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Olsen MK, Stechuchak KM, Hung A, Oddone EZ, Damschroder LJ, Edelman D, Maciejewski ML. A data-driven examination of which patients follow trial protocol. Contemp Clin Trials Commun 2020; 19:100631. [PMID: 32913914 PMCID: PMC7471618 DOI: 10.1016/j.conctc.2020.100631] [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: 02/24/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 11/25/2022] Open
Abstract
Protocol adherence in behavioral intervention clinical trials is critical to trial success. There is increasing interest in understanding which patients are more likely to adhere to trial protocols. The objective of this study was to demonstrate the use of a data-driven approach to explore patient characteristics associated with the lowest and highest rates of adherence in three trials assessing interventions targeting behaviors related to lifestyle and risk for cardiovascular disease. Each trial included a common set of baseline variables. Model-based recursive partitioning (MoB) was applied in each trial to identify participant characteristics of subgroups characterized by these baseline variables with differences in protocol adherence. Bootstrap resampling was conducted to provide optimism-corrected c-statistics of the final solutions. In the three trials, rates of protocol adherence varied from 56.9% to 87.5%. Evaluation of heterogeneity of protocol adherence via MoB in each trial resulted in trees with 2–4 subgroups based on splits of 1–3 variables. In two of the three trials, the first split was based on pain in the past week, and those reporting lower pain were less likely to be adherent. In one of these trials, the second and third splits were based on education and employment, where those with lower education levels and who were employed were less likely to be adherent. In the third trial, the two splits were based on smoking status and then marriage status, where smokers who were married were least likely to be adherent. Optimism-corrected c-statistics ranged from 0.54 to 0.63. Model-based recursive partitioning can be a useful approach to explore heterogeneity in protocol adherence in behavioral intervention trials. An important next step would be to assess whether patterns hold in other similar studies and samples. Identifying subgroups who are less likely to be adherent to an intervention can help inform modifications to the intervention to help tailor the intervention to these subgroups and increase future uptake and impact. Trial registration ClinicalTrials.gov identifiers: NCT01828567, NCT02360293, and NCT01838226.
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Affiliation(s)
- Maren K Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Karen M Stechuchak
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,DCRI, Duke University, Durham, NC, USA
| | - Eugene Z Oddone
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Laura J Damschroder
- Ann Arbor VA HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.,VA PROVE QUERI, Ann Arbor, MI, USA
| | - David Edelman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
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2
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van der Laan DM, Langendoen-Gort M, Nijpels G, Boons CCLM, Elders PJM, Hugtenburg JG. Implementation fidelity of an intervention programme to enhance adherence to antihypertensive medication in Dutch community pharmacies. Int J Clin Pharm 2019; 41:1031-1046. [PMID: 31093942 PMCID: PMC6677874 DOI: 10.1007/s11096-019-00845-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/04/2019] [Indexed: 11/01/2022]
Abstract
Background Insight into the delivery of interventions is necessary to gain a better understanding of what caused an intervention to succeed or fail. The Cardiovascular medication non-Adherence Tailored Intervention (CATI) study failed to show effectiveness of a patient-tailored, pharmacist-led intervention programme on self-reported adherence to antihypertensive medication. Objective To evaluate the implementation fidelity of the CATI intervention programme. Setting Twenty Dutch community pharmacies. Method The process of a randomised controlled trial was evaluated. Both quantitative and qualitative data were collected and analysed according to Carrolls' Conceptual Framework for Implementation Fidelity. Implementation fidelity is defined as the degree to which the intervention was implemented as intended. Main outcome measure Four key intervention components of the intervention programme (i.e., first consultation: barrier identification, information and advice, written summary, and follow-up consultation). Results For most participants the key intervention components were implemented as intended. The training of pharmacists, intensive monitoring during the study and structured and easy-to-use intervention materials facilitated the implementation of the intervention. The method to select participants for the intervention programme was considered insufficient and pharmacists questioned the eligibility of some participants because of a low degree of intake non-adherence. Conclusion Implementation fidelity was moderate to high for all key intervention components. Therefore, the absence of effectiveness of the CATI intervention programme on self-reported medication adherence cannot be explained by poor implementation of the intervention. However, the limited genuine eligibility of some participants resulted in a limited potential for improvement in medication adherence.
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Affiliation(s)
- Danielle M van der Laan
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Marlous Langendoen-Gort
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:1-11. [PMID: 30788283 PMCID: PMC6366352 DOI: 10.2147/iprp.s133088] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.
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Affiliation(s)
- Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, VIC, Australia,
- Deakin Health Economics, Centre for Population Health, Deakin University, Geelong, VIC, Australia,
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| | - Hamzah Alzubaidi
- Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, Sharjah, United Arab Emirates
| | - John Keith Jackson
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
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Sendall MC, Ostermann L, Brown C, Mccosker L. Health promotion of bowel cancer and breast cancer screening in community pharmacies: Pharmacists' perceptions of their role, knowledge and confidence. Pharm Pract (Granada) 2018; 16:1275. [PMID: 30637027 PMCID: PMC6322987 DOI: 10.18549/pharmpract.2018.04.1275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives: To identify community pharmacists’ perceptions of their role,
knowledge and confidence in relation to bowel cancer and breast cancer
screening health promotion. Methods: This was a mixed-methods study with community pharmacists and key informants
in the Metro South Health (MSH) region of Brisbane, Queensland, Australia.
In Part 1, quantitative data was collected from community pharmacists via an
electronic survey. In Part 2, qualitative data was collected from community
pharmacists and key informants via in-depth interviews. This paper reports
the findings of community pharmacists’ perceptions of their role,
knowledge and confidence to promote bowel cancer and breast cancer screening
in community pharmacies. Results: A total of 27 community pharmacists (13 males, 14 females) completed the
survey. Most (71%) either ‘agreed’ or ‘strongly
agreed’ discussing health advice, such as cancer screening, with
their consumers was valuable and integral to their broader role. An average
of 60% described their confidence as ‘average’ or
‘good’ when discussing bowel and breast cancer screening and
prevention with consumers. In eight knowledge questions about bowel and
breast cancer and cancer screening, an average of 82% of community
pharmacists responded with correct answers (range 52% to
100%). Community pharmacists were consistently more confident and
knowledgeable about bowel cancer services than breast cancer services. Five
(5) community pharmacists participated in in-depth interviews. The interview
findings supported the quantitative findings. Most community pharmacists
described their confidence to promote bowel cancer and breast cancer
screening as moderate, and consistently reflected they felt more
knowledgeable and confident about bowel cancer topics than breast cancer
topics. Conclusions: Overall, this research supports the feasibility of promoting bowel cancer
screening in community pharmacies. It suggests further training is warranted
for community pharmacists to increase their knowledge of breast cancer and
their confidence in promoting breast cancer referral and screening services.
It highlights the important role community pharmacists have in increasing
engagement in the national bowel cancer and breast cancer screening
programs, and in potentially decreasing the mortality rates of these
cancers.
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Affiliation(s)
- Marguerite C Sendall
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology. Brisbane, QLD (Australia).
| | - Liz Ostermann
- Cancer Screening Unit, Preventive Health Branch, Department of Health, Queensland Government. Brisbane, QLD (Australia).
| | - Carolyn Brown
- BreastScreen Queensland, Metro South Health, Queensland Government. Brisbane, QLD (Australia).
| | - Laura Mccosker
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology. Brisbane, QLD (Australia).
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Walton H, Spector A, Tombor I, Michie S. Measures of fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions: A systematic review of measure quality. Br J Health Psychol 2017; 22:872-903. [PMID: 28762607 PMCID: PMC5655766 DOI: 10.1111/bjhp.12260] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/21/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Understanding the effectiveness of complex, face-to-face health behaviour change interventions requires high-quality measures to assess fidelity of delivery and engagement. This systematic review aimed to (1) identify the types of measures used to monitor fidelity of delivery of, and engagement with, complex, face-to-face health behaviour change interventions and (2) describe the reporting of psychometric and implementation qualities. METHODS Electronic databases were searched, systematic reviews and reference lists were hand-searched, and 21 experts were contacted to identify articles. Studies that quantitatively measured fidelity of delivery of, and/or engagement with, a complex, face-to-face health behaviour change intervention for adults were included. Data on interventions, measures, and psychometric and implementation qualities were extracted and synthesized using narrative analysis. RESULTS Sixty-six studies were included: 24 measured both fidelity of delivery and engagement, 20 measured fidelity of delivery, and 22 measured engagement. Measures of fidelity of delivery included observation (n = 17; 38.6%), self-report (n = 15; 34%), quantitatively rated qualitative interviews (n = 1; 2.3%), or multiple measures (n = 11; 25%). Measures of engagement included self-report (n = 18; 39.1%), intervention records (n = 11; 24%), or multiple measures (n = 17; 37%). Fifty-one studies (77%) reported at least one psychometric or implementation quality; 49 studies (74.2%) reported at least one psychometric quality, and 17 studies (25.8%) reported at least one implementation quality. CONCLUSION Fewer than half of the reviewed studies measured both fidelity of delivery of, and engagement with complex, face-to-face health behaviour change interventions. More studies reported psychometric qualities than implementation qualities. Interpretation of intervention outcomes from fidelity of delivery and engagement measurements may be limited due to a lack of reporting of psychometric and implementation qualities. Statement of contribution What is already known on this subject? Evidence of fidelity and engagement is needed to understand effectiveness of complex interventions Evidence of fidelity and engagement are rarely reported High-quality measures are needed to measure fidelity and engagement What does this study add? Evidence that indicators of quality of measures are reported in some studies Evidence that psychometric qualities are reported more frequently than implementation qualities A recommendation for intervention evaluations to report indicators of quality of fidelity and engagement measures.
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Affiliation(s)
- Holly Walton
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
| | - Aimee Spector
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
| | - Ildiko Tombor
- Department of Epidemiology and Public HealthUniversity College LondonUK
| | - Susan Michie
- Department of Clinical, Educational and Health PsychologyUniversity College LondonUK
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Mc Namara KP, Peterson GM, Hughes J, Krass I, Versace V, Clark RA, Dunbar J. Cardiovascular Disease Risk Assessment in Australian Community Pharmacy. Heart Lung Circ 2016; 26:667-676. [PMID: 28089788 DOI: 10.1016/j.hlc.2016.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Population screening and monitoring of cardiovascular risk is suboptimal in Australian primary care. The role of community pharmacy has increased considerably, but without any policy framework for development. The aim of this study was to explore the nature of community pharmacy-based screening models in Australia, capacity to increase delivery of pharmacy screening, and barriers and enablers to increasing capacity. METHODS An online survey weblink was emailed to pharmacy managers at every quality-accredited pharmacy in Australia by the Quality Pharmacy Care Program. The 122-item survey explored the nature of screening services, pharmacy capacity to deliver services, and barriers and enablers to service delivery in considerable detail. Adaptive questioning was used extensively to reduce the participant burden. Pharmacy location details were requested to facilitate geo-coding and removal of duplicate entries. A descriptive analysis of responses was undertaken. RESULTS There were 294 valid responses from 4890 emails, a 6% response rate. Most pharmacies (79%) had private counselling areas. Blood pressure assessment was nearly universal (96%), but other common risk factor assessments were offered by a minority. Most did not charge for assessments, and 59% indicated capacity to provide multiple risk factor assessments. Fewer than one in five (19%) reported any formal arrangements with general practice for care coordination. Financial viability was perceived as a key barrier to service expansion, amid concerns of patient willingness to pay. Support from government and non-governmental organisations for their role was seen as necessary. CONCLUSION There appears to be a critical mass of pharmacies engaging in evidence-based and professional services. Considerable additional support appears required to optimise performance across the profession.
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Affiliation(s)
- Kevin P Mc Namara
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Vic, Australia.
| | - Gregory M Peterson
- Unit for Medicines Outcomes Research and Evaluation, Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Josie Hughes
- Unit for Medicines Outcomes Research and Evaluation, Pharmacy, School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Vincent Versace
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia
| | - Robyn A Clark
- School of Nursing and Midwifery, Faculty of Health, Flinders University, Adelaide, SA, Australia
| | - James Dunbar
- Deakin Rural Health, Faculty of Health, Deakin University, Melbourne, Vic, Australia
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