1
|
Cossu G, Kalcev G, Sancassiani F, Primavera D, Gyppaz D, Zreik T, Carta MG. The long-term adherence following the end of Community Treatment Order: A systematic review. Acta Psychiatr Scand 2024. [PMID: 38796307 DOI: 10.1111/acps.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/16/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out-of-hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long-term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders. METHOD Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879. RESULTS Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long-term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased. CONCLUSION Scientific evidence supporting the hypothesis that CTO has a positive role on long-term adherence post-obligation is currently not sufficient. Given the importance of modern recovery-oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence.
Collapse
Affiliation(s)
- Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Davide Gyppaz
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
2
|
Burgos-Alonso N, Torrecilla M, Mendiguren A, Pérez-Gómez Moreta M, Bruzos-Cidón C. Strategies to Improve Therapeutic Adherence in Polymedicated Patients over 65 Years: A Systematic Review and Meta-Analysis. PHARMACY 2024; 12:35. [PMID: 38392942 PMCID: PMC10892390 DOI: 10.3390/pharmacy12010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Part of the population over 65 years of age suffer from several pathologies and are therefore polymedicated. In this systematic review and metanalysis, we aimed to determine the efficacy of several strategies developed to improve adherence to pharmacological treatment in polymedicated elderly people. DESIGN Web Of Science, PubMed and the Cochrane Library were searched until 2 January 2024. In total, 17 of the 1508 articles found evaluated the efficacy of interventions to improve adherence to medication in polymedicated elderly patients. Methodological quality and the risk of bias were rated using the Cochrane risk of bias tool. Open Meta Analyst® software was used to create forest plots of the meta-analysis. RESULTS In 11 of the 17 studies, an improvement in adherence was observed through the use of different measurement tools and sometimes in combination. The most frequently used strategy was using instructions and counselling, always in combination, in a single strategy used to improve adherence; one involved the use of medication packs and the other patient follow-up. In both cases, the results in improving adherence were positive. Five studies using follow-up interventions via visits and phone calls showed improved adherence on the Morisky Green scale compared to those where usual care was received [OR = 1.900; 95% CI = 1.104-3.270] (p = 0.021). DISCUSSION There is a high degree of heterogeneity in the studies analyzed, both in the interventions used and in the measurement tools for improving adherence to treatment. Therefore, we cannot make conclusions about the most efficacious strategy to improve medication adherence in polymedicated elderly patients until more evidence of single-intervention strategies is available.
Collapse
Affiliation(s)
- Natalia Burgos-Alonso
- Public Health Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - María Torrecilla
- Pharmacology Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Aitziber Mendiguren
- Pharmacology Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Marta Pérez-Gómez Moreta
- Public Health Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Cristina Bruzos-Cidón
- Nursing I Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| |
Collapse
|
3
|
Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
Collapse
Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
4
|
Data on medication adherence in adults with neurological disorders: The NeuroGerAd study. Sci Data 2022; 9:734. [PMID: 36450760 PMCID: PMC9709359 DOI: 10.1038/s41597-022-01847-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Nonadherence to medication is a common issue that goes along with increased morbidity and mortality and immense health care costs. To improve medication adherence and outcome in ill people, their reasons of not taking their prescribed medication must be known. Here a dataset is presented based on the longitudinal observational NeuroGerAd study in adults with neurological disorders (N = 910). The dataset contains demographic background variables as well as measures of adherence, medication changes after hospital discharge, comprehensive geriatric assessments, personality, patient-physician relationship, and health-related quality of life. As such, the dataset offers unique opportunities to enable a plethora of analyses on personal, social, and institutional factors influencing medication adherence.
Collapse
|
5
|
Sansone A, Reisman Y, Meto S, Dolci S, Jannini EA. The Role of the "Anti-Inflammatory" Couple for the Management of Hyperuricemia With Deposition. Sex Med 2022; 10:100562. [PMID: 36087454 PMCID: PMC9537271 DOI: 10.1016/j.esxm.2022.100562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Gout is the most prevalent inflammatory crystal arthropathy worldwide and is a chronic disease requiring strict, lifelong adherence to drug therapy and healthy lifestyles. Gout has a heavy burden on the patient's sexual health, owing to the associated inflammatory status, long-term complications, and chronic pain; however, the effects of gout also extend to the partner's sexual health. AIMS We aimed to investigate how the presence of a partner could influence the complex interaction between risk factors for sexual dysfunctions in gout in order to define novel strategies to improve sexual health and disease management. METHODS Clinical and experimental data on the role of the couple in chronic diseases, as well as on the association between gout and sexual health, were searched through Pubmed. MAIN OUTCOME MEASURES Evidence from studies describing how the presence of a couple and leveraging sexual health can improve management and clinical outcomes for chronic diseases. RESULTS Treatment adherence can improve the sexual health of gout patients and their partners; likewise, by leveraging sexual health, it would be possible to promote better health-seeking behaviors, ultimately improving gout management. CLINICAL IMPLICATIONS Promoting awareness of the sexual health relevance of gout can potentially be a pivotal strategy to improve disease management and prevent the progression of sexual dysfunctions from subclinical to overt forms. STRENGTHS AND LIMITATIONS Identifying a bidirectional association between sexual health and disease management paves the way for improved disease control and can potentially prevent the development of sexual dysfunctions in couples affected by gout. However, the relevance of the couple has not been adequately addressed in gout management, and most evidence comes from other chronic diseases. CONCLUSION Improving gout management results in better sexual health, and vice-versa promoting better sexual health can improve disease control for gout. The presence of a partner improves the behavioral well-being of gout patients, with beneficial effects on both sexual health and gout management. Sansone A, Reisman Y, Meto S, et al. The Role of the "Anti-Inflammatory" Couple for the Management of Hyperuricemia With Deposition. Sex Med 2022;10:100562.
Collapse
Affiliation(s)
- Andrea Sansone
- Chair of Endocrinology & Medical Sexology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Suada Meto
- A. Menarini Industrie Farmaceutiche Riunite S.R.L, Florence, Italy
| | - Susanna Dolci
- Chair of Anatomy, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| |
Collapse
|
6
|
Homętowska H, Świątoniowska-Lonc N, Klekowski J, Chabowski M, Jankowska-Polańska B. Treatment Adherence in Patients with Obstructive Pulmonary Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11573. [PMID: 36141843 PMCID: PMC9517069 DOI: 10.3390/ijerph191811573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
COPD is the third most common cause of death globally. Adherence rates in patients with obstructive pulmonary diseases usually range between 10% and 40%. The aim of the study was to evaluate the level of treatment adherence to inhaled therapy in patients with obstructive pulmonary diseases. A total of 325 patients, of mean age 63.04 ± 11.29, with COPD or asthma, were included into the study between 2020 and 2021. The following questionnaires were used: Beliefs about Medicines Questionnaire, Test of Adherence to Inhalers and Adherence to Refills and Medications Scale. The respondents tended to be convinced of the necessity of their medication (3.87 points per question). The patients reported moderate levels of overall adherence (21.15 ± 6.23). A total of 74% of patients demonstrated sporadic non-compliance. We conclude that patients with obstructive pulmonary diseases are moderately adherent to their medication. Beliefs about medicines have a significant impact on adherence to medications. Being unemployed, being a non-smoker and belief in the necessity of medication are independent determinants of better medication adherence. The number of hospital admissions due to exacerbations of the disease over the last year and belief that medicines are harmful are independent determinants of poorer medication adherence.
Collapse
Affiliation(s)
- Henryka Homętowska
- Specialistic Hospital of the Ministry of Interior and Administration, 40 Karłowicza Street, 48-340 Głuchołazy, Poland
| | | | - Jakub Klekowski
- Student Research Group No. 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
- Division of Anaesthesiologic and Surgical Nursing, Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland
| | - Beata Jankowska-Polańska
- Innovation and Research Center, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
| |
Collapse
|
7
|
Schönenberg A, Mühlhammer HM, Lehmann T, Prell T. Adherence to Medication in Neurogeriatric Patients: Insights from the NeuroGerAd Study. J Clin Med 2022; 11:5353. [PMID: 36143000 PMCID: PMC9501565 DOI: 10.3390/jcm11185353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023] Open
Abstract
Nonadherence to medication is associated with increased morbidity, mortality, and healthcare costs, especially in older adults with higher chances of multimorbidity. However, comprehensive data on factors influencing adherence in this patient group are rare. Thus, data for 910 patients were acquired, including demographic data, nonadherence (Stendal Adherence to Medication), depression (Beck Depression Inventory), cognition (Montreal Cognitive Assessment), personality (Big Five Inventory), satisfaction with healthcare (Health Care Climate Questionnaire), quality of life (36-item Short Form Survey), mobility, diagnoses, and medication. Elastic net regularization was used to analyze the predictors of adherence. Principal component and general estimation equations were calculated to analyze the underlying patterns of adherence. Only 21.1% of patients were fully adherent. Nonadherence was associated with male gender, higher number of medications, diagnosis, depression, poor patient-physician relationship, personality, impaired cognition, and impaired mobility. Nonadherence was classified into three sub-factors: forgetting (46.2%), missing knowledge about medication (29%), and intentional modification of medication (24.8%). While depression exerted the strongest influence on modification, a high number of medications was associated with missing knowledge. The different patterns of nonadherence (i.e., modification, missing knowledge, and forgetting) are influenced differently by clinical factors, indicating that specific approaches are needed for interventions targeting adherence.
Collapse
Affiliation(s)
- Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
| | | | - Thomas Lehmann
- Institute for Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07747 Jena, Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany
| |
Collapse
|
8
|
Mendorf S, Prell T, Schönenberg A. Detecting Reasons for Nonadherence to Medication in Adults with Epilepsy: A Review of Self-Report Measures and Key Predictors. J Clin Med 2022; 11:jcm11154308. [PMID: 35893399 PMCID: PMC9331129 DOI: 10.3390/jcm11154308] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
This review presents individual reasons for self-reported nonadherence in people with epilepsy (PWE). A literature search was performed on the PubMed/Medline and Scopus databases for studies published up to March 2022. Thirty-six studies were included using the following inclusion criteria: original studies on adults with epilepsy, use of subjective self-report adherence measurement methods, and publication in English. Data were extracted using a standardized data extraction table, including the year of publication, authors, cohort size, study design, adherence measurement method, and self-reported reasons for nonadherence. Self-reported reasons for nonadherence were grouped following the WHO model with the five dimensions of nonadherence. In addition, study characteristics and sociodemographic information are reported. Of the 36 included studies, 81% were observational. The average nonadherence rate was nearly 50%. Across all studies, patient-associated, therapy-associated, and circumstance-related factors were the most frequently reported dimensions of nonadherence. These factors include forgetfulness, presence of side-effects, and history of seizures. Regarding healthcare system factors, financial problems were the most reported reason for nonadherence. Stigmatization and quality of life were the most frequently cited factors influencing nonadherence in the disease- and circumstance-related dimensions. The results suggest that interventions for improving adherence should incorporate all dimensions of nonadherence.
Collapse
Affiliation(s)
- Sarah Mendorf
- Department of Neurology, University Hospital Jena, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9323511
| | - Tino Prell
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
| | - Aline Schönenberg
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
| |
Collapse
|
9
|
Schwarzkopf A, Schönenberg A, Prell T. Patterns and Predictors of Medication Change after Discharge from Hospital: An Observational Study in Older Adults with Neurological Disorders. J Clin Med 2022; 11:jcm11030563. [PMID: 35160015 PMCID: PMC8836689 DOI: 10.3390/jcm11030563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Medication is often changed after inpatient treatment, which affects the course of the disease, health behavior and adherence. Thus, it is important to understand patterns of medication changes after discharge from hospital. Methods: Inpatients at the Department of Neurology received a comprehensive assessment during their stay, including adherence, depression, cognition, health and sociodemographic variables. A month after being discharged, patients were contacted to enquire about post-discharge medication changes. Results: 910 older adults aged 70 ± 8.6 years participated, of which 204 (22.4%) reported medication changes. The majority of changes were initiated by physicians (n = 112, 56.3%) and only 25 (12.6%) patients reported adjusting medication themselves. Reasons for medication changes differed between patients and doctors (p < 0.001), with side effects or missing effects cited frequently. Sociodemographic and patient-related factors did not significantly predict medication changes. Conclusion: Patients reported less post-discharge medication changes than expected, and contrary to previous literature on nonadherence, only a fraction of those changes were performed by patients themselves. Socioeconomic and clinical parameters regarding personality, mood and cognition were poorly associated with post-discharge medication changes. Instead, individual health-related factors play a role, with patient factors only indirectly influencing physicians’ decisions.
Collapse
Affiliation(s)
- Anna Schwarzkopf
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (A.S.); (T.P.)
| | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
- Correspondence:
| | - Tino Prell
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (A.S.); (T.P.)
- Department of Geriatrics, Halle University Hospital, 06120 Halle, Germany
| |
Collapse
|
10
|
Sánchez-Nieto JM, Bernabeu-Mora R, Fernández-Muñoz I, Carrillo-Alcaraz A, Alcántara-Fructuoso J, Fernández-Alvarez J, Vera-Olmos JC, Martínez-Ferre MJ, Olea MGV, Valenciano MJC, Martínez DS. Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. NPJ Prim Care Respir Med 2022; 32:1. [PMID: 35013343 PMCID: PMC8748930 DOI: 10.1038/s41533-021-00262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.
Collapse
Affiliation(s)
- Juan Miguel Sánchez-Nieto
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain.,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain
| | - Roberto Bernabeu-Mora
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain. .,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain. .,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain.
| | - Irene Fernández-Muñoz
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | - Andrés Carrillo-Alcaraz
- Division of Intensive Care Unit, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | - Juan Carlos Vera-Olmos
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | | | - Diego Salmerón Martínez
- Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Health and Social Sciences, Murcia University, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
11
|
Prell T, Franke GH, Jagla-Franke M, Schönenberg A. Identifying Patterns of Self-Reported Nonadherence Using Network Analysis in a Mixed German Cohort. Patient Prefer Adherence 2022; 16:1153-1162. [PMID: 35535253 PMCID: PMC9078445 DOI: 10.2147/ppa.s362464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Nonadherence is a complex behaviour that contributes to poor health outcomes; therefore, it is necessary to understand its underlying structure. Network analysis is a novel approach to explore the relationship between multiple variables. PATIENTS AND METHODS Patients from four different studies (N = 1.746) using the self-reported Stendal Adherence to Medication Score (SAMS) were pooled. Network analysis using EBICglasso followed by confirmatory factor analysis were performed to understand how different types of nonadherence covered in the SAMS items are related to each other. RESULTS Network analysis revealed different categories of nonadherence: lack of knowledge about medication, forgetting to take medication, and intentional modification of medication. The intentional modification can further be sub-categorized into two groups, with one group modifying medication based on changes in health (improvement of health or adverse effects), whereas the second group adjusts medication based on overall medication beliefs and concerns. Adverse effects and taking too many medications were further identified as most influential variables in the network. CONCLUSION The differentiation between modification due to health changes and modification due to overall medication beliefs is crucial for intervention studies. Network analysis is a promising tool for further exploratory studies of adherence.
Collapse
Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Gabriele Helga Franke
- Department of Psychology of Rehabilitation, University of Applied Sciences Magdeburg-Stendal, Magdeburg-Stendal, Germany
| | - Melanie Jagla-Franke
- Department of Psychology of Rehabilitation, University of Applied Sciences Magdeburg-Stendal, Magdeburg-Stendal, Germany
- Department of Psychology in Health Promotion and Prevention, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Correspondence: Aline Schönenberg, Department of Geriatrics, Halle University Hospital, Halle, Germany, Tel +49 345 5574071, Email
| |
Collapse
|
12
|
Singh JA. SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) in African American veterans with gout: a trial study protocol. Trials 2021; 22:879. [PMID: 34863255 PMCID: PMC8645140 DOI: 10.1186/s13063-021-05847-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Medication adherence in gout is suboptimal, and the lack of effective interventions to address it presents a huge challenge. Medication adherence and gout outcomes are worse in racial/ethnic minorities. The objective of this paper was to provide the details of the study protocol for randomized, controlled trial (RCT) in African Americans (AAs) with gout that will test the effectiveness of a culturally appropriate gout storytelling intervention. Methods The SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) study will be a 12-month, multicenter, open-label RCT that will assess the effect of a culturally appropriate gout storytelling in at least 300 AA veterans with gout. Participants will be randomized to gout-storytelling intervention vs. a stress reduction video in a 1:1 ratio. The primary outcome is urate-lowering therapy (ULT) adherence measured with MEMSCap™, an electronic monitoring system (efficacy, 6 months; sustenance of efficacy, 12 months). Secondary outcomes include gout flares, serum urate (SU), gout-specific health-related quality of life [HRQOL], self-reported ULT adherence, patient satisfaction with treatment, and patient understanding of the intervention. AA veterans with gout who met the 1977 Preliminary American College of Rheumatology (ACR) classification criteria for gout, currently prescribed an oral ULT medication (allopurinol or febuxostat) for at least 6 months, and not using a pillbox to redistribute their medications, will be invited to an in-person study visit. After the study coordinators obtain informed consent, and ensure that participants meet the inclusion criteria, the eligible participants will be provided with their current ULT in a MEMSCap™ bottle for the 1-month run-in period and asked to return to the clinic in 1 month. ULT adherence with MEMSCap™ will be recorded at a 1-month return visit. Interested participants will complete the baseline assessments, randomized using the computerized system to either gout-storytelling intervention or a stress reduction intervention video arm and watch the respective video in-clinic. Patients will be interviewed on the phone at 2 and 4 months regarding the viewing of the videos at home at each time. Participants will be assessed in-clinic at 3, 6, 9, and 12 months; MEMSCap™ data and patient surveys will be captured at each visit. For any missed visit, assessments will be completed on the phone and MEMSCap™ data captured at the next in-clinic visit. Discussion The study will assess the efficacy of a behavioral intervention to improve ULT adherence in minority populations with gout. Trial registration ClinicalTrials.gov NCT 02741700. Registered on 14 September 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05847-9.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, 35233, USA. .,Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
| |
Collapse
|
13
|
Zipprich HM, Mendorf S, Schönenberg A, Prell T. The impact of poor medication knowledge on health-related quality of life in people with Parkinson's disease: a mediation analysis. Qual Life Res 2021; 31:1473-1482. [PMID: 34797508 PMCID: PMC9023397 DOI: 10.1007/s11136-021-03024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to determine how limited medication knowledge as one aspect of health literacy contributes to poorer health-related quality of life (HRQoL) in people with Parkinson's disease (PD). METHODS Demographical data, PD-specific data (MDS-Unified Parkinson's Disease-Rating Scale, Nonmotor symptom scale), and data about depressive symptoms (Beck's depression inventory), cognition (Montreal cognitive assessment), HRQoL (Short-Form Health Questionnaire-36, SF-36), and medication knowledge (names, time of taking, indication, dosage) were assessed in 193 patients with PD. Multivariate analysis of variance (MANOVA), multivariate analysis of covariance, and mediation analyses were used to study the relationship between medication knowledge and HRQoL in combination with different mediators and covariates. RESULTS Overall, 43.5% patients showed deficits in at least one of the 4 knowledge items, which was associated with higher age, number of medications per day and depression level, and poorer cognitive function, motor function, and lower education level. Using one-way MANOVA, we identified that medication knowledge significantly impacts physical functioning, social functioning, role limitations due to physical problems, and role limitations due to emotional problems. Mediation models using age, education level, and gender as covariates showed that the relationship between knowledge and SF-36 domains was fully mediated by Beck's Depression Inventory but not by Montreal Cognitive Assessment. CONCLUSIONS Patients who expressed unawareness of their medication did not necessarily have cognitive deficits; however, depressive symptoms may instead be present. This concomitant depressive symptomatology is crucial in explaining the contribution of nonadherence and decreased medication knowledge to poor quality of life.
Collapse
Affiliation(s)
- Hannah M Zipprich
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Aline Schönenberg
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| |
Collapse
|
14
|
Zhao M, Rodriguez MA, Wang B, Santa Ana EJ, Friedberg J, Fang Y, Allegrante JP, Natarajan S. Validity and reliability of a short self-efficacy instrument for hypertension treatment adherence among adults with uncontrolled hypertension. PATIENT EDUCATION AND COUNSELING 2021; 104:1781-1788. [PMID: 33516592 DOI: 10.1016/j.pec.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/19/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To establish the reliability and validity of a self-report measure designed to assess self-efficacy for hypertension treatment adherence. METHODS This investigation was embedded within a six-month randomized clinical trial (RCT), which demonstrated that a tailored, stage-matched intervention was more effective at improving hypertension control than usual care among individuals (n = 533) with repeated uncontrolled hypertension. The instrument used to assess self-efficacy for hypertension treatment adherence (SE-HTA) comprised three subscales that assessed diet self-efficacy (DSE), exercise self-efficacy (ESE), and medication self-efficacy (MSE). To determine SE-HTA validity and reliability, we assessed internal consistency using Cronbach's α coefficients, conducted exploratory factor analysis, and evaluated convergent and discriminant validity, as well as test-retest reliability using Spearman's ρ correlation coefficients. RESULTS Cronbach's α (internal consistency) values for DSE, ESE, and MSE were 0.81, 0.82 and 0.74. Factor analysis and the scree plot demonstrated three distinct factors, which correspond to the three subscales contained in the SE-HTA instrument. SE-HTA possessed good convergent and discriminant validity, and moderate test-retest reliability. CONCLUSION The SE-HTA instrument containing diet, exercise, and medication adherence subscales is valid and reliable in adults with uncontrolled hypertension. PRACTICE IMPLICATIONS This SE-HTA instrument measures self-efficacy and could help facilitate behavior change in hypertension.
Collapse
Affiliation(s)
- Matthew Zhao
- VA New York Harbor Healthcare System, New York, NY, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maria A Rodriguez
- VA New York Harbor Healthcare System, New York, NY, USA; Northcentral University, La Jolla, CA, USA
| | - Binhuan Wang
- VA New York Harbor Healthcare System, New York, NY, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth J Santa Ana
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Jennifer Friedberg
- VA New York Harbor Healthcare System, New York, NY, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - Yixin Fang
- New York University Grossman School of Medicine, New York, NY, USA
| | - John P Allegrante
- Teachers College, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, New York, NY, USA; New York University Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
15
|
Rodriguez MA, Wang B, Hyoung S, Friedberg J, Wylie-Rosett J, Fang Y, Allegrante JP, Lipsitz SR, Natarajan S. Sustained Benefit of Alternate Behavioral Interventions to Improve Hypertension Control: A Randomized Clinical Trial. Hypertension 2021; 77:1867-1876. [PMID: 33979183 PMCID: PMC8115432 DOI: 10.1161/hypertensionaha.120.15192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Supplemental Digital Content is available in the text. Little is known about the long-term effects of behavioral interventions to improve blood pressure (BP) control. We evaluated whether a telephone-delivered, behavioral stage-matched intervention (SMI), or a nontailored health education intervention (HEI) delivered for 6 months improves BP control (or lowers systolic BP) over 12 months, as well as its sustainability 6 months after intervention implementation ended, compared with usual care in participants with repeated uncontrolled BP at baseline. A 3-arm, randomized controlled trial was designed to evaluate the effectiveness of 2 interventions, each compared with a usual-care control group. Participants were 533 adults with persistent uncontrolled BP who were treated at 2 Veterans Affairs Medical Centers. The intervention was implemented for 6 months, followed by 6 months of observation. Compared with usual care, the odds of having BP under control over 12 months in SMI were 84% higher (odds ratio, 1.84 [95% CI, 1.28–2.67]; P=0.001), and 48% higher in HEI (odds ratio, 1.48 [95% CI, 1.02–2.14]; P=0.04).Over the 12 months, compared with usual care, systolic blood pressure was 2.80 mm Hg lower in SMI ([95% CI, 0.27 to 5.33]; P=0.03) while it was 2.58 mm Hg lower in HEI ([95% CI, −0.40 to 5.55]; P=0.09). From 6 to 12 months, SMI sustained improved BP control and lower systolic blood pressure, while HEI, which did not have significantly better BP control or lower systolic blood pressure at 6 months, appeared to improve BP control and lower systolic blood pressure. SMI and HEI are promising interventions that can be implemented in clinical practice to improve BP management.
Collapse
Affiliation(s)
- Maria Antonia Rodriguez
- VA New York Harbor Healthcare System (M.A.R., S.H., J.F., S.N.).,Northcentral University, La Jolla, CA (M.A.R.)
| | - Binhuan Wang
- New York University School of Medicine (B.W., Y.F., S.N.)
| | - Sangmin Hyoung
- VA New York Harbor Healthcare System (M.A.R., S.H., J.F., S.N.)
| | | | | | - Yixin Fang
- New York University School of Medicine (B.W., Y.F., S.N.)
| | - John P Allegrante
- Teachers College (J.P.A.), Columbia University, New York.,Mailman School of Public Health (J.P.A.), Columbia University, New York
| | - Stuart R Lipsitz
- Brigham and Womens Hospital/Harvard Medical School, Boston, MA (S.R.L.)
| | - Sundar Natarajan
- VA New York Harbor Healthcare System (M.A.R., S.H., J.F., S.N.).,New York University School of Medicine (B.W., Y.F., S.N.)
| |
Collapse
|
16
|
Sugiyama H, Harada N, Amasawa E, Hirao M, Yahagi N. A Prototype Method for Selecting Interventions for Enhancing Medication Adherence in Medicine Taking Processes. JOURNAL OF CHEMICAL ENGINEERING OF JAPAN 2021. [DOI: 10.1252/jcej.20we090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Norikazu Harada
- Department of Chemical System Engineering, The University of Tokyo
| | - Eri Amasawa
- Department of Chemical System Engineering, The University of Tokyo
| | - Masahiko Hirao
- Department of Chemical System Engineering, The University of Tokyo
| | - Naohisa Yahagi
- Graduate School of Media and Governance, Keio University
| |
Collapse
|
17
|
Foley L, Larkin J, Lombard-Vance R, Murphy AW, Molloy GJ. Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol. HRB Open Res 2021; 2:29. [PMID: 32296748 PMCID: PMC7140769 DOI: 10.12688/hrbopenres.12961.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions. Study registration: The systematic review is prospectively registered in PROSPERO (
CRD42019133849); registered on 12 June 2019.
Collapse
Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland.,HRB Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| |
Collapse
|
18
|
Kim HJ, Shim YS, Park KH, Lee CN, Jung S, Yoon SJ, Jeong SK, Jeong JH, Choi SH, Kim EJ, Jang JW, Kang K, Yang Y, Kim S. Impact of an Education Program for Caregivers of Patients with Alzheimer's Disease on Treatment Discontinuation and Compliance in Korea. J Clin Neurol 2021; 17:368-375. [PMID: 34184444 PMCID: PMC8242308 DOI: 10.3988/jcn.2021.17.3.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Reportedly 30-50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer's disease patients who had newly been prescribed donepezil. METHODS This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer's disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. RESULTS The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. CONCLUSIONS Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.
Collapse
Affiliation(s)
- Hee Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong S Shim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Hyung Park
- Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Chan Nyoung Lee
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - San Jung
- Department of Neurology, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Seul Ki Jeong
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jae Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - YoungSoon Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
19
|
Sadeghi C, Khan HA, Gudleski G, Reynolds JL, Bakhai SY. Multifaceted strategies to improve blood pressure control in a primary care clinic: A quality improvement project. Int J Cardiol Hypertens 2020; 7:100060. [PMID: 33447781 PMCID: PMC7803046 DOI: 10.1016/j.ijchy.2020.100060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Approximately 80% of patients with hypertension in the Internal Medicine Clinic were uncontrolled (BP > 130/80 mmHg), according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines, leading to increased morbidity and mortality. The aim of this quality improvement (QI) was to improve BP control <130/80 from the baseline rates of 20%-30% and <140/90 from the baseline rates of 40%-60% between ages of 18-75 years, within 12 months. METHODS We used the Plan-Do-Study-Act method. A multidisciplinary QI team identified barriers by fish bone diagram. Barriers included: 1) Physicians' knowledge gap and clinical inertia in optimization of medications, and 2) Patients' nonadherence to medication and appointments. The outcome measures were the percentage of patients with BP < 140/90 and < 130/80. Process measures included: 1) attendance rates of physician and nurses at educational sessions, 2) medication reconciliation completion rates and 3) care guide order rates. Key interventions were: 1) physicians and nurses' education regarding ACC/AHA guidelines, 2) patient education and engagement and 3) enhancement of health information technology. Data analysis was performed using monthly statistical process control charts. RESULTS We achieved 62.6% (n = 885/1426) for BP < 140/90 and 24.47% (n = 349/1426) for BP < 130/80 within 12 months project period. We sustained and exceeded at 72.64% (n = 945/1301) for BP < 140/90 and 44.58% (n = 580/1301) for BP < 130/80 during the 10 months post-project period. CONCLUSIONS Overcoming physician clinical inertia, enhancing patient adherence to appointments and medications, and a high functioning multidisciplinary team were the key drivers for the success.
Collapse
Affiliation(s)
- Cirous Sadeghi
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Hassan A. Khan
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Gregory Gudleski
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jessica L. Reynolds
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Smita Y. Bakhai
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
20
|
Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart Lung 2020; 49:537-547. [DOI: 10.1016/j.hrtlng.2020.02.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/21/2023]
|
21
|
Pirri S, Lorenzoni V, Turchetti G. Scoping review and bibliometric analysis of Big Data applications for Medication adherence: an explorative methodological study to enhance consistency in literature. BMC Health Serv Res 2020; 20:688. [PMID: 32709237 PMCID: PMC7379348 DOI: 10.1186/s12913-020-05544-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication adherence has been studied in different settings, with different approaches, and applying different methodologies. Nevertheless, our knowledge and efficacy are quite limited in terms of measuring and evaluating all the variables and components that affect the management of medication adherence regimes as a complex phenomenon. The study aim is mapping the state-of-the-art of medication adherence measurement and assessment methods applied in chronic conditions. Specifically, we are interested in what methods and assessment procedures are currently used to tackle medication adherence. We explore whether Big Data techniques are adopted to improve decision-making procedures regarding patients' adherence, and the possible role of digital technologies in supporting interventions for improving patient adherence and avoiding waste or harm. METHODS A scoping literature review and bibliometric analysis were used. Arksey and O'Malley's framework was adopted to scope the review process, and a bibliometric analysis was applied to observe the evolution of the scientific literature and identify specific characteristics of the related knowledge domain. RESULTS A total of 533 articles were retrieved from the Scopus academic database and selected for the bibliometric analysis. Sixty-one studies were identified and included in the final analysis. The Morisky medication adherence scale (36%) was the most frequently adopted baseline measurement tool, and cardiovascular/hypertension disease, the most investigated illness (38%). Heterogeneous findings emerged from the types of study design and the statistical methodologies used to assess and compare the results. CONCLUSIONS Our findings reveal a lack of Big Data applications currently deployed to address or measure medication adherence in chronic conditions. Our study proposes a general framework to select the methods, measurements and the corpus of variables in which the treatment regime can be analyzed.
Collapse
Affiliation(s)
- Salvatore Pirri
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | | | | |
Collapse
|
22
|
Macquart de Terline D, Kramoh KE, Bara Diop I, Nhavoto C, Balde DM, Ferreira B, Houenassi MD, Hounsou D, Ikama MS, Kane A, Kimbally-Kaki SG, Kingue S, Koffi F, Kouam Kouam C, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'goran Y, Sesso Z, Sidi Aly A, Toure IA, Plouin PF, Azizi M, Perier MC, Narayanan K, Empana JP, Jouven X, Antignac M. Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries. Arch Cardiovasc Dis 2020; 113:433-442. [PMID: 32434710 DOI: 10.1016/j.acvd.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.
Collapse
Affiliation(s)
- Diane Macquart de Terline
- Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France.
| | | | | | | | - Dadhi M Balde
- Department of Cardiology, University Hospital of Conakry, Guinea
| | | | | | - Dominique Hounsou
- National University Hospital of Hubert K. Maga (CNHU-HKM), 01 BP 386, Cotonou, Bénin
| | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo
| | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | - Suzy Gisèle Kimbally-Kaki
- Cardiology Department, National University Hospital of Brazzaville, Marien Ngouabi University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Cameroon
| | - Florent Koffi
- Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Yves N'goran
- Institute of Cardiology of Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | | | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamordé, Niamey University, Niamey, Niger
| | - Pierre François Plouin
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Michel Azizi
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Marie Cécile Perier
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
| | | | - Jean Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France; Université de Paris, Paris, France; Department of Cardiology, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Marie Antignac
- Sorbonne Université, AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de Pharmacie, 75012 Paris, France; Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Integrative Epidemiology of cardiovascular disease, Paris, France
| |
Collapse
|
23
|
Askland K, Wright L, Wozniak DR, Emmanuel T, Caston J, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 4:CD007736. [PMID: 32255210 PMCID: PMC7137251 DOI: 10.1002/14651858.cd007736.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although highly effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) is not universally accepted by users. Educational, supportive and behavioural interventions may help people with OSA initiate and maintain regular and continued use of CPAP. OBJECTIVES To assess the effectiveness of educational, supportive, behavioural, or mixed (combination of two or more intervention types) strategies that aim to encourage adults who have been prescribed CPAP to use their devices. SEARCH METHODS Searches were conducted on the Cochrane Airways Group Specialised Register of trials. Searches are current to 29 April 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed intervention(s) designed to inform participants about CPAP/OSA, to support them in using CPAP, or to modify their behaviour to increase use of CPAP devices. DATA COLLECTION AND ANALYSIS We assessed studies to determine their suitability for inclusion in the review. Data were extracted independently and were entered into RevMan for analysis. 'Risk of bias' assessments were performed, using the updated 'Risk of bias 2' tool, for the primary outcome, CPAP usage. Study-level 'Risk of bias' assessments were performed using the original 'Risk of bias' tool. GRADE assessment was performed using GRADEpro. MAIN RESULTS Forty-one studies (9005 participants) are included in this review; 16 of these studies are newly identified with updated searches. Baseline Epworth Sleepiness Scale (ESS) scores indicate that most participants suffered from excessive daytime sleepiness. The majority of recruited participants had not used CPAP previously. When examining risk of bias for the primary outcome of hourly machine usage/night, 58.3% studies have high overall risk (24/41 studies), 39.0% have some concerns (16/41 studies), and 2.4% have low overall risk (1/41 studies). We are uncertain whether educational interventions improve device usage, as the certainty of evidence was assessed as very low. We were unable to perform meta-analyses for number of withdrawals and symptom scores due to high study heterogeneity. Supportive interventions probably increase device usage by 0.70 hours/night (95% confidence interval (CI) 0.36 to 1.05, N = 1426, 13 studies, moderate-certainty evidence), and low-certainty evidence indicates that the number of participants who used their devices ≥ 4 hours/night may increase from 601 to 717 per 1000 (odds ratio (OR), 1.68, 95% CI 1.08 to 2.60, N = 376, 2 studies). However, the number of withdrawals may also increase from 136 to 167 per 1000 (OR 1.27, 95% CI 0.97 to 1.66, N = 1702, 11 studies, low-certainty evidence). Participants may experience small improvements in symptoms (ESS score -0.32 points, 95% CI -1.19 to 0.56, N = 470, 5 studies, low-certainty evidence), and we are uncertain whether quality of life improves with supportive interventions, as the certainty of evidence was assessed as very low. When compared with usual care, behavioural interventions produce a clinically-meaningful increase in device usage by 1.31 hours/night (95% CI 0.95 to 1.66, N = 578, 8 studies, high-certainty evidence), probably increase the number of participants who used their machines ≥ 4 hours/night from 371 to 501 per 1000 (OR 1.70, 95% CI 1.20 to 2.41, N = 549, 6 studies, high-certainty evidence), and reduce the number of study withdrawals from 146 to 101 per 1000 (OR 0.66, 95% CI 0.44 to 0.98, N = 939, 10 studies, high-certainty evidence). Behavioural interventions may reduce symptoms (ESS score -2.42 points, 95% CI -4.27 to -0.57, N = 272, 5 studies, low-certainty evidence), but probably have no effect on quality of life (Functional Outcomes of Sleep Questionnaire (FOSQ), standardised mean difference (SMD) 0.00, 0.95% CI -0.26 to 0.26, N = 228, 3 studies, moderate-certainty evidence). We are uncertain whether behavioural interventions improve apnoea hypopnoea index (AHI), as the certainty of evidence was assessed as very low. We are uncertain if mixed interventions improve device usage, increase the number of participants using their machines ≥ 4 hours/night, reduce study withdrawals, improve quality of life, or reduce anxiety symptoms, as the certainty of evidence for these outcomes was assessed to be very low. Symptom scores via the ESS could not be measured due to considerable heterogeneity between studies. AUTHORS' CONCLUSIONS In CPAP-naïve people with OSA, high-certainty evidence indicates that behavioural interventions yield a clinically-significant increase in hourly device usage when compared with usual care. Moderate certainty evidence shows that supportive interventions increase usage modestly. Very low-certainty evidence shows that educational and mixed interventions may modestly increase CPAP usage. The impact of improved CPAP usage on daytime sleepiness, quality of life, and mood and anxiety scores remains unclear since these outcomes were not assessed in the majority of included studies. Studies addressing the choice of interventions that best match individual patient needs and therefore result in the most successful and cost-effective therapy are needed.
Collapse
Affiliation(s)
- Kathleen Askland
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Lauren Wright
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
- AstraZeneca Canada Inc.MississaugaOntarioCanada
| | - Dariusz R Wozniak
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
| | - Talia Emmanuel
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Jessica Caston
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Ian Smith
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
| | | |
Collapse
|
24
|
Foley L, Larkin J, Lombard-Vance R, Murphy AW, Molloy GJ. Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol. HRB Open Res 2019; 2:29. [DOI: 10.12688/hrbopenres.12961.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions. Study registration: The systematic review is prospectively registered in PROSPERO (CRD42019133849); registered on 12 June 2019.
Collapse
|
25
|
Qualitative study of patients with metastatic prostate cancer to adherence of hormone therapy. Eur J Oncol Nurs 2019; 38:8-12. [DOI: 10.1016/j.ejon.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/25/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
|
26
|
Russell AM, Smith SG, Bailey SC, Belter LT, Pandit AU, Hedlund LA, Bojarski EA, Rush SR, Wolf MS. Older Adult Preferences of Mobile Application Functionality Supporting Medication Self-Management. JOURNAL OF HEALTH COMMUNICATION 2018; 23:1064-1071. [PMID: 30526400 DOI: 10.1080/10810730.2018.1554728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Health systems and insurers alike are increasingly interested in leveraging mHealth (mobile health) tools to support patient health-related behaviors including medication adherence. However, these tools are not widely used by older patients. This study explores patient preferences for functionality in a smartphone application (app) that supports medication self-management among older adults with multiple chronic conditions. We conducted six discussion groups in Chicago, Miami, and Denver (N = 46). English-speaking older adults (55 and older) who owned smartphones and took five or more prescription medicines were invited to participate. Discussions covered familiarity with and use of current apps and challenges with taking multidrug regimens. Participants reviewed a range of possible mobile app functions and were asked to give feedback regarding the acceptability and desirability of each to support medication management. Very few participants (n = 3) reported current use of a mobile app for medication support, although all were receptive. Challenges to medication use were forgetfulness, fear of adverse events, and managing medication information from multiple sources. Desired features included (1) a list and consolidated schedule of medications, (2) identification and warning of unsafe medication interactions, (3) reminder alerts to take medicine, and (4) the ability record when medications were taken. Features relating to refill ordering, pharmacy information, and comparing costs for medication were not considered to be as important for an app.
Collapse
Affiliation(s)
- Andrea M Russell
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Samuel G Smith
- b Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | - Stacy C Bailey
- c Division of Pharmaceutical Outcomes and Policy , UNC Eshelman School of Pharmacy , Chapel Hill , NC , USA
| | - Lisa T Belter
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Anjali U Pandit
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Laurie A Hedlund
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Elizabeth A Bojarski
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| | - Steven R Rush
- d UnitedHealth Group Health Literacy Innovations Program , United HealthCare Services Inc , Minneapolis , MN , USA
| | - Michael S Wolf
- a Division of General Internal Medicine , Feinberg School of Medicine at Northwestern University , Chicago , IL , USA
| |
Collapse
|
27
|
Ritschl V, Lackner A, Boström C, Mosor E, Lehner M, Omara M, Ramos R, Studenic P, Smolen JS, Stamm TA. I do not want to suppress the natural process of inflammation: new insights on factors associated with non-adherence in rheumatoid arthritis. Arthritis Res Ther 2018; 20:234. [PMID: 30340628 PMCID: PMC6235214 DOI: 10.1186/s13075-018-1732-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that 50-70% of patients with rheumatoid arthritis (RA) are non-adherent to their recommended treatment. Non-adherent patients have a higher risk of not reaching an optimal clinical outcome. We explored factors associated with nonadherence from the patient's perspective. METHODS Four hundred and fifty-nine RA patients (346 (75.4%) females; mean age 63.0 ± 14.8 years) who failed to attend follow-up visits in two rheumatology centres were eligible to participate in a qualitative interview study. We used this strategy to identify patients who were potentially non-adherent to medicines and/or non-pharmacological interventions. By means of meaning condensation analysis, we identified new and some already well known insights to factors associated with non-adherence. We used the capability, opportunity, and motivation model of behaviour (COM-B) model as a frame of reference to classify the factors. RESULTS Forty-three of 131 patients (32.8%) who agreed to participate in the qualitative interviews were found to be non-adherent. New insights on factors associated with non-adherence included strong opinions of patients, such as pain being considered as an indicator of hard work and something to be proud of, or inflammation being a natural process that should not be suppressed; feeling not to be in expert's hands when being treated by a physician/health professional; the experience of excessive self-control over the treatment; and rheumatologists addressing only drugs and omitting non-pharmacological aspects. The COM-B model comprehensively covered the range of our findings. CONCLUSIONS The new insights on factors associated with non-adherence allow a better understanding of this phenomenon and can substantially enhance patient care by helping to develop targeted interventions.
Collapse
Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Division of Occupational Therapy, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Angelika Lackner
- Department of Rheumatology, Medical University of Graz, Styria, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Karolinska Institute, Care Sciences and Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Michaela Lehner
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Romualdo Ramos
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Josef Sebastian Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Tanja Alexandra Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| |
Collapse
|
28
|
Ip RNS, Tenney JW, Chu ACK, Chu PLM, Young GWM. Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial. Geriatrics (Basel) 2018; 3:E53. [PMID: 31011090 PMCID: PMC6319213 DOI: 10.3390/geriatrics3030053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15-0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.
Collapse
Affiliation(s)
- Rosanna Nga Suet Ip
- Department of Pharmacy, Tuen Mun Hospital, Hong Kong, China.
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Justin Wade Tenney
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | | | | | | |
Collapse
|
29
|
Gatchel RJ, Reuben DB, Dagenais S, Turk DC, Chou R, Hershey AD, Hicks GE, Licciardone JC, Horn SD. Research Agenda for the Prevention of Pain and Its Impact: Report of the Work Group on the Prevention of Acute and Chronic Pain of the Federal Pain Research Strategy. THE JOURNAL OF PAIN 2018; 19:837-851. [DOI: 10.1016/j.jpain.2018.02.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 01/13/2023]
|
30
|
Ernawati I, Islamiyah WR, Sumarno. How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication Adherence? A Literature Review. Open Access Maced J Med Sci 2018; 6:1174-1179. [PMID: 29983823 PMCID: PMC6026415 DOI: 10.3889/oamjms.2018.235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 11/09/2022] Open
Abstract
Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent seizures. Non-adherence situation plays an important factor in the failure of seizure control. Such a condition may generate several impacts on clinical, social, and economic aspect. Several methods are used to measure adherence in epilepsy patients, including direct and indirect measurement. The direct measure involves measurement of drug levels in hair or body fluids such as blood and saliva. Whereas, indirect measure involves the non-biological tools, for example, a self-report measure, pill counts, appointment attendance, medication refills, and seizure frequency. Numerous factors may affect adherence in epilepsy patients, such as age, sex, and seizure aetiology, seizure sites, which are categorised as irreversible factors and hardly to be improved. However, there are factors that can be influenced to improve adherence such as patient knowledge, medication, cultural, health care professionals, and national health policies, which are related to treatment and education factor which is associated with behaviour to be likely adherence.
Collapse
Affiliation(s)
- Iin Ernawati
- Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| | | | - Sumarno
- Department of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| |
Collapse
|
31
|
Ng YK, Shah NM, Loong LS, Pee LT, Hidzir SAM, Chong WW. Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist-patient consultations. Patient Prefer Adherence 2018; 12:615-624. [PMID: 29731609 PMCID: PMC5923248 DOI: 10.2147/ppa.s159113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study investigated patients' and pharmacists' attitudes toward concordance in a pharmacist-patient consultation and how patients' attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use. SUBJECTS AND METHODS A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making. RESULTS A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making (p<0.05). CONCLUSION Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.
Collapse
Affiliation(s)
- Yew Keong Ng
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Ly Sia Loong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lay Ting Pee
- Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Wei Wen Chong
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
32
|
Thomson K, Brouwers C, Damman OC, de Bruijne MC, Timmermans DR, Melles M. How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study. JMIR Hum Factors 2018; 5:e7. [PMID: 29463494 PMCID: PMC5840481 DOI: 10.2196/humanfactors.8948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/05/2017] [Indexed: 02/01/2023] Open
Abstract
Background Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. Objective The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods A Web-based prototype of the eHealth app—MIK—was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians’ evaluations. Results On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient’s understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. Conclusions The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM.
Collapse
Affiliation(s)
- Karen Thomson
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Corline Brouwers
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| |
Collapse
|
33
|
Lemstra M, Nwankwo C, Bird Y, Moraros J. Primary nonadherence to chronic disease medications: a meta-analysis. Patient Prefer Adherence 2018; 12:721-731. [PMID: 29765208 PMCID: PMC5944464 DOI: 10.2147/ppa.s161151] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Medication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence. OBJECTIVES The objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications. MATERIALS AND METHODS We conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model. RESULTS Twenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%-16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%-25.6%). The rates in North America (17.0%; 95% CI: 14.4%-19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%-9.9%). The absence of social support (20%; 95% CI: 14.4%-26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence. CONCLUSION Evidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention.
Collapse
Affiliation(s)
- Mark Lemstra
- Alliance Health Medical Clinics, Moose Jaw, Regina and Saskatoon, Saskatchewan, Canada
- Correspondence: Mark Lemstra, Alliance Health Medical Clinics, B70 500 – 1st Avenue NW, Moose Jaw, SK S6H 3M5, Canada, Email
| | - Chijioke Nwankwo
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yelena Bird
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
34
|
Dalseth N, Reed RS, Hennessy M, Eisenberg MM, Blank MB. Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness. AIDS Behav 2018; 22:265-275. [PMID: 28536741 PMCID: PMC6281165 DOI: 10.1007/s10461-017-1795-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. TRIAL REGISTRATION clinicaltrials.gov 29 identifier NCT00264823.
Collapse
Affiliation(s)
- Natasha Dalseth
- Department of Psychiatry and Behavioral Science, Lewis Katz School of Medicine, Temple University, Episcopal Campus, 100 E Lehigh Ave MAB 305, Philadelphia, PA, 19125, USA.
| | - Regina Szucs Reed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marlene M Eisenberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
35
|
Senft Y, Kirsch M, Denhaerynck K, Dobbels F, Helmy R, Russell CL, Berben L, De Geest S. Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study. Eur J Cardiovasc Nurs 2017; 17:356-367. [PMID: 29231747 DOI: 10.1177/1474515117747577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians' responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level. RESULTS The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75-88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7-28.6%), the number of strategies decreased. CONCLUSIONS Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.
Collapse
Affiliation(s)
- Yuliya Senft
- 1 Department of Haematology, University Hospital of Basel, Switzerland
| | - Monika Kirsch
- 2 Department of Anesthesiology, University Hospital of Basel, Switzerland
| | - Kris Denhaerynck
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | | | - Remon Helmy
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Cynthia L Russell
- 5 School of Nursing and Health Studies, University of Missouri-Kansas City, USA
| | - Lut Berben
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Sabina De Geest
- 3 Institute of Nursing Science, University of Basel, Switzerland.,4 Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | | |
Collapse
|
36
|
Abu Farha R, Abu Hammour K, Alefishat E, Alsaeed H, Alma'aiah S. Drive-thru pharmacy service: Assessments of awareness, perception and barriers among pharmacists in Jordan. Saudi Pharm J 2017; 25:1231-1236. [PMID: 29204073 PMCID: PMC5688229 DOI: 10.1016/j.jsps.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Drive-thru pharmacy services have become widely recognized service worldwide. Despite its proven success, there were doubts in its ability to maintain safe practice. Thus, the aim of the current study was to investigate the awareness, perception and barriers of drive-thru pharmacy services among pharmacists in Jordan. METHODS A cross-sectional study was conducted in Amman-Jordan between February-May 2017. During the study period, 226 pharmacists were approached. Pharmacists were interviewed to assess their perception toward drive-thru services, and to assess their opinions regarding the advantages and disadvantages of this system using validated questionnaire. RESULTS Although the majority of pharmacists reported that they were aware about the concept of drive-thru pharmacy service (n = 194, 85.5%), but only 27.9% (n = 63) reported that they are willing to register with this service. The most important advantage of drive-thru pharmacy service was serving sick patients, elderly, disabled people or women with child in the car (n = 166, 88.0%). Most of pharmacists agreed that drive-thru pharmacy service may negatively affect the image of pharmacy profession (n = 168, 74.6%), and it makes pharmacists feel more like a fast food worker than a pharmacist (n = 147, 65.9%). Pharmacists working in chain community pharmacies showed better perception to drive-thru pharmacy service compared to pharmacists who are working in independent community pharmacies (p-value = 0.004). CONCLUSION Most of the study pharmacists showed relatively poor perception toward drive-thru pharmacy service and were unwilling to use this service. More effort is needed to better introduce the concept of drive-thru pharmacy service among pharmacists in Jordan since the benefit of this service is well established across the world.
Collapse
Affiliation(s)
- Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Eman Alefishat
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Hiba Alsaeed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Sajida Alma'aiah
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| |
Collapse
|
37
|
Medication adherence among allogeneic hematopoietic stem cell transplant recipients: a pilot single-center study. Bone Marrow Transplant 2017; 53:231-233. [PMID: 29155420 DOI: 10.1038/bmt.2017.233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
38
|
Development and rationale for a multifactorial, randomized controlled trial to test strategies to promote adherence to complex drug regimens among older adults. Contemp Clin Trials 2017; 62:21-26. [PMID: 28823927 DOI: 10.1016/j.cct.2017.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/03/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with chronic conditions are often responsible for self-managing complex, multi-drug regimens with minimal professional clinical support. While numerous interventions to promote and support medication adherence have been tested, most have had limited success or have been too resource-intensive for real-world implementation. OBJECTIVE To compare the effectiveness of multiple low-cost, technology-enabled strategies, alone and in combination, for promoting medication regimen adherence among older adults. METHODS Older, English or Spanish-speaking patients on complex drug regimens (N=1505) will be recruited from a community health system in Chicago, IL. Enrolled patients will be randomized to one of four study arms, receiving either: 1) enhanced usual care alone; 2) daily medication reminders via SMS text messages; 3) medication monitoring via a patient portal-based assessment; or 4) both SMS text message reminders and portal-based medication monitoring. The primary outcome of the study is medication adherence, which will be assessed via multiple measures at baseline, 2months, and 6months. The effect of intervention strategies on clinical markers (hemoglobin A1c, blood pressure, cholesterol level), as well as intervention fidelity and the barriers and costs of implementation will also be evaluated. CONCLUSIONS This randomized controlled trial will evaluate the impact of various low-cost intervention strategies on adherence to complex medication regimens and will explore barriers to implementation. If the studied intervention strategies are shown to be effective, then these approaches could be effectively deployed across a diverse range of clinical settings and patient populations. CLINICAL TRIAL REGISTRATION This trial is registered on clinicaltrials.govNCT02820753.
Collapse
|
39
|
Amin K, Farley JF, Maciejewski ML, Domino ME. Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence. J Manag Care Spec Pharm 2017; 23:337-345. [PMID: 28230447 PMCID: PMC10398003 DOI: 10.18553/jmcp.2017.23.3.337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2001, the North Carolina (NC) Medicaid program reduced the number of days prescription supply that enrollees could fill from 100 days to 34 days and increased copayments for brand-name medications. Previous work has shown that a change in these policies led to a decrease in medication adherence from 2.9 to 8.0 percentage points in specific populations with chronic conditions. Studies have also shown that days supply limits and copayment increases have heterogeneous effects based on enrollees' baseline characteristics, including baseline adherence. However, this phenomenon has not been studied in the Medicaid population. We undertook this study to assess the heterogeneous effect of the NC Medicaid policy changes in groups with varying levels of baseline adherence. OBJECTIVE To examine whether restrictions on days supply had heterogeneous effects in subgroups defined by medication adherence before the policy changes. METHODS A partial difference-in-difference-in-differences model with fixed effects was used to compare medication adherence before and after the NC Medicaid policy changes among Medicaid enrollees subject to the policy changes because of their use of long prescriptions (> 40 days) as compared with (a) NC Medicaid enrollees using short prescriptions (< 40 days) before policy adoption, as well as (b) Medicaid enrollees in Georgia restricted to a 31 days supply through the study period. Medicaid enrollees were included if they filled a prescription for 1 of the following medication classes: antihypertensives, lipid-lowering drugs, or antipsychotics. The effect of the policy changes on medication adherence, calculated using the proportion of days covered (PDC) each quarter by baseline adherence level and clinical condition group, was studied. Average adherence levels over the 18-month prechange period were used to stratify individuals into 3 baseline adherence groups: fully adherent (PDC ≥ 80%), partially adherent (50%-79%), and nonadherent (PDC ≤ 50%). RESULTS Enrollees fully adherent at baseline observed a 2.0 (P = 0.001) and 1.2 (P < 0.001) percentage-point decline in adherence for the lipid-lowering drug and antihypertensive cohorts, respectively, in the period after the policy changes. The nonadherent and partially adherent cohorts in the statin group observed an increase in adherence by 1.7-2.6 (P < 0.05) percentage points in the post-index period. CONCLUSIONS Adherence changes after cost containment policies have a heterogeneous effect on individuals with varying baseline adherence in the Medicaid population. Individuals fully adherent at baseline decreased adherence following policy changes, while individuals partially adherent and nonadherent at baseline either had no change or showed increases in adherence, possibly because of increased contact with pharmacists and clinicians required by shorter prescription lengths. Managed care strategies to control costs should take into consideration the heterogeneity of responses by the enrollees to these policies. Furthermore, policies that consider baseline characteristics of enrollees may be more effective in improving adherence. DISCLOSURES This study was partly funded by a grant from the Robert Wood Johnson Foundation for use in data creation. Maciejewski was supported by a Research Career Scientist Award from the Department of Veterans Affairs (RCS 10-391) and owns stock in Amgen. Farley reports consultancy fees from Daiichi Sankyo outside of the conduct of this study. The other authors report no financial or other conflicts of interest related to the subject of this article. The views expressed in this article are those of the authors and do not reflect the position or policy of the Centers for Medicare & Medicaid Services, University of North Carolina at Chapel Hill, Department of Veteran Affairs, or Duke University. Study design and concept were contributed by Amin and Domino, along with Farley and Maciejewski. Domino collected the data, and data interpretation was performed primarily by Amin, along with Domino, with assistance from Farley and Maciejewski. The manuscript was primarily written by Amin, along with Domino, and revised by all the authors.
Collapse
Affiliation(s)
- Krutika Amin
- 1 Centers for Medicare & Medicaid Services, Washington, DC
| | - Joel F Farley
- 2 University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Matthew L Maciejewski
- 3 Center for Health Services Research in Primary Care, Durham VA Medical Center, and Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marisa E Domino
- 4 Department of Health Policy and Management, The Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| |
Collapse
|
40
|
Hong SJ. Not at All Effective: Differences in Views on the Causes of Prescription Non-adherence Between North Korean Defectors and Medical Providers in South Korea. J Immigr Minor Health 2016; 17:867-84. [PMID: 24647785 DOI: 10.1007/s10903-014-0008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
By focusing on North Korean defectors' medical experiences in South Korea and their medical providers' experiences treating the defectors, this article considers the differences between the views of these two groups in regard to the causes of prescription non-adherence. The results suggest that (a) whereas the defectors tended to see their symptoms as being physical in nature, the medical providers often ascribed symptoms to psychological/socio-cultural influence; (b) whereas the defectors tended to trust in their ability to self-diagnose and in their belief systems established in North Korea, the medical providers tended not to place trust in these aspects; (c) whereas the defectors tended to view the available medical treatment as inappropriate for them, the medical providers often noted the presence of tolerant bacterial strains as causes of treatment failure; and (d) whereas the defectors felt that the treatment they received was slow and ineffective and attributed this to capitalism, the medical providers felt that the defectors failed to understand the concept of staged treatments. Based on the findings, some solutions are suggested to address the complex issue of North Korean defectors' prescription non-adherence in terms of subjective/objective health assessments and patient-centered care. North Korean defectors' established health beliefs/lack of medical knowledge based on their previous medical and cultural experiences gave rise to beliefs and practices associated with medicine that differ significantly from those of the health providers and that have the potential to severely compromise the defectors' health. Therefore, therapy negotiation and appropriate education are suggested as possible solutions, and as an agenda, the notion of civic friendship is addressed. Implications for medical practice, prevention, and intervention are also discussed.
Collapse
Affiliation(s)
- Soo Jung Hong
- Department of Communication Arts and Sciences, 234 Sparks Building, The Pennsylvania State University State College, University Park, PA, 16802, USA,
| |
Collapse
|
41
|
George J, Munro K, McCaig DJ, Stewart DC. Prescription Medications: Beliefs, Experiences, Behavior, and Adherence of Sheltered Housing Residents. Ann Pharmacother 2016; 40:2123-9. [PMID: 17077169 DOI: 10.1345/aph.1h355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Data on medication utilization among residents of sheltered housing complexes (SHCs) are limited. Objective: To evaluate the extent of nonadherence to prescribed medications among residents of SHCs and identify factors associated with nonadherence. Methods: A 58 item, pre-piloted questionnaire with validated items for patient self-assessment of medication risk; adherence; disability; health beliefs, experiences, and behavior; and general items on demographics, health, and medication use was mailed to 1137 SHC residents in Aberdeen, Scotland. Predictors of nonadherence (Morisky score >0) were identified using logistic regression. Results: Of the 695 (61.1%) respondents, 645 (mean ± SD age, 78.2 ± 7.8 y) reported using prescribed drugs. Nonadherence was reported by 176 of 627 (28.1%) residents. The predictors of nonadherence were: disagreeing with the statement, “I ensure I have enough medicines so that I don't run out” (OR 0.48; 95% CI 0.30 to 0.77), agreeing with the statements, “I make changes in the recommended management to suit my lifestyle” (OR 1.32; 95% CI 1.09 to 1.60) and “I get confused about my medicines” (OR 1.39; 95% CI 1.10 to 1.77), younger age (OR 0.96; 95% CI 0.94 to 0.99), not getting help from someone to use the medications correctly (OR 2.20; 95% CI 1.21 to 3.99), and agreeing with the statement, “I am concerned about the side effects from my medicines” (OR 1.31; 95% CI 1.05 to 1.63). Conclusions: Over one-quarter of SHC residents were found to be nonadherent to prescribed drugs. Risk factors for nonadherence include younger age, confusion about drugs, lack of support for drug supply and administration, interference of treatment recommendations with lifestyle, and a perceived view of risks outweighing benefits in using recommended drug therapy.
Collapse
Affiliation(s)
- Johnson George
- School of Pharmacy, The Robert Gordon University, School-hill, Aberdeen, Scotland.
| | | | | | | |
Collapse
|
42
|
Allemann SS, Nieuwlaat R, van den Bemt BJF, Hersberger KE, Arnet I. Matching Adherence Interventions to Patient Determinants Using the Theoretical Domains Framework. Front Pharmacol 2016; 7:429. [PMID: 27895583 PMCID: PMC5107738 DOI: 10.3389/fphar.2016.00429] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/27/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction: Despite much research, interventions to improve medication adherence report disappointing and inconsistent results. Tailored approaches that match interventions and patient determinants of non-adherence were seldom used in clinical trials. The presence of a multitude of theoretical frameworks and models to categorize interventions and patient determinants complicated the development of common categories shared by interventions and determinants. We retrieved potential interventions and patient determinants from published literature on medication adherence, matched them like locks and keys, and categorized them according to the Theoretical Domains Framework (TDF). Methods: We identified the most relevant literature reviews on interventions and determinants in a pragmatic literature search, extracted all interventions and determinants, grouped similar concepts to umbrella terms and assigned them to TDF categories. All steps were finalized in consensus discussion between the authors. Results: Sixteen articles (5 with determinants, 11 with interventions) were included for analysis. We extracted 103 interventions and 42 determinants that we divided in 26 modifiable and 16 unmodifiable determinants. All interventions and modifiable determinants were matched within 11 categories (Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Beliefs about consequences; Intentions; Memory, Attention and decision processes; Environmental context and resources; Social influences; Emotion; and Behavioral regulation). Conclusion: In published trials on medication adherence, the congruence between interventions and determinants can be assessed with matching interventions to determinants. To be successful, interventions in medication adherence should target current modifiable determinants and be tailored to the unmodifiable determinants. Modifiable and unmodifiable determinants need to be assessed at inclusion of intervention studies to identify the patients most in need of an adherence intervention. Our matched categories may be useful to develop interventions in trials that investigate the effectiveness of adherence interventions.
Collapse
Affiliation(s)
- Samuel S. Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of BaselBasel, Switzerland
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
| | - Bart J. F. van den Bemt
- Department of Pharmacy, Radboud University Medical CenterNijmegen, Netherlands
- Department of Pharmacy, Sint MaartenskliniekNijmegen, Netherlands
| | - Kurt E. Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of BaselBasel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of BaselBasel, Switzerland
| |
Collapse
|
43
|
Russell CL, Conn VS, Ashbaugh C, Madsen R, Hayes K, Ross G. Intrasubject Medication Adherence Patterns. Clin Nurs Res 2016; 16:153-63. [PMID: 17452433 DOI: 10.1177/1054773806296429] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this prospective descriptive study was to explore the patterns of intrasubject (between medication) adherence of two similarly timed, twice-daily medications using the Medication Event Management System® electronic monitoring cap. Medication adherence was measured for 6 months using electronic monitoring in 25 adult renal-transplant recipients. Data were available from 7,119 electronic medication events. Results indicated that two twice-daily medications scheduled to be taken simultaneously were taken within 5 min of each other 77% of the time and within 10 min, 92% of the time. When only the first scheduled dose of the day was examined, the results are 79% and 95%, respectively. These findings are important to researchers and clinicians who must evaluate medication adherence in transplant recipients while balancing cost and subject burden. This study provides empirical support for monitoring a single immunosuppressive medication electronically to estimate medication adherence with double or triple immunosuppressive drug therapy.
Collapse
|
44
|
Russell CL, Moore S, Hathaway D, Cheng AL, Chen G, Goggin K. MAGIC Study: Aims, Design and Methods using SystemCHANGE™ to Improve Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients. BMC Nephrol 2016; 17:84. [PMID: 27421884 PMCID: PMC4947243 DOI: 10.1186/s12882-016-0285-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/24/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Among adult kidney transplant recipients, non-adherence to immunosuppressive medications is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of kidney transplant patients experience medication non-adherence even though the problem is preventable. Existing adherence interventions have proven marginally effective for those with acute and chronic illnesses and ineffective for adult kidney transplant recipients. Our purpose is to describe the design and methods of the MAGIC (Medication Adherence Given Individual SystemCHANGE™) trial METHODS/DESIGN We report the design of a randomized controlled trial with an attention-control group to test an innovative 6-month SystemCHANGE™ intervention designed to enhance immunosuppressive medication adherence in adult non-adherent kidney transplant recipients from two transplant centers. Grounded in the Socio-Ecological Model, SystemCHANGE™ seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-led experiments to change and maintain behavior. After a 3-month screening phase of 190 eligible adult kidney transplant recipients, those who are <85 % adherent as measured by electronic monitoring, will be randomized into a 6-month SystemCHANGE™ intervention or attention-control phase, followed by a 6-month maintenance phase without intervention or attention. Differences in adherence between the two groups will be assessed at baseline, 6 months (intervention phase) and 12 months (maintenance phase). Adherence mediators (social support, systems-thinking) and moderators (ethnicity, perceived health) are examined. Patient outcomes (creatinine/blood urea nitrogen, infection, acute/chronic rejection, graft loss, death) and cost effectiveness are to be examined. DISCUSSION Based on the large effect size of 1.4 found in our pilot study, intervention shows great promise for increasing adherence. Grounded in the socio-ecological model, SystemCHANGE™ seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-lead experiments to change and maintain behavior. Medication adherence will be measured by electronic monitoring. Medication adherence persistence will be examined by evaluating differences between the two groups at the end of the 6-and 12- month phases. Mediators and moderators of medication adherence will be examined. Patient outcomes will be compared and a cost-effectiveness analysis will be conducted. TRIAL REGISTRATION ClinicalTrials.gov Registry: NCT02416479 Registered April 3, 2015.
Collapse
Affiliation(s)
- Cynthia L. Russell
- />School of Nursing and Health Studies, University of Missouri-Kansas City, Health Sciences Building 2407, Kansas City, MO 64108 USA
| | - Shirley Moore
- />Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106 USA
| | - Donna Hathaway
- />Department of Advanced Practice and Doctoral Studies, 920 Madison, #924, Memphis, TN 38163 USA
| | - An-Lin Cheng
- />School of Nursing and Health Studies, University of Missouri-Kansas City, Health Sciences Building 2407, Kansas City, MO 64108 USA
| | - Guoqing Chen
- />Department of Internal Medicine, University of Kansas Medical Center, 4043 Wescoe, MS 1037 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Kathy Goggin
- />Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, University of Missouri - Kansas City Schools of Medicine and Pharmacy, 2401 Gillham Road, Kansas City, MO 64108 USA
| |
Collapse
|
45
|
Pedrosa RBDS, Rodrigues RCM. Adaptation and evaluation of the measurement properties of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale. Rev Lat Am Enfermagem 2016; 24:e2692. [PMID: 27192417 PMCID: PMC4877142 DOI: 10.1590/1518-8345.0167.2692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/25/2015] [Indexed: 12/20/2022] Open
Abstract
Objectives: to undertake the cultural adaptation of, and to evaluate the measurement
properties of, the Brazilian version of the Self-efficacy for Appropriate
Medication Adherence Scale in coronary heart disease (CHD) patients, with
outpatient monitoring at a teaching hospital. Method: the process of cultural adaptation was undertaken in accordance with the
international literature. The data were obtained from 147 CHD patients, through
the application of the sociodemographic/clinical characterization instrument, and
of the Brazilian versions of the Morisky Self-Reported Measure of Medication
Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy
for Appropriate Medication Adherence Scale. Results: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence
Scale presented evidence of semantic-idiomatic, conceptual and cultural
equivalencies, with high acceptability and practicality. The floor effect was
evidenced for the total score and for the domains of the scale studied. The
findings evidenced the measure's reliability. The domains of the Brazilian version
of the Self-efficacy for Appropriate Medication Adherence Scale presented
significant inverse correlations of moderate to strong magnitude between the
scores of the Morisky scale, indicating convergent validity, although correlations
with the measure of general self-efficacy were not evidenced. The validity of
known groups was supported, as the scale discriminated between "adherents" and
"non-adherents" to the medications, as well as to "sufficient dose" and
"insufficient dose". Conclusion: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence
Scale presented evidence of reliability and validity in coronary heart disease
outpatients.
Collapse
|
46
|
Gilbert CE, Babu RG, Gudlavalleti ASV, Anchala R, Shukla R, Ballabh PH, Vashist P, Ramachandra SS, Allagh K, Sagar J, Bandyopadhyay S, Murthy GVS. Eye care infrastructure and human resources for managing diabetic retinopathy in India: The India 11-city 9-state study. Indian J Endocrinol Metab 2016; 20:S3-S10. [PMID: 27144134 PMCID: PMC4847447 DOI: 10.4103/2230-8210.179768] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is a paucity of information on the availability of services for diagnosis and management of diabetic retinopathy (DR) in India. OBJECTIVES The study was undertaken to document existing healthcare infrastructure and practice patterns for managing DR. METHODS This cross-sectional study was conducted in 11 cities and included public and private eye care providers. Both multispecialty and stand-alone eye care facilities were included. Information was collected on the processes used in all steps of the program, from how diabetics were identified for screening through to policies about follow-up after treatment by administering a semistructured questionnaire and by using observational checklists. RESULTS A total of 86 eye units were included (31.4% multispecialty hospitals; 68.6% stand-alone clinics). The availability of a dedicated retina unit was reported by 68.6% (59) facilities. The mean number of outpatient consultations per year was 45,909 per responding facility, with nearly half being new registrations. A mean of 631 persons with sight-threatening-DR (ST-DR) were registered per year per facility. The commonest treatment for ST-DR was laser photocoagulation. Only 58% of the facilities reported having a full-time retina specialist on their rolls. More than half the eye care facilities (47; 54.6%) reported that their ophthalmologists would like further training in retina. Half (51.6%) of the facilities stated that they needed laser or surgical equipment. About 46.5% of the hospitals had a system to track patients needing treatment or for follow-up. CONCLUSIONS The study highlighted existing gaps in service provision at eye care facilities in India.
Collapse
Affiliation(s)
- Clare E. Gilbert
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - R. Giridhara Babu
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Aashrai Sai Venkat Gudlavalleti
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Raghupathy Anchala
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Rajan Shukla
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Pant Hira Ballabh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Praveen Vashist
- Department of Community Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Srikrishna S. Ramachandra
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Komal Allagh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Jayanti Sagar
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - Souvik Bandyopadhyay
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| | - G. V. S. Murthy
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, Telangana, India
| |
Collapse
|
47
|
Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
Collapse
Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| |
Collapse
|
48
|
Sharma S, Roshi, Tandon VR, Mahajan A. A Study Evaluating Adherence and Compliance of Anti-rheumatic Drugs in Women Suffering from Rheumatoid Arthritis. J Clin Diagn Res 2015; 9:OC01-4. [PMID: 26676079 DOI: 10.7860/jcdr/2015/15806.6729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of Rheumatoid arthritis (RA) has always remained challenging, complex and associated with high level of non adherence, noncompliance in clinical practice. AIM To evaluate the satisfaction/adherence/compliance rates of most commonly prescribed anti-rheumatic drugs among Indian women. MATERIALS AND METHODS A cross-sectional descriptive obser-vational study was undertaken to evaluate the adherence/compliance rates of most commonly prescribed anti-rheumatic drugs among women in a tertiary care teaching hospital in North India. Hundred women on anti rheumatic treatment for rheumatoid arthritis diagnosed by American College of Rheumatology (ACR) criteria were evaluated at one point analysis for adherence/compliance/satisfaction. RESULTS Dissatisfaction rate with the anti rheumatic treatment was significantly high p<0.0001 among 68% of the women. Non compliance/ non adherence rate was also recorded very high among 52% and interrupted compliance rate was noticed among 6% of the women suffering from RA. Switch over rate to other treatment or doctors was also significantly (p<0.0001) very high among 66% of the women. Switch over to alternative treatment, treatment under quacks and intermittent self medication was recorded by 12%, 4% & 16% respectively. Among the self medication 12% of the women took corticosteroids and 4% preferred taking intermittent NSAIDs. CONCLUSION Treatment compliance is not very good with anti-rheumatic drugs among women patients of RA due to multi-factorial reasons.
Collapse
Affiliation(s)
- Sudhaa Sharma
- Associate Professor, Department of Obstetrics and Gynalcology, Government Medical College , Jammu- J&K, India
| | - Roshi
- Postgraduate Student, Department of Pharmacology, Government Medical College , Jammu- J&K, India
| | - Vishal R Tandon
- Assistant Professor, Department of Pharmacology, Government Medical College , Jammu- J&K, India
| | - Annil Mahajan
- Professor and Head, Department of Medicine, Government Medical College , Jammu- J&K, India
| |
Collapse
|
49
|
Barillet M, Prevost V, Joly F, Clarisse B. Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol 2015; 80:1289-302. [PMID: 26255807 DOI: 10.1111/bcp.12734] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022] Open
Abstract
AIMS Oral therapies, including hormone-based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies. METHODS We conducted a literature-based narrative review of studies obtained from Pubmed using medical subject heading terms and free-text terms combining concepts related to oral anticancer medication and adherence. RESULTS The analysis is based on 48 studies published since 1990, mostly assessing hormone-based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self-report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related-factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time. CONCLUSION Adherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.
Collapse
Affiliation(s)
- Marie Barillet
- Centre Hospitalier J Monod, rue Eugène Garnier BP 219, 61104, Flers cedex
| | - Virginie Prevost
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Florence Joly
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Bénédicte Clarisse
- Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| |
Collapse
|
50
|
Poole SG, Bell JS, Jokanovic N, Kirkpatrick CM, Dooley MJ. A systematic review of medication exposure assessment in prospective cohort studies of community dwelling older australians. PLoS One 2015; 10:e0124247. [PMID: 25909191 PMCID: PMC4409061 DOI: 10.1371/journal.pone.0124247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/27/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction It is not known to what extent medication use has been comprehensively assessed in prospective cohort studies of older Australians. Understanding the varying methods to assess medication use is necessary to establish comparability and to understand the opportunities for pharmacoepidemiological analysis. The objective of this review was to compare and contrast how medication-related data have been collected in prospective cohorts of community-dwelling older Australians. Methods MEDLINE and EMBASE (1990–2014) were systematically searched to identify prospective cohorts of ≥1000 older participants that commenced recruitment after 1990. The data collection tools used to assess medication use in each cohort were independently examined by two investigators using a structured approach. Results Thirteen eligible cohorts were included. Baseline medication use was assessed in participant self-completed surveys (n = 3), by an investigator inspecting medications brought to a clinic interview (n = 7), and by interviewing participants in their home (n = 3). Five cohorts sought participant consent to access administrative claims data. Six cohorts used multiple methods to assess medication use across one or more study waves. All cohorts assessed medication use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded prescription medications by trade or generic name; 12 cohorts recorded medication strength; and 9 recorded the daily medication dose in at least one wave of the cohort. Seven cohorts asked participants about their “current” medication use without providing a definition of “current”; and nine cohorts asked participants to report medication use over recall periods ranging from 1-week to 3-months in at least one wave of the cohort. Sixty-five original publications, that reported the prevalence or outcomes of medication use, in the 13 cohorts were identified (median = 3, range 1–21). Conclusion There has been considerable variability in the assessment of medication use within and between cohorts. This may limit the comparability of medication data collected in these cohorts.
Collapse
Affiliation(s)
- Susan G. Poole
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
- * E-mail:
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Natali Jokanovic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Carl M. Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael J. Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|