1
|
Amiesimaka OI, Aluzaite K, Braund R, Schultz M. "It's just like putting your socks on": patients' perspectives on inflammatory bowel disease medication adherence. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100385. [PMID: 38146319 PMCID: PMC10749283 DOI: 10.1016/j.rcsop.2023.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Background A careful, often life-long, medication regimen is central to therapy for Inflammatory Bowel Disease (IBD) - a chronic gut disorder. Hence, medication adherence (MA) - patients taking medications in line with prescription - is important. Previous research indicates that a third of patients with IBD in southern New Zealand have poor medication adherence (MA). Objective This study investigated these patients' experiences to determine factors that influence their MA, for the first time. Methods Two focus group discussions (FGDs) were held with IBD patients in Otago, New Zealand. Reflexive thematic analysis from a 'direct realist' viewpoint was used to analyse the data. Results Data were analysed in three segments: perceptions, experiences and support. Participants perceived MA as a "duty" that was very important to their wellbeing. The participants' MA was centred around a routine requiring proactivity to maintain. MA was negatively impacted by side effects and regimen factors including (high) pill numbers/dose frequency, and getting refills was framed as challenging; whilst healthcare professionals were presented as major MA facilitators. Lastly, the support structures identified included family, friends and colleagues as well as targeted health system factors e.g. medication subsidies. Conclusions Factors spanning those related to the patients, their socioeconomic status, the disease, IBD therapy and the health system were presented as influencing IBD patients' MA in southern NZ. Thus, multifaceted interventions are needed across the health system to overcome the inhibiting and promote the facilitating elements.
Collapse
Affiliation(s)
- Obreniokibo Ibifubara Amiesimaka
- Gastroenterology Research Unit, Department of Medicine, Dunedin School of Medicine (DSM), University of Otago, Dunedin, New Zealand
| | - Kristina Aluzaite
- Gastroenterology Research Unit, Department of Medicine, Dunedin School of Medicine (DSM), University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Gastroenterology Research Unit, Department of Medicine, Dunedin School of Medicine (DSM), University of Otago, Dunedin, New Zealand
- Gastroenterology Unit, Dunedin Hospital, Te Whatu Ora/Health New Zealand, Dunedin, New Zealand
| |
Collapse
|
2
|
Krousel-Wood M, Craig LS, Peacock E, Zlotnick E, O’Connell S, Bradford D, Shi L, Petty R. Medication Adherence: Expanding the Conceptual Framework. Am J Hypertens 2021; 34:895-909. [PMID: 33693474 DOI: 10.1093/ajh/hpab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022] Open
Abstract
Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.
Collapse
Affiliation(s)
- Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Leslie S Craig
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emily Zlotnick
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O’Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - David Bradford
- Department of Public Administration and Policy, University of Georgia, Athens, Georgia, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Richard Petty
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
3
|
The Medication Experience: A Concept Analysis. PHARMACY 2020; 9:pharmacy9010007. [PMID: 33396387 PMCID: PMC7839002 DOI: 10.3390/pharmacy9010007] [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] [Received: 11/30/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
This is a concept analysis of the medication experience with a focus on how it applies to the pharmaceutical care practice framework used by pharmacist practitioners. The medication experience is a vital component of pharmaceutical care practice and of patient-centered care. Although the experience of taking medication has been studied across disciplines for decades, a concept analysis of the medication experience is lacking. Rodgers’ evolutionary concept analysis method was utilized. Ovid Medline, CINAHL, PsycINFO, Sociological Abstracts and Google Scholar databases, references and hand searches were used to compile an international dataset of 66 papers published from 1982 to 2020. As a result of the available literature, the medication experience is defined as one of ambivalence and vulnerability in which the patient is actively engaged in an ongoing process or negotiation, which is pragmatic to the ways in which they live and experience life, contextualized and nuanced within the social construction of their individual realities. The concept of medication experience is an important addition to the scientific literature. The definition of medication experience from the perspective of the patient will help to better explain the concept for future research and theory development to move the discipline of pharmaceutical care practice forward.
Collapse
|
4
|
Eisele M, Harder M, Rakebrandt A, Boczor S, Marx G, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. Association of depression and anxiety with adherence in primary care patients with heart failure-cross-sectional results of the observational RECODE-HF cohort study. Fam Pract 2020; 37:695-702. [PMID: 32358596 DOI: 10.1093/fampra/cmaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients' adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence. METHOD This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence. RESULTS Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence. CONCLUSION Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients' self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.
Collapse
Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Malte Harder
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Gabriella Marx
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck
| | - Stefan Störk
- University and University Hospital Würzburg, Comprehensive Heart Failure Center Würzburg, Am Schwarzenberg, Würzburg
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| |
Collapse
|
5
|
Breuning M, Lucius-Hoene G, Burbaum C, Himmel W, Bengel J. [Patient experiences and patient centeredness : The website project DIPEx Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:453-461. [PMID: 28251275 DOI: 10.1007/s00103-017-2524-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient centeredness is a central concept in the treatment and rehabilitation of persons with chronic illness in Germany. There are various concepts of and approaches to patient centeredness, most of them developed from the perspective of health care research and the institutions. In terms of participation requirements, there has been a lack of understanding of the patient's perspective and experiences so far. In this article, the authors assume that the collection and analysis of patient experiences can improve patient participation and provide access to the experience of living and coping with an illness, including the patient's interactions with the health care system, their participation, and their preferences for participation. Potential uses for and the limits and risks of utilizing patient experiences are discussed, using the example of the website project Krankheitserfahrungen.de (DIPEx Germany). The project collects patient experiences in the form of narrative interviews. In the course of sharing their stories, the speakers become experts on their own lives and describe where and how they feel engaged in their health care and how they wish to become further engaged, thereby experiencing participation in terms of the International Classification of Functioning. The experience of rehabilitation is viewed in a comprehensive manner for those affected. It is not limited to experiences in specific institutions, but rather, the patient experience includes the context and processes, and describes how patients can find their way back to their lives after the interruption of an illness.
Collapse
Affiliation(s)
- Martina Breuning
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland.
| | - Gabriele Lucius-Hoene
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Christina Burbaum
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Jürgen Bengel
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| |
Collapse
|
6
|
Herrera PA, Moncada L, Defey D. Understanding Non-Adherence From the Inside: Hypertensive Patients' Motivations for Adhering and Not Adhering. QUALITATIVE HEALTH RESEARCH 2017; 27:1023-1034. [PMID: 27282381 DOI: 10.1177/1049732316652529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.
Collapse
Affiliation(s)
| | | | - Denise Defey
- 2 University of the Republic, Montevideo, Uruguay
| |
Collapse
|
7
|
Simmenroth-Nayda A, Marx G, Lorkowski T, Himmel W. Working as simulated patient has effects on real patient life - Preliminary insights from a qualitative study. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc42. [PMID: 27275507 PMCID: PMC4894358 DOI: 10.3205/zma001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Persons who simulate patients during medical education understand the routines and the underlying script of medical consultations better. We aimed to explore how simulated patients (SPs) integrated this new understanding into their daily life, how this work affected their private life as patients, and what we can learn from these changes for concepts of empowerment. DESIGN, SETTING, AND PARTICIPANTS A qualitative interview study. All SPs of Göttingen medical school who had been working longer than three semesters (n=14) were invited and agreed to take part in an open interview about their daily experience with real doctors. Documentary method was used to identify the main issues. Several cases were chosen according to maximum contrast and analysed by in-depth analysis to provide vivid examples of how simulations may affect the real life of the SPs as patients. RESULTS Our analysis revealed three main changes in the behaviour of SPs as real patients. They were more attentive, had a better understanding of the circumstances under which doctors work, and acted more self-confidently. From the selected cases it became apparent that working as a SP may lead to a constant and significant decrease of fear of hospitals and medical procedures or, in other cases, may enable the SPs to develop new abilities for giving feedback, questioning procedures, and explanations for real doctors. CONCLUSION working as a simulated patient seems to be well-suited to understand own progression of diseases, to increase self-responsibility and to a confident attitude as patient.
Collapse
Affiliation(s)
- Anne Simmenroth-Nayda
- University Medical Center Göttingen, Department of General Practice/Family Medicine, Göttingen, Germany
| | - Gabriella Marx
- University Medical Center Göttingen, Postdoctoral Fellow, Clinic for Palliative Medicine, Göttingen, Germany
| | - Thorsten Lorkowski
- University Medical Center Göttingen, Department of General Practice/Family Medicine, Göttingen, Germany
| | - Wolfgang Himmel
- University Medical Center Göttingen, Department of General Practice/Family Medicine, Göttingen, Germany
| |
Collapse
|
8
|
Oliveira LPBAD, Santos SMAD. [An integrative review of drug utilization by the elderly in primary health care]. Rev Esc Enferm USP 2016; 50:167-79. [PMID: 27007434 DOI: 10.1590/s0080-623420160000100021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/10/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To identify knowledge produced about drug utilization by the elderly in the primary health care context from 2006 to 2014. METHOD An integrative review of the PubMed, LILACS, BDENF, and SCOPUS databases, including qualitative research papers in Portuguese, English, and Spanish. It excluded papers with insufficient information regarding the methodological description. RESULTS Search found 633 papers that, after being subjected to the inclusion and exclusion criteria, made up a corpusof 76 publications, mostly in English and produced in the United States, England, and Brazil. Results were pooled in eight thematic categories showing the current trend of drug use in the elderly, notably the use of psychotropics, polypharmacy, the prevention of adverse events, and adoption of technologies to facilitate drug management by the elderly. Studies point out the risks posed to the elderly as a consequence of changes in metabolism and simultaneous use of several drugs. CONCLUSION There is strong concern about improving communications between professionals and the elderly in order to promote an exchange of information about therapy, and in this way prevent major health complications in this population.
Collapse
|
9
|
Naanyu V, Vedanthan R, Kamano JH, Rotich JK, Lagat KK, Kiptoo P, Kofler C, Mutai KK, Bloomfield GS, Menya D, Kimaiyo S, Fuster V, Horowitz CR, Inui TS. Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. J Gen Intern Med 2016; 31:304-14. [PMID: 26728782 PMCID: PMC4762819 DOI: 10.1007/s11606-015-3566-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/24/2015] [Accepted: 12/04/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS Mabaraza (traditional community assembly) participants (n = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n = 169). APPROACH We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide.
Collapse
Affiliation(s)
- Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Rajesh Vedanthan
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA. .,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.
| | - Jemima H Kamano
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Jackson K Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Kennedy K Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Claire Kofler
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Kennedy K Mutai
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Gerald S Bloomfield
- Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Duke University Medical Center, Durham, NC, USA
| | - Diana Menya
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Sylvester Kimaiyo
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Thomas S Inui
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| |
Collapse
|
10
|
Farris KB, Salgado TM, Batra P, Piette JD, Singh S, Guhad A, Newman S, Marshall VD, An L. Confirming the theoretical structure of expert-developed text messages to improve adherence to anti-hypertensive medications. Res Social Adm Pharm 2015; 12:578-91. [PMID: 26525857 DOI: 10.1016/j.sapharm.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Text messages can improve medication adherence and outcomes in several conditions. For this study, experts developed text messages addressing determinants of medication adherence: disease beliefs, medication necessity, medication concerns, and forgetfulness, as well as positive reinforcement messages for patients who were adherent. OBJECTIVES To validate expert-developed text messages to address medication non-adherence with a group of non-researchers. METHODS A two-wave, card-sorting activity was conducted with students and staff at the University of Michigan. In the first wave, 40 participants grouped 32 messages addressing barriers for medication adherence (disease beliefs, medication necessity, medication concerns, and forgetfulness) according to their perceived relationship. Messages with poor grouping agreement were deleted or modified. In the second wave, positive reinforcement messages were developed and tested along with the previous categories (36 messages) by 37 participants. Similarity and cluster analyses were used to assess agreement between experts and participants. RESULTS In the first card-sorting wave, participants grouped messages into between 2 and 13 separate categories. Similarity analysis showed four groupings of messages, however, some had an agreement below 50% and clusters appeared dispersed. In the second wave, and after messages being edited, participants grouped the messages into between 4 and 9 categories. Five groups (now including positive reinforcement messages) were identified with higher agreement in the similarity and cluster analyses. CONCLUSIONS The structure of expert-developed text messages to address medication adherence key barriers was confirmed. Messages will be used in future research to determine their impact on affecting medication adherence to anti-hypertensive medications using a reinforcement learning controlled text messaging service.
Collapse
Affiliation(s)
- Karen B Farris
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA.
| | - Teresa M Salgado
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Peter Batra
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA
| | - John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, USA; University of Michigan School of Public Health, Ann Arbor, USA; University of Michigan School of Medicine, Ann Arbor, USA
| | - Satinder Singh
- Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan College of Engineering, Ann Arbor, USA
| | - Ahmed Guhad
- University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Sean Newman
- Division of Computer Science and Engineering, Department of Electrical Engineering and Computer Science, University of Michigan College of Engineering, Ann Arbor, USA
| | - Vincent D Marshall
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Larry An
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, USA
| |
Collapse
|
11
|
Etengoff C, Daiute C. Clinicians' perspective of the relational processes for family and individual development during the mediation of religious and sexual identity disclosure. JOURNAL OF HOMOSEXUALITY 2014; 62:394-426. [PMID: 25364980 DOI: 10.1080/00918369.2014.977115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although the psychological literature regarding gay men from religious families is continually expanding, it is also limited in that few studies focus on the use of therapy in the negotiation of the interrelated systems of religion, sexuality, and family. Utilizing a cultural historical activity theory-based process of analysis, this study focuses on the narratives of 12 clinicians discussing 230 conflicts and how those conflicts are mediated in both productive (e.g., seeking secular support) and unproductive ways (e.g., bringing one's son to an exorcist) by gay men and their religious families independent of and at the advice of their therapists.
Collapse
Affiliation(s)
- Chana Etengoff
- a Department of Psychology , Barnard College, Columbia University , New York , New York , USA
| | | |
Collapse
|
12
|
Santiago LM, Pereira C, Botas P, Simões AR, Carvalho R, Pimenta G, Neto G. Hypertensive patients in a general practice setting: comparative analysis between controlled and uncontrolled hypertension. Rev Port Cardiol 2014; 33:419-24. [PMID: 25062612 DOI: 10.1016/j.repc.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To study the differences between controlled and uncontrolled hypertensive patients. METHODS This was a cross-sectional observational study of the hypertensive population on the lists of three general practitioners in the district of Coimbra in central Portugal in 2013, with a margin of error of 6% and 95% confidence interval in each sample, organized in ascending order of health care user numbers. Data were gathered electronically by the investigators after approval by the Regional Health Authority's ethics committee. RESULTS A sample of 201 individuals was studied, of whom 104 (51.7%) were male and 86 (42.8%) were aged under 65 (p=0.127 for gender and age-group). Hypertension was controlled in 130 (64.7%). We found significant differences in target organ damage, more frequent in those with controlled hypertension (33.1% vs. 19.7%, p=0.031), in hypertension control, better in those taking at least one anti-hypertensive drug at night (56.9% vs. 29.6%, p<0.001), and in prescription of non-steroidal anti-inflammatory drugs, more frequent in those with uncontrolled hypertension (11.3% vs. 3.8%, p=0.043). CONCLUSION Hypertension control is significantly associated with target organ damage, taking at least one anti-hypertensive drug at night and not taking non-steroidal anti-inflammatory drugs simultaneously.
Collapse
Affiliation(s)
- Luiz Miguel Santiago
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal; USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal.
| | - Carolina Pereira
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Philippe Botas
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Ana Rita Simões
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Rosa Carvalho
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Gonçalo Pimenta
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| | - Glória Neto
- USF Topázio, ACES Baixo Mondego, ARS do Centro IP, Coimbra, Portugal
| |
Collapse
|
13
|
Santiago LM, Pereira C, Botas P, Simões AR, Carvalho R, Pimenta G, Neto G. Hypertensive patients in a general practice setting: Comparative analysis between controlled and uncontrolled hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
14
|
Type 2 diabetes patients' perspectives on lifestyle counselling and weight management in general practice: a qualitative study. BMC FAMILY PRACTICE 2014; 15:97. [PMID: 24885605 PMCID: PMC4027991 DOI: 10.1186/1471-2296-15-97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 05/07/2014] [Indexed: 11/25/2022]
Abstract
Background Lifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition. Methods Narrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method. Results Many patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care. Conclusions Ambivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.
Collapse
|
15
|
Vasylyeva TL, Singh R, Sheehan C, Chennasamudram SP, Hernandez AP. Self-reported adherence to medications in a pediatric renal clinic: psychological aspects. PLoS One 2013; 8:e69060. [PMID: 23874868 PMCID: PMC3715481 DOI: 10.1371/journal.pone.0069060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 06/10/2013] [Indexed: 11/22/2022] Open
Abstract
Background Chronically ill children and adolescents comprise a vulnerable population that requires specific considerations in order to positively impact their treatment outcome. Pediatric renal patients can be non-compliant and also forgetful in taking their medications. Objective The objectives of the study were to (a) assess medication adherence and (b) to identify emotionality and variables that influence non-adherence by use of “The Child & Adolescent Adherence to Medication Questionnaire” (CAAMQ), which was constructed at Texas Tech University Health Sciences Center. Methods Pediatric renal patients from 10 to 21 years-of-age, taking three or more medications, for longer than a three-month period, were eligible to complete the CAAMQ. Results Thirty-four patients participated in the study. Many of the respondents had problems remembering to take their medications on weekends (P = 0.021). The majority of the patients stated that they were not bothered about having to take their medications (70.6%); and that taking pills did not interfere with their daily activities (85.3%). Open-ended questions in the CAAMQ identified patients’ feelings of sadness, distress, and the importance of strong family support systems. The study participants reported that they preferred to take their medications at school, in the nurses’ office or in a place where privacy was assured. The results indicated that Prednisone was the most disliked of all of the medications. Female patients were more reactive and secretive than males regarding peers knowing about their disease and medication schedules (P<0.017). Conclusions Non-adherence in pediatric patients is a complex and serious problem, which ultimately affects the patients’ health. Privacy and daily routine were found to impact the patients’ adherence to medications. Creative and individualized reminders for teenagers need to be developed and validated. Further studies that take into consideration developmental and motivational factors may help researchers identify modifiable psychosocial predictors that will lead to improved medication adherence.
Collapse
Affiliation(s)
- Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center at Amarillo, Amarillo, Texas, USA.
| | | | | | | | | |
Collapse
|
16
|
Campbell NL, Boustani MA, Skopelja EN, Gao S, Unverzagt FW, Murray MD. Medication Adherence in Older Adults With Cognitive Impairment: A Systematic Evidence-Based Review. ACTA ACUST UNITED AC 2012; 10:165-77. [DOI: 10.1016/j.amjopharm.2012.04.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/10/2012] [Accepted: 04/19/2012] [Indexed: 12/15/2022]
|