Scholars@Duke
Connor David Drake

Connor David Drake

Assistant Professor in Population Health Sciences
Population Health Sciences
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Selected Publications

Association of Patient-Reported Social Needs with Emergency Department Visits and Hospitalizations Among Federally Qualified Health Center Patients.

Journal Article J Gen Intern Med · May 8, 2024 BACKGROUND: Health care systems are increasingly screening for unmet social needs. The association between patient-reported social needs and health care utilization is not well understood. OBJECTIVE: To investigate the association between patient-reported ... Full text Link to item Cite

Adaptation to Telehealth of Personalized Group Visits for Late Stage Diabetic Kidney Disease.

Journal Article Kidney360 · December 1, 2023 KEY POINTS: Improving late stage diabetic kidney disease care requires adapting evidence-based, self-management programs for telehealth delivery. We adapted and pilot-tested a telehealth approach and found it to be feasible. Preliminary data suggested it i ... Full text Link to item Cite

Association of Unmet Social Needs With Metformin Use Among Patients With Type 2 Diabetes.

Journal Article Diabetes Care · November 1, 2023 OBJECTIVE: To evaluate the relationship between social needs and metformin use among adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: In a prospective cohort study of adults with T2D (n = 722), we linked electronic health record (EHR) and Su ... Full text Open Access Link to item Cite

Risk factors of food insecurity among students at diverse post-secondary education institutions: a cross-sectional examination.

Journal Article J Am Coll Health · September 19, 2023 OBJECTIVE: Identify the prevalence of food insecurity (FI) and compare sociodemographic, mental, physical, behavioral, and environmental risk factors for FI among students at a private university, community college, and historically black college or univer ... Full text Link to item Cite

Adherence to cardiovascular disease risk factor medications among patients with cancer: a systematic review.

Journal Article J Cancer Surviv · June 2023 PURPOSE: The most common cause of mortality for many cancer survivors is cardiovascular disease (CVD). This requires a shift in thinking where control of CVD risk factor-related comorbidity is paramount. Our objective was to provide an understanding of adh ... Full text Link to item Cite

Intervention components of link worker social prescribing programmes: A scoping review.

Journal Article Health Soc Care Community · November 2022 In the United Kingdom (UK), link worker social prescribing has emerged as an option to improve long-term condition management and address primary care patients' non-medical needs by linking patients with community-based activities and support. Social presc ... Full text Link to item Cite

A Tailored SMS Text Message-Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study.

Journal Article JMIR Res Protoc · October 11, 2022 BACKGROUND: Health care providers are increasingly screening patients for unmet social needs (eg, food, housing, transportation, and social isolation) and referring patients to relevant community-based resources and social services. Patients' connection to ... Full text Open Access Link to item Cite

Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations.

Journal Article Curr Hypertens Rep · August 2022 PURPOSE OF REVIEW: There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an interv ... Full text Open Access Link to item Cite

National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation.

Journal Article Int J Environ Res Public Health · July 7, 2022 Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, 'Whole ... Full text Link to item Cite

Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map.

Journal Article J Gen Intern Med · May 2022 BACKGROUND: Experiences of homelessness and serious mental illness (SMI) negatively impact health and receipt of healthcare. Interventions that promote the use of primary care services for people with both SMI and homelessness may improve health outcomes, ... Full text Link to item Cite

Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic.

Journal Article J Am Heart Assoc · April 5, 2022 Background The COVID-19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow-up via telemedicine is as effective as in-person visits for reducing 30-day readmissions in pati ... Full text Link to item Cite

Achieving Whole Health: A Preliminary Study of TCMLH, a Group-Based Program Promoting Self-Care and Empowerment Among Veterans.

Journal Article Health Educ Behav · April 2022 OBJECTIVE: An emerging literature suggests patients with chronic illnesses can benefit from integrated, person-centric approaches to health care, including group-based programs. However, much of the research in this area is disease specific. The objective ... Full text Link to item Cite

Understanding Telemedicine's "New Normal": Variations in Telemedicine Use by Specialty Line and Patient Demographics.

Journal Article Telemed J E Health · January 2022 Background:Our objective was to examine the variation in telemedicine adoption by specialty line and patient demographic characteristics after the initial peak period of the coronavirus disease 2019 pandemic when in-person visits had resumed and visit volu ... Full text Open Access Link to item Cite

Patient Barriers to Accessing Referred Resources for Unmet Social Needs.

Journal Article J Am Board Fam Med · 2022 INTRODUCTION: Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is diff ... Full text Link to item Cite

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit.

Journal Article Front Public Health · 2022 INTRODUCTION: Few resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become "community resource navigators" to serve pati ... Full text Link to item Cite

"A reinstilled hope that they can change": Facilitator perspectives on a self-care and health promotion peer group program for veterans.

Journal Article Front Public Health · 2022 INTRODUCTION: This study assessed the relevance, value, and effectiveness of "Taking Charge of My Life and Health" (TCMLH), a patient wellbeing peer group program for U.S. veterans focused on empowering them to identify what really matters in their lives a ... Full text Link to item Cite

The direct clinic-level cost of the implementation and use of a protocol to assess and address social needs in diverse community health center primary care clinical settings

Journal Article Journal of Health Care for the Poor and Underserved · November 1, 2021 Purpose. Social determinants of health, including food insecurity, housing insta-bility, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, ... Full text Cite

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

Journal Article BMC Health Serv Res · September 17, 2021 BACKGROUND: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is ... Full text Link to item Cite

Association of Patient-Reported Social Needs with Emergency Department Visits and Hospitalizations Among Federally Qualified Health Center Patients.

Journal Article J Gen Intern Med · May 8, 2024 BACKGROUND: Health care systems are increasingly screening for unmet social needs. The association between patient-reported social needs and health care utilization is not well understood. OBJECTIVE: To investigate the association between patient-reported ... Full text Link to item Cite

Adaptation to Telehealth of Personalized Group Visits for Late Stage Diabetic Kidney Disease.

Journal Article Kidney360 · December 1, 2023 KEY POINTS: Improving late stage diabetic kidney disease care requires adapting evidence-based, self-management programs for telehealth delivery. We adapted and pilot-tested a telehealth approach and found it to be feasible. Preliminary data suggested it i ... Full text Link to item Cite

Association of Unmet Social Needs With Metformin Use Among Patients With Type 2 Diabetes.

Journal Article Diabetes Care · November 1, 2023 OBJECTIVE: To evaluate the relationship between social needs and metformin use among adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: In a prospective cohort study of adults with T2D (n = 722), we linked electronic health record (EHR) and Su ... Full text Open Access Link to item Cite

Risk factors of food insecurity among students at diverse post-secondary education institutions: a cross-sectional examination.

Journal Article J Am Coll Health · September 19, 2023 OBJECTIVE: Identify the prevalence of food insecurity (FI) and compare sociodemographic, mental, physical, behavioral, and environmental risk factors for FI among students at a private university, community college, and historically black college or univer ... Full text Link to item Cite

Adherence to cardiovascular disease risk factor medications among patients with cancer: a systematic review.

Journal Article J Cancer Surviv · June 2023 PURPOSE: The most common cause of mortality for many cancer survivors is cardiovascular disease (CVD). This requires a shift in thinking where control of CVD risk factor-related comorbidity is paramount. Our objective was to provide an understanding of adh ... Full text Link to item Cite

Intervention components of link worker social prescribing programmes: A scoping review.

Journal Article Health Soc Care Community · November 2022 In the United Kingdom (UK), link worker social prescribing has emerged as an option to improve long-term condition management and address primary care patients' non-medical needs by linking patients with community-based activities and support. Social presc ... Full text Link to item Cite

A Tailored SMS Text Message-Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study.

Journal Article JMIR Res Protoc · October 11, 2022 BACKGROUND: Health care providers are increasingly screening patients for unmet social needs (eg, food, housing, transportation, and social isolation) and referring patients to relevant community-based resources and social services. Patients' connection to ... Full text Open Access Link to item Cite

Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations.

Journal Article Curr Hypertens Rep · August 2022 PURPOSE OF REVIEW: There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an interv ... Full text Open Access Link to item Cite

National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation.

Journal Article Int J Environ Res Public Health · July 7, 2022 Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, 'Whole ... Full text Link to item Cite

Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map.

Journal Article J Gen Intern Med · May 2022 BACKGROUND: Experiences of homelessness and serious mental illness (SMI) negatively impact health and receipt of healthcare. Interventions that promote the use of primary care services for people with both SMI and homelessness may improve health outcomes, ... Full text Link to item Cite

Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic.

Journal Article J Am Heart Assoc · April 5, 2022 Background The COVID-19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow-up via telemedicine is as effective as in-person visits for reducing 30-day readmissions in pati ... Full text Link to item Cite

Achieving Whole Health: A Preliminary Study of TCMLH, a Group-Based Program Promoting Self-Care and Empowerment Among Veterans.

Journal Article Health Educ Behav · April 2022 OBJECTIVE: An emerging literature suggests patients with chronic illnesses can benefit from integrated, person-centric approaches to health care, including group-based programs. However, much of the research in this area is disease specific. The objective ... Full text Link to item Cite

Understanding Telemedicine's "New Normal": Variations in Telemedicine Use by Specialty Line and Patient Demographics.

Journal Article Telemed J E Health · January 2022 Background:Our objective was to examine the variation in telemedicine adoption by specialty line and patient demographic characteristics after the initial peak period of the coronavirus disease 2019 pandemic when in-person visits had resumed and visit volu ... Full text Open Access Link to item Cite

Patient Barriers to Accessing Referred Resources for Unmet Social Needs.

Journal Article J Am Board Fam Med · 2022 INTRODUCTION: Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is diff ... Full text Link to item Cite

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit.

Journal Article Front Public Health · 2022 INTRODUCTION: Few resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become "community resource navigators" to serve pati ... Full text Link to item Cite

"A reinstilled hope that they can change": Facilitator perspectives on a self-care and health promotion peer group program for veterans.

Journal Article Front Public Health · 2022 INTRODUCTION: This study assessed the relevance, value, and effectiveness of "Taking Charge of My Life and Health" (TCMLH), a patient wellbeing peer group program for U.S. veterans focused on empowering them to identify what really matters in their lives a ... Full text Link to item Cite

The direct clinic-level cost of the implementation and use of a protocol to assess and address social needs in diverse community health center primary care clinical settings

Journal Article Journal of Health Care for the Poor and Underserved · November 1, 2021 Purpose. Social determinants of health, including food insecurity, housing insta-bility, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, ... Full text Cite

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

Journal Article BMC Health Serv Res · September 17, 2021 BACKGROUND: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is ... Full text Link to item Cite

Evaluating the association of social needs assessment data with cardiometabolic health status in a federally qualified community health center patient population.

Journal Article BMC Cardiovasc Disord · July 14, 2021 BACKGROUND: Health systems are increasingly using standardized social needs screening and response protocols including the Protocol for Responding to and Assessing Patients' Risks, Assets, and Experiences (PRAPARE) to improve population health and equity; ... Full text Link to item Cite

A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting.

Journal Article Int J Integr Care · February 5, 2021 INTRODUCTION: While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. In this case study, we describe the development and implementation of a model utilizing s ... Full text Link to item Cite

Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center.

Journal Article J Prim Care Community Health · 2021 INTRODUCTION: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study a ... Full text Link to item Cite

The Direct Clinic-Level Cost of the Implementation and Use of a Protocol to Assess and Address Social Needs in Diverse Community Health Center Primary Care Clinical Settings.

Journal Article J Health Care Poor Underserved · 2021 PURPOSE: Social determinants of health, including food insecurity, housing instability, social isolation, and unemployment are important drivers of health outcomes and utilization. To inform implementation of social needs screening and response protocols, ... Full text Link to item Cite

An evaluation of the facilitator training to implement 'Taking charge of my life and health', a peer-led group program to promote self-care and patient empowerment in Veteran participants.

Journal Article Patient Educ Couns · June 21, 2020 OBJECTIVE: We developed a peer-led group program for Veterans called Taking Charge of My Life and Health (TCMLH) that emphasizes patient education, goal setting, shared decision making, and whole person care. Our aim was to conduct an evaluation of a facil ... Full text Link to item Cite

Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods.

Journal Article Syst Rev · April 25, 2020 BACKGROUND: Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires ... Full text Open Access Link to item Cite

Assessing and Addressing Social Needs in Primary Care

Journal Article New England Journal of Medicine Catalyst · November 6, 2019 Link to item Cite

Self-management of Epilepsy: A Systematic Review.

Journal Article Ann Intern Med · July 16, 2019 BACKGROUND: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. PURPOSE: To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwe ... Full text Open Access Link to item Cite

Bridging the integration gap between patient-generated blood glucose data and electronic health records.

Journal Article J Am Med Inform Assoc · July 1, 2019 Telemedicine can facilitate population health management by extending the reach of providers to efficiently care for high-risk, high-utilization populations. However, for telemedicine to be maximally useful, data collected using telemedicine technologies m ... Full text Open Access Link to item Cite

Working together to learn new oral hygiene techniques: Pilot of a carepartner-assisted intervention for persons with cognitive impairment.

Journal Article Geriatr Nurs · 2019 We pilot tested a carepartner-assisted intervention to improve oral hygiene in persons with cognitive impairment (participants) and help carepartners become leaders who can adapt approaches that foster participants' ability to develop new skills for oral h ... Full text Link to item Cite

Characteristics and Delivery of Diabetes Shared Medical Appointments in North Carolina.

Journal Article N C Med J · 2019 BACKGROUND Successful diabetes care requires patient engagement and health self-management. Diabetes shared medical appointments (SMAs) are an evidence-based approach that enables peer support, diabetes group education, and medication management to improve ... Full text Open Access Link to item Cite

An evaluation of mHealth adoption and health self-management in emerging adulthood.

Journal Article AMIA Annu Symp Proc · 2019 This study offers a description of factors that predict the adoption of mobile health technologies (mHealth) and their application for health self-management in emerging adults. Primary data collection occurred at three diverse postsecondary educational in ... Link to item Cite

Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus.

Journal Article South Med J · November 2018 OBJECTIVES: This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs wi ... Full text Link to item Cite

Health Care Reform in the United States.

Journal Article JAMA · November 8, 2016 Full text Link to item Cite

Value of Personalized Medicine.

Journal Article JAMA · February 9, 2016 Full text Link to item Cite

Personalized Health Planning in Primary Care Settings.

Journal Article Fed Pract · January 2016 Personalized health planning can be operationalized as a health care delivery model to support personalized, proactive, patient-driven care. ... Open Access Link to item Cite