR],
1.49; 95% CI, 1.06-2.10;
P
= .02). The relationship remained af-
ter excluding those with at
least 1 documented home or clinic
818
JAMA
Internal
Medicine
May
2014
Volume
174,
Number
5
jamainternalmedicine.com
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