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Rao PS, Modi N, Nguyen NTT, Vu DH, Xie YL, Gandhi M, Gerona R, Metcalfe J, Heysell SK, Alffenaar JWC. Alternative Methods for Therapeutic Drug Monitoring and Dose Adjustment of Tuberculosis Treatment in Clinical Settings: A Systematic Review. Clin Pharmacokinet 2023; 62:375-398. [PMID: 36869170 PMCID: PMC10042915 DOI: 10.1007/s40262-023-01220-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Quantifying exposure to drugs for personalized dose adjustment is of critical importance in patients with tuberculosis who may be at risk of treatment failure or toxicity due to individual variability in pharmacokinetics. Traditionally, serum or plasma samples have been used for drug monitoring, which only poses collection and logistical challenges in high-tuberculosis burden/low-resourced areas. Less invasive and lower cost tests using alternative biomatrices other than serum or plasma may improve the feasibility of therapeutic drug monitoring. METHODS A systematic review was conducted to include studies reporting anti-tuberculosis drug concentration measurements in dried blood spots, urine, saliva, and hair. Reports were screened to include study design, population, analytical methods, relevant pharmacokinetic parameters, and risk of bias. RESULTS A total of 75 reports encompassing all four biomatrices were included. Dried blood spots reduced the sample volume requirement and cut shipping costs whereas simpler laboratory methods to test the presence of drug in urine can allow point-of-care testing in high-burden settings. Minimal pre-processing requirements with saliva samples may further increase acceptability for laboratory staff. Multi-analyte panels have been tested in hair with the capacity to test a wide range of drugs and some of their metabolites. CONCLUSIONS Reported data were mostly from small-scale studies and alternative biomatrices need to be qualified in large and diverse populations for the demonstration of feasibility in operational settings. High-quality interventional studies will improve the uptake of alternative biomatrices in guidelines and accelerate implementation in programmatic tuberculosis treatment.
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Affiliation(s)
- Prakruti S Rao
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Nisha Modi
- Global TB Institute and Department of Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Nam-Tien Tran Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Dinh Hoa Vu
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Yingda L Xie
- Global TB Institute and Department of Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Roy Gerona
- Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - John Metcalfe
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jan-Willem C Alffenaar
- Pharmacy School, The University of Sydney, Pharmacy Building (A15), Science Road, Sydney, NSW, 2006, Australia.
- The University of Sydney at Westmead Hospital, Sydney, NSW, Australia.
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia.
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Kelleher D, Doherty E, O'Neill C. Examining the transnational preventive healthcare utilisation of a group of Eastern European migrants living full-time in another European state. Health Policy 2022; 126:318-324. [DOI: 10.1016/j.healthpol.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
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Harsha N, Papp M, Kőrösi L, Czifra Á, Ádány R, Sándor J. Enhancing Primary Adherence to Prescribed Medications through an Organized Health Status Assessment-Based Extension of Primary Healthcare Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203797. [PMID: 31600998 PMCID: PMC6843248 DOI: 10.3390/ijerph16203797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
This study was part of monitoring an intervention aimed at developing a general practitioner cluster (GPC) model of primary healthcare (PHC) and testing its effectiveness in delivering preventive services integrated into the PHC system. The aim was to demonstrate whether GPC operation could increase the percentage of drugs actually dispensed. Using national reference data of the National Health Insurance Fund for each anatomical-therapeutic chemical classification ATC group of drugs, dispensed-to-prescribed ratios standardized (sDPR) for age, sex, and exemption certificate were calculated during the first quarter of 2012 (before-intervention) and the third quarter of 2015 (post-intervention). The after-to-before ratios of the sDPR as the relative dispensing ratio (RDR) were calculated to describe the impact of the intervention program. The general medication adherence increased significantly in the intervention area (RDR = 1.064; 95% confidence interval (CI): 1.054-1.073). The most significant changes were observed for cardiovascular system drugs (RDR = 1.062; 95% CI: 1.048-1.077) and for alimentary tract and metabolism-specific drugs (RDR = 1.072; 95% CI: 1.049-1.097). The integration of preventive services into a PHC without any specific medication adherence-increasing activities is beneficial for medication adherence, especially among patients with cardiovascular, alimentary tract, and metabolic disorders. Monitoring the percentage of drugs actually dispensed is a useful element of PHC-oriented intervention evaluation frames.
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Affiliation(s)
- Nouh Harsha
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, Debrecen 4012, Hungary;
| | - Magor Papp
- Doctoral School of Health Sciences, University of Debrecen, Debrecen 4012, Hungary;
- Semmelweis Center for Health Promotion, Medical Faculty, Semmelweis University, Budapest 1094, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Budapest 1139, Hungary;
| | - Árpád Czifra
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
- Correspondence: ; Tel.: +36-52-512-769
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A systematic review of non-pharmacological interventions to improve therapeutic adherence in tuberculosis. Heart Lung 2019; 48:452-461. [PMID: 31084923 DOI: 10.1016/j.hrtlng.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reviews examining non-pharmacological interventions to improve therapeutic adherence in tuberculosis have several limitations (design, quality assessment…). Consequently, for clinical practice, it is important to generate a review containing all the information to improve patient adherence, solving the previous issues. OBJECTIVES To examine non-pharmacological interventions to improve therapeutic adherence in tuberculosis through clinical trials. METHODS A systematic review in MEDLINE/EMBASE was performed. RESULTS Thirty seven papers were analysed. The disease treatment interventions were disparate, grouped into: education, psychological interventions, new technologies, directly observed treatment, incentives and improved access to health services. In the treatment of latent infection, the majority of studies were conducted in the marginal population (drug addicts, homeless individuals and prisoners) and were based mainly on the provision of incentives. Study quality was generally low. CONCLUSIONS Great variability exists in the studies comparing strategies for identifying interventions, objectives and effects. The designs carried out generally have methodological deficits.
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Clyne W, Mshelia C, McLachlan S, Jones P, de Geest S, Ruppar T, Siebens K, Dobbels F, Kardas P. A multinational cross-sectional survey of the management of patient medication adherence by European healthcare professionals. BMJ Open 2016; 6:e009610. [PMID: 26832430 PMCID: PMC4746470 DOI: 10.1136/bmjopen-2015-009610] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine which interventions healthcare professionals use to support patients with taking medicines and their perceptions about the effectiveness of those actions. DESIGN Cross-sectional multinational study. SETTING Online survey in Austria, Belgium, England, France, Germany, Hungary, The Netherlands, Poland, Portugal and Switzerland. PARTICIPANTS A total of 3196 healthcare professionals comprising doctors (855), nurses (1047) and pharmacists (1294) currently registered and practising in primary care and community settings. PRIMARY OUTCOME Responses to the question 'I ask patients if they have missed any doses of their medication' for each profession and in each country.Secondary outcome: Responses to 50 items concerning healthcare professional behaviour to support patients with medication-taking for each profession and in each country. RESULTS Approximately half of the healthcare professionals in the survey ask patients with long-term conditions whether they have missed any doses of their medication on a regular basis. Pharmacists persistently report that they intervene less than the other two professions to support patients with medicines. No country effects were found for the primary outcome. CONCLUSIONS Healthcare professionals in Europe are limited in the extent to which they intervene to assist patients having long-term conditions with medication adherence. This represents a missed opportunity to support people with prescribed treatment. These conclusions are based on the largest international survey to date of healthcare professionals' management of medication adherence.
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Affiliation(s)
- Wendy Clyne
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Comfort Mshelia
- Leeds Institute of Health Sciences, Leeds University, Leeds, UK
| | | | - Peter Jones
- Institute of Science and Technology in Medicine, Keele University, Keele, UK
| | - Sabina de Geest
- Institute of Nursing Science, University of Basel, Switzerland
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Todd Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, USA
| | - Kaat Siebens
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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Clyne W, McLachlan S, Mshelia C, Jones P, De Geest S, Ruppar T, Siebens K, Dobbels F, Kardas P. "My patients are better than yours": optimistic bias about patients' medication adherence by European health care professionals. Patient Prefer Adherence 2016; 10:1937-1944. [PMID: 27713621 PMCID: PMC5045226 DOI: 10.2147/ppa.s108827] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The objectives of this study were to determine the perceptions of European physicians, nurses, and pharmacists about the extent of nonadherence by patients in their country relative to their perception of nonadherence by their own patients, and to investigate the occurrence of optimistic bias about medication adherence. The study explored a key cognitive bias for prevalence and likelihood estimates in the context of health care professionals' beliefs about patients' use of medicines. METHODS A cross-sectional online survey of 3,196 physicians (855), nurses (1,294), and pharmacists (1,047) in ten European countries (Austria, Belgium, England, France, Germany, Hungary, the Netherlands, Poland, Portugal, and Switzerland) was used. RESULTS Participants differed in their perceptions of the prevalence of medication adherence initiation, implementation, and persistence present in their own patients with a chronic illness in comparison to patients with a chronic illness in general. Health care professionals demonstrated optimistic bias for initiation and persistence with medicine taking, perceiving their own patients to be more likely to initiate and persist with treatment than other patients, but reported significantly lower prevalence of medication adherence levels for their own patients than for patients in general. This finding is discussed in terms of motivational and cognitive factors that may foster optimistic bias by health care professionals about their patients, including heightened knowledge of, and positive beliefs about, their own professional competence and service delivery relative to care and treatment provided elsewhere. CONCLUSION Health care professionals in Europe demonstrated significant differences in their perceptions of medication adherence prevalence by their own patients in comparison to patients in general. Some evidence of optimistic bias by health care professionals about their patients' behavior is observed. Further social cognitive theory-based research of health care professional beliefs about medication adherence is warranted to enable theory-based practitioner-focused interventions to be tested and implemented.
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Affiliation(s)
- Wendy Clyne
- Faculty of Health and Life Sciences, Coventry University, Coventry
- Correspondence: Wendy Clyne, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Fourth Floor, Priory Street, Coventry CV1 5FB, UK, Tel +44 24 7765 4636, Email
| | | | - Comfort Mshelia
- Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Peter Jones
- Institute of Science and Technology in Medicines, Keele University, Keele, UK
| | - Sabina De Geest
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Todd Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Kaat Siebens
- Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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Valls V, Ena J. Short-course treatment of latent tuberculosis infection in patients with rheumatic conditions proposed for anti-TNF therapy. Clin Rheumatol 2014; 34:29-34. [PMID: 24464437 DOI: 10.1007/s10067-014-2495-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/31/2013] [Accepted: 01/10/2014] [Indexed: 11/30/2022]
Abstract
Tuberculosis reactivation is a serious threat in patients treated with anti-tumour necrosis factor therapy. A 6-month regimen with isoniazid is considered as the standard of care, but patient adherence is a major shortcoming. We carried out an open-label, single-arm intervention study to assess the efficacy, the completion rate and the tolerability of a 3-month regimen with isoniazid plus rifampin. Seventy-eight patients with rheumatic conditions proposed for anti-tumour necrosis factor (TNF) therapy and at risk of tuberculosis reactivation were offered to participate in the study. Nine patients were excluded due to deficit of glucose-6-phosphate dehydrogenase (n = 1), salicylate hypersensitivity (n = 1), declining to participate (n = 5) or preferring a 6-month isoniazid regimen (n = 6). Sixty-nine patients were treated with a 3-month regimen with isoniazid and rifampin. No cases of tuberculosis were observed after a mean follow-up of 90 months (range from 66 to 121 months). Sixty (87 %) patients completed the therapy. Nine (13 %) patients discontinued the therapy due to rifampin hypersensitivity (n = 1), symptomatic grade 3-4 hepatotoxicity (n = 2), abdominal discomfort (n = 2), pruritus (n = 1), arthritis (n = 1) and personal concerns (n = 2). A short course treatment with isoniazid and rifampin provided efficacy, good tolerability and good completion rate in patients with rheumatic conditions proposed for anti-TNF therapy.
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Affiliation(s)
- Victoria Valls
- Service of Preventive Medicine, Hospital General Universitario Virgen de la Salud, Elda, Alicante, Spain,
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8
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Boyd M, Waring J, Barber N, Mehta R, Chuter A, Avery AJ, Salema NE, Davies J, Latif A, Tanajewski L, Elliott RA. Protocol for the New Medicine Service Study: a randomized controlled trial and economic evaluation with qualitative appraisal comparing the effectiveness and cost effectiveness of the New Medicine Service in community pharmacies in England. Trials 2013; 14:411. [PMID: 24289059 PMCID: PMC4220816 DOI: 10.1186/1745-6215-14-411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/13/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Medication non-adherence is considered an important cause of morbidity and mortality in primary care. This study aims to determine the effectiveness, cost effectiveness and acceptability of a complex intervention delivered by community pharmacists, the New Medicine Service (NMS), compared with current practice in reducing non-adherence to, and problems with, newly prescribed medicines for chronic conditions. METHODS/DESIGN Research subject group: patients aged 14 years and above presenting in a community pharmacy for a newly prescribed medicine for asthma/chronic obstructive pulmonary disease (COPD); hypertension; type 2 diabetes or anticoagulant/antiplatelet agents in two geographical regions in England. DESIGN parallel group patient-level pragmatic randomized controlled trial. INTERVENTIONS patients randomized to either: (i) current practice; or (ii) NMS intervention comprising pharmacist-delivered support for a newly prescribed medicine. PRIMARY OUTCOMES proportion of adherent patients at six, ten and 26 weeks from the date of presenting their prescriptions at the pharmacy; cost effectiveness of the intervention versus current practice at 10 weeks and 26 weeks; in-depth qualitative understanding of the operationalization of NMS in pharmacies. SECONDARY OUTCOMES impact of NMS on: patients' understanding of their medicines, pharmacovigilance, interprofessional and patient-professional relationships and experiences of service users and stakeholders.Economic analysis: Trial-based economic analysis (cost per extra adherent patient) and long-term modeling of costs and health effects (cost per quality-adjusted-life-year) will be conducted from the perspective of National Health Service (NHS) England, comparing NMS with current practice.Qualitative analysis: a qualitative study of NMS implementation in different community settings, how organizational influences affect NMS delivery, patterns of NMS consultations and experiences of professionals and patients participating in NMS, and patients receiving current practice. SAMPLE SIZE 250 patients in each treatment arm would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a reduction in patient-reported non-adherence from 20% to 10% in the NMS arm compared with current practice, assuming a 20% drop-out rate. DISCUSSION At the time of submission of this article, 58 community pharmacies have been recruited and the interventions are being delivered. Analysis has not yet been undertaken. TRIAL REGISTRATION Current controlled trials: ISRCTN23560818. Clinical Trials US (clinicaltrials.gov): NCT01635361.
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Affiliation(s)
- Matthew Boyd
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Justin Waring
- Center for Health Innovation, Leadership & Learning, Nottingham University Business School, Jubilee Campus, University of Nottingham, Nottingham NG8 2BB, UK
| | - Nick Barber
- Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Rajnikant Mehta
- Trent Research Design Service, Division of Primary Care, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Antony Chuter
- 68 Brighton Cottages, Copyhold Lane, Lindfield, Haywards Heath RH16 1XT, UK
| | - Anthony J Avery
- Division of Primary Care, The Medical School, Queen’s Medical Center, Nottingham NG7 2UH, UK
| | - Nde-Eshimuni Salema
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - James Davies
- Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Asam Latif
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Lukasz Tanajewski
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Rachel A Elliott
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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Allenet B, Baudrant M, Lehmann A, Gauchet A, Roustit M, Bedouch P, Golay A. Comment évaluer l’adhésion médicamenteuse ? Le point sur les méthodes. ANNALES PHARMACEUTIQUES FRANÇAISES 2013; 71:135-41. [DOI: 10.1016/j.pharma.2012.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/25/2012] [Accepted: 10/02/2012] [Indexed: 11/15/2022]
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Welch LC, Botelho EM, Joseph JJ, Tennstedt SL. A qualitative inquiry of patient-reported outcomes: the case of lower urinary tract symptoms. Nurs Res 2012; 61:283-90. [PMID: 22565104 DOI: 10.1097/nnr.0b013e318251d8f6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-reported outcomes are a valuable tool for assessing healthcare, particularly for symptom-based conditions that lack definitive physiological measures of treatment efficacy. OBJECTIVE To explore the value of qualitative methods for understanding and developing patient-reported outcomes of medical care for symptom-based conditions by examining the case of lower urinary tract symptoms. METHODS Semistructured interviews were conducted with a diverse community sample of 90 respondents who had spoken with a provider about their urinary symptoms. Content and thematic analyses were conducted for the areas of symptom relief, patient adherence, and satisfaction with care according to gender, race or ethnicity, and socioeconomic status. RESULTS Across social groups, most patients experienced either no symptom relief or partial relief, reported that they adhered to recommendations, and were satisfied with the care received. The primary reason for no symptom relief was not receiving a treatment recommendation. For patients, even partial relief made symptoms more manageable both physically and emotionally. Satisfaction with care was mediated by the quality of the patient-provider relationship as well as expectations other than symptom relief, particularly for patients of low socioeconomic status. DISCUSSION Patients' assessments of the outcomes of seeking medical care for this symptom-based condition broadened the criteria for quality of care beyond providing a cure. For healthcare providers, this can widen the path for meeting patient needs, even without complete symptom relief. For providers and researchers, as the evidence base expands to include patient reports, the context provided by a qualitative approach can enhance understanding of patients' perspectives and the ability to construct meaningful quantitative measures.
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Affiliation(s)
- Lisa C Welch
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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Schmitz KE, Hovell MF, Wong CA, Kelley NJ, Nilsen D, Blumberg EJ, Hill L, Sipan CL, Kolody B, Chatfield DA. The reliability and practicality of the Arkansas method assay of isoniazid adherence. Clin Nurs Res 2010; 19:131-43. [PMID: 20435784 PMCID: PMC3510760 DOI: 10.1177/1054773810363473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Arkansas method (AM) for isoniazid (INH) metabolite detection is a relatively inexpensive, simple, objective measure of adherence. The purpose of the study was to explore whether variations in urine sample handling and storage will produce accurate assay outcomes. Participants were a convenience sample of 28 adults and adolescents prescribed INH for latent tuberculosis infection. Participants provided one sample to test effects of the following: mixing processes; durations at room temperature, in a refrigerator, or frozen; and effects of freeze/thaw cycles on AM outcomes. No manipulations had a discernible impact on outcomes with concordant positive rates from 85% to 100%. Concordance rates of manipulated samples did not appear to differ from rates of norm samples. Results suggest that urine samples can withstand a variety of manipulations in both handling and storage without affecting the accuracy of AM assay results. These findings have important implications for providers of treatment and researchers and provide the impetus for both to examine the potential of using the AM of INH metabolite testing as a measure of medication adherence.
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Affiliation(s)
- Katharine E. Schmitz
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770; fax (858) 505-8614;
| | - Melbourne F. Hovell
- Distinguished Professor of Public Health and Director of the Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4772; fax (858) 505-8614;
| | - Charlene A. Wong
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770; fax (858) 505-8614;
| | - Norma J. Kelley
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770; fax (858) 505-8614;
| | - Donata Nilsen
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770; fax (858) 505-8614;
| | - Elaine J. Blumberg
- Graduate School of Public Health, San Diego State University and Assistant Director/Research Scientist, The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770, x139; fax (858) 505-8614;
| | - Linda Hill
- Department of Family and Preventive Medicine, University of California, San Diego; 9500 Gilman Dr., MS0811, La Jolla, CA, 92037-0811; telephone (619) 840-6258; fax (858) 622-1463;
| | - Carol L. Sipan
- The Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University; 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA; telephone (858) 505-4770; fax (858) 505-8614;
| | - Bo Kolody
- Department of Sociology, San Diego State University; 5500 Campanile Drive, San Diego, CA 92182-4423; telephone (619) 594-4826; fax (619) 594-1325;
| | - Dale A. Chatfield
- Department of Chemistry and Biochemistry, San Diego State University; 5500 Campanile Drive, San Diego, CA 92182-1030; telephone (619) 594-5806; fax (619) 594-4634;
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MacIntyre CR, Cauchemez S, Dwyer DE, Seale H, Cheung P, Browne G, Fasher M, Wood J, Gao Z, Booy R, Ferguson N. Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis 2009; 15:233-41. [PMID: 19193267 PMCID: PMC2662657 DOI: 10.3201/eid1502.081167] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mask use is associated with low adherence, but adherent mask users are significantly protected against seasonal disease. Many countries are stockpiling face masks for use as a nonpharmaceutical intervention to control virus transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non–fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households. Mask use adherence was self-reported. During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited. We found that adherence to mask use significantly reduced the risk for ILI-associated infection, but <50% of participants wore masks most of the time. We concluded that household use of face masks is associated with low adherence and is ineffective for controlling seasonal respiratory disease. However, during a severe pandemic when use of face masks might be greater, pandemic transmission in households could be reduced. Many countries are stockpiling face masks for use as nonpharmaceutical interventions to reduce viral transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non–fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households. During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited. Intent-to-treat analysis showed no significant difference in the relative risk of ILI in the mask use groups compared with the control group; however, <50% of those in the mask use groups reported wearing masks most of the time. Adherence to mask use was associated with a significantly reduced risk of ILI-associated infection. We concluded that household use of masks is associated with low adherence and is ineffective in controlling seasonal ILI. If adherence were greater, mask use might reduce transmission during a severe influenza pandemic.
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Affiliation(s)
- C Raina MacIntyre
- niversity of New South Wales School of Public Health and Community Medicine, Sydney, New South Wales, Australia.
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Abstract
Non-adherence to medicines is common, with convincing evidence for adverse effects on patient health and costs to health systems. At least half of reported non-adherence is intentional. An extensive body of research suggests that, while patient characteristics may contribute to this behaviour, key influences are linked to beliefs and experiences of an illness and its medicines. Characteristics of the health system such as patient-practitioner relationships and access are also significant drivers. Inadvertent effects of some policies, such as co-payments, reduce adherence. Interventions to improve adherence have not utilized available research evidence fully and are not integrated into service delivery, so have been disappointing in producing sustained behaviour change. Policies relying on patients' adherence to medicines will not be as effective as hoped if adherence is assumed rather than supported. Substantial gains could be made by patients and health systems if patients, practitioners, researchers and policy-makers worked together to improve this crucial area of health behaviour.
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Affiliation(s)
- Rachel Elliott
- Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.
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Zeller A, Taegtmeyer A, Martina B, Battegay E, Tschudi P. Physicians' ability to predict patients' adherence to antihypertensive medication in primary care. Hypertens Res 2009; 31:1765-71. [PMID: 18971555 DOI: 10.1291/hypres.31.1765] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Addressing adherence to medication is essential and notoriously difficult. The purpose of this study was to determine physicians' ability to predict patients' adherence to antihypertensive therapy. Primary care physicians were asked to predict the adherence to medication of their hypertensive patients (n=42) by using a visual analogue scale (VAS) at the beginning of the study period. The patients were asked to report their adherence to medication using a VAS. The adherence was then monitored by using a Medical Event Monitoring System (MEMS) for 42+/-14 d. The means+/-SD (range) of MEMS measures for timing adherence, correct dosing, and adherence to medication were 82+/-27% (0 to 100%), 87+/-24% (4 to 100%), and 94+/-18% (4 to 108%), respectively. The physicians' prediction of their patients' adherence was 92+/-15%. The Spearman rank correlations between the physician's prediction and the MEMS measures of timing adherence, correct dosing, and adherence to medication was 0.42 (p=0.006), 0.47 (p=0.002), and -0.02 (p=0.888), respectively. The patients reported their own adherence to medication at 98+/-2% (range 83 to 100%). The Spearman correlations between the reported and actual behaviours were 0.27 (p=0.08) for timing adherence, 0.25 (p=0.12) for correct dosing, and 0.11 (p=0.51) for adherence to medication. The physicians' ability to predict patients' adherence to antihypertensive medication is limited and not accurate for identifying non-adherent patients in clinical practice. Even patients themselves are unable to give accurate reports of their own adherence to medication.
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Affiliation(s)
- Andreas Zeller
- Medical Outpatient Department, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
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Kern S, Reichmann H, Ziemssen T. [Adherence to neurologic treatment. Lessons from multiple sclerosis]. DER NERVENARZT 2008; 79:877-8, 880-2, 884-6 passim. [PMID: 18335191 DOI: 10.1007/s00115-008-2419-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In light of increasing prevalence rates of chronic conditions and a growing elderly population, patients' nonadherence to medical regimes reflects a significant problem in modern health care. In the past, patients were primarily held responsible for problematic adherence. Over the past decades this attitude has changed dramatically, and it is now acknowledged that lack of adherence reflects a problem requiring different approaches and interventions on many different levels. Here we highlight central aspects and consequences of adherence problems in long-term therapy. Factors affecting treatment motivation in multiple sclerosis patients are summarized focusing on neurologic treatment issues, and specific intervention strategies for patients, doctors, and nurses are discussed.
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Affiliation(s)
- S Kern
- Klinik und Poliklinik für Neurologie,Multiple Sklerose Zentrum, Carl Gustav Carus Universitätsklinik, Fetscherstrasse 74, 01307, Dresden.
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Glintborg B, Hillestrøm PR, Olsen LH, Dalhoff KP, Poulsen HE. Are patients reliable when self-reporting medication use? Validation of structured drug interviews and home visits by drug analysis and prescription data in acutely hospitalized patients. J Clin Pharmacol 2008; 47:1440-9. [PMID: 17962430 DOI: 10.1177/0091270007307243] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The medication history among hospitalized patients often relies on patients' self-reports due to insufficient communication between health care professionals. The aim of the present study was to estimate the reliability of patients' self-reported medication use. Five hundred patients admitted to an acute medical department at a Danish university hospital were interviewed on the day of admission about their recent medication use. Blood samples drawn immediately after admission were screened for contents of 5 drugs (digoxin, bendroflumethiazide, amlodipine, simvastatin, glimepiride), and the results were compared to the patients' self-reported medication history. Information on prescribed drugs dispensed from any Danish pharmacy was collected from nationwide real-time pharmacy records. The authors performed home visits in a subgroup of 115 patients 4 weeks after their discharge. Stored drugs were inspected, and patients were interviewed about their drug use. Additional blood samples were drawn for drug analysis. The median age of included patients was 72 years, and 298 patients (60%) were women. Patients reported use of 3 (median) prescription-only medications (range, 0-14) during the structured interview. The congruence between self-report and drug analysis was high for all 5 drugs measured (all kappa >0.8). However, 9 patients (2%) reported use of drugs that were not detected in their blood samples. In 29 patients (6%), the blood samples contained drugs not reported during the structured interview, but 14 of these drugs were registered in either hospital files or pharmacy records. Overall, the sensitivity of information from hospital files, structured interviews, and pharmacy records in identifying drug users was 87% to 93%, with no significant differences between methods. In conclusion, patients' self-reports are reliable when estimating recent use of cardiovascular and antidiabetic drugs.
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Affiliation(s)
- Bente Glintborg
- Department of Clinical Pharmacology Q7642, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Grosset KA, Bone I, Reid JL, Grosset D. Measuring therapy adherence in Parkinson's disease: a comparison of methods. J Neurol Neurosurg Psychiatry 2006; 77:249-51. [PMID: 16421131 PMCID: PMC2077597 DOI: 10.1136/jnnp.2005.064709] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED The objective of this study was to assess different methods of measuring therapy adherence in Parkinson's disease (PD). In a single centre observational study, 112 patients with idiopathic PD were randomised to a crossover trial of active monitoring (n = 69, simple tablet count and electronic monitoring), or to no monitoring (n = 43, control group). All patients completed a self report and visual analogue scale (VAS) indicating therapy intake. In the active monitoring group, 56 (81% of cases) used > or = 80% of their medication, and 13 (19% of cases) used <80%, based on electronic monitoring. Median adherence for self report was 100% (interquartile range (IQR) 100 to 100) and for VAS was 100% (IQR 95 to 100), in both active and control groups. Patients taking > or = 80% of prescribed medication had a median total adherence of 98% (IQR 93 to 101) by electronic monitoring, which was similar to that from other METHODS self report 100%, IQR 100 to 100; VAS 100%, IQR 95 to 100; simple tablet count 98%, IQR 89 to 100. Median total adherence in patients taking <80% of medication was significantly lower by electronic monitoring (69%, IQR 44 to 74) than by other methods: self report 100%, IQR 100 to 100; VAS 100%, IQR 95 to 100; and simple tablet count 90%, IQR 78 to 100 (all p<0.0001). Sensitivities of self report (10%), VAS (17%), and simple tablet count (50%) were all low for detecting suboptimal medicine intake. Self report, VAS, and simple tablet counts are insensitive as predictors of suboptimal medicine usage in PD. How patients take their medicines influences interpretation of the therapy response and consequent management decisions, with implications for clinical trial analysis and clinical practice.
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Affiliation(s)
- K A Grosset
- Institute of Neurological Sciences, Department of Neurology, Southern General Hospital, Glasgow G51 4TF.
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