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Marshall MR, Curd S, Kennedy J, Khatri D, Lee S, Pireva K, Taule’alo O, Tiavale-Moore P, Wolley MJ, Ma TM, Kam AL, Suh JS, Aspden TJ. Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients. Patient Prefer Adherence 2024; 18:855-878. [PMID: 38645697 PMCID: PMC11032681 DOI: 10.2147/ppa.s454248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship. Patients and Methods This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models. Results Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]). Conclusion Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.
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Affiliation(s)
- Mark R Marshall
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Medicine, Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Samantha Curd
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Kennedy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dharni Khatri
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sophia Lee
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krenare Pireva
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Olita Taule’alo
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Porsche Tiavale-Moore
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Wolley
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
- Department of Nephrology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Tian M Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Institute for Innovation + Improvement, North Shore Hospital, Auckland, New Zealand
| | - Angela L Kam
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
- Barts Health NHS Trust, London, UK
| | - Jun S Suh
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Trudi J Aspden
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Pettersen TR, Schjøtt J, Allore H, Bendz B, Borregaard B, Fridlund B, Hadjistavropoulos HD, Larsen AI, Nordrehaug JE, Rasmussen TB, Rotevatn S, Valaker I, Wentzel-Larsen T, Norekvål TM. Discharge Information About Adverse Drug Reactions Indicates Lower Self-Reported Adverse Drug Reactions and Fewer Concerns in Patients After Percutaneous Coronary Intervention. Heart Lung Circ 2024; 33:350-361. [PMID: 38238118 DOI: 10.1016/j.hlc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 04/07/2024]
Abstract
AIM There are discrepancies between the information patients desire about adverse drug reactions (ADRs) and the information they receive from healthcare providers; this is an impediment to shared decision-making. This study aimed to establish whether patients received information about ADRs resulting from prescribed pharmacotherapy, before hospital discharge, after percutaneous coronary intervention (PCI) and to determine whether receiving information about ADRs was associated with incidence of self-reported ADRs or concerns related to prescribed pharmacotherapy. METHODS CONCARDPCI, a prospective multicentre cohort study including 3,417 consecutive patients after PCI, was conducted at seven high-volume referral PCI centres in two Nordic countries. Clinical data were collected from patients' medical records and national quality registries. Patient-reported outcome measures were registered 2 months (T1), 6 months (T2), and 12 months (T3) after discharge. Covariate-adjusted logistic regression yielded adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS At discharge, 38% of participants had been informed about potential ADRs. For these patients, the incidence of self-reported ADRs was significantly lower at T1 (aOR 0.61, 95% CI 0.50-0.74; p<0.001), T2 (aOR 0.60, 95% CI 0.49-0.74; p<0.001), and T3 (aOR 0.57, 95% CI 0.46-0.71; p<0.001). Those who were not informed reported higher levels of concern about prescribed pharmacotherapy at all measuring points (p<0.001 for all comparisons). Those living alone (aOR 0.73, 95% CI 0.57-0.92; p=0.008), who were female (aOR 0.57, 95% CI 0.44-0.72; p<0.001), and with three or more versus no comorbidities (aOR 0.61, 95% CI 0.44-0.84; p=0.002) were less likely to receive information. CONCLUSION A substantial proportion of patients were not informed about potential ADRs from prescribed pharmacotherapy after PCI. Patients informed about ADRs had lower incidences of self-reported ADRs and fewer concerns about prescribed pharmacotherapy.
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Affiliation(s)
| | - Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | | | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Førde, Norway
| | | | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Te Paske R, Vervloet M, Linn AJ, Brabers AEM, van Boven JFM, van Dijk L. The impact of trust in healthcare and medication, and beliefs about medication on medication adherence in a Dutch medication-using population. J Psychosom Res 2023; 174:111472. [PMID: 37741115 DOI: 10.1016/j.jpsychores.2023.111472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Trust in healthcare and medication, defined as feelings of reassurance and confidence in the healthcare system or medication, may be a key prerequisite before engaging in the use of medication. However, earlier studies have focussed on beliefs about medication rather than trust as predictors of medication adherence. This study therefore aims to simultaneously explore the relationship of trust in healthcare, medication and beliefs about medication, with medication adherence. METHODS In a cross-sectional study, an online questionnaire was sent out to 1500 members of the Dutch Health Care Consumer Panel of Nivel in November 2018. Respondents were asked to grade their level of trust in healthcare and medication (scale 1-10). The Beliefs About Medicines Questionnaire (BMQ) for general and specific medication beliefs was used to address beliefs, the Medication Adherence Report Scale (MARS-5) to measure medication adherence. Data were analysed using structural equation modelling (SEM) with a backward stepwise approach. Out of 753 people that completed the questionnaire, 407 people used prescription medication and were included in the analyses. RESULTS A positive association between trust in medication and medication adherence was found (0.044, p < 0.05). BMQ subscales Overuse (-0.083, p < 0.05), Necessity (0.075, p < 0.05) and Concerns (-0.134, p < 0.01) related with medication adherence. BMQ subscale Harm did not relate to medication adherence. CONCLUSION Trust in medication and beliefs about medication were both individually associated with medication adherence. Healthcare providers should therefore not only focus on patients' medication beliefs, but also on strengthening patients' trust in medication to improve medication adherence.
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Affiliation(s)
- Roland Te Paske
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, - Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands.
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Annemiek J Linn
- University of Amsterdam/Amsterdam School of Communication Research, Amsterdam, the Netherlands
| | - Anne E M Brabers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; University of Groningen, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, - Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands
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Metzner G, von der Warth R, Glattacker M. The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review. Health Psychol Rev 2023:1-35. [PMID: 37675876 DOI: 10.1080/17437199.2023.2253300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.
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Affiliation(s)
- Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Tully IA, Kim JP, Simpson N, Palaniappan L, Tutek J, Gumport NB, Dietch JR, Manber R. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med 2023; 19:1247-1257. [PMID: 36883379 PMCID: PMC10315611 DOI: 10.5664/jcsm.10552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
STUDY OBJECTIVES To examine beliefs about prescription sleep medications (hypnotics) among individuals with insomnia disorder seeking cognitive behavioral therapy for insomnia and predictors of wishing to reduce use. METHODS Baseline data was collected from 245 adults 50 years and older enrolled in the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study. T-tests compared characteristics of prescription sleep medication users with those of nonusers. Linear regression assessed predictors of patients' beliefs about sleep medication necessity and hypnotic-related concerns. Among users, we examined predictors of wishing to reduce sleep medications, including perceived hypnotic dependence, beliefs about medications, and demographic characteristics. RESULTS Users endorsed stronger beliefs about the necessity of sleep medications and less concern about potential harms than nonusers (P < .01). Stronger dysfunctional sleep-related cognitions predicted greater beliefs about necessity and concern about use (P < .01). Patients wishing to reduce sleep medications reported greater perceived hypnotic dependence than those disinterested in reduction (P < .001). Self-reported dependence severity was the strongest predictor of wishing to reduce use (P = .002). CONCLUSIONS Despite expressing strong beliefs about necessity, and comparatively less concern about taking sleep medications, three-quarters of users wished to reduce prescription hypnotics. Results may not generalize to individuals with insomnia not seeking nonpharmacological treatments. Upon completion, the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study will provide information about the extent to which therapist-led and digital cognitive behavioral therapy for insomnia contribute to prescription hypnotic reduction. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING); URL: https://clinicaltrials.gov/ct2/show/NCT03532282; Identifier: NCT03532282. CITATION Tully IA, Kim JP, Simpson N, et al. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med. 2023;19(7):1247-1257.
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Affiliation(s)
- Isabelle A. Tully
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Joshua Tutek
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Nicole B. Gumport
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Başkaya E, Demir S. The problems and information needs of patients with bipolar disorder during the treatment process: A qualitative study in Turkey. Arch Psychiatr Nurs 2023; 42:45-54. [PMID: 36842827 DOI: 10.1016/j.apnu.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
The objective of the present study was to determine the problems and information needs of patients with bipolar disorder during the treatment process. The present research is in the type of descriptive and qualitative study. In-depth individual interviews were conducted with 11 volunteer patients with bipolar disorder. The data collected from the interviews were evaluated using the descriptive analysis method. In the study, four categories (disease onset/diagnosis stage, adherence to treatment, interpersonal relationships, information needs) and nine main themes (symptoms, family support, factors that positively affect treatment adherence, factors that negatively affect treatment adherence, positive effects of treatment, negative effects of treatment, stigmatization, treatment, disease) were determined. Patients with bipolar disorder can be helped to cope with the problems they experience by providing information about the disease, adherence to treatment, the treatment process, and the effects of drugs.
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Affiliation(s)
- Ebru Başkaya
- Uşak University, Vocational School of Health Services, Department of Health Care Services, Uşak, Turkey.
| | - Satı Demir
- Gazi University, Faculty of Health Sciences, Department of Psychiatric Nursing, Ankara, Turkey
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Halvorsen LV, Bergland OU, Søraas CL, Larstorp ACK, Hjørnholm U, Kjær VN, Kringen MK, Clasen PE, Haldsrud R, Kjeldsen SE, Rostrup M, Fadl Elmula FEM, Opdal MS, Høieggen A. Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy. J Am Heart Assoc 2022; 11:e025879. [PMID: 36073648 DOI: 10.1161/jaha.121.025879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.
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Affiliation(s)
- Lene V Halvorsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ola U Bergland
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Section for Environmental and Occupational Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Anne Cecilie K Larstorp
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Medical Biochemistry Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Vibeke N Kjær
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | | | - Per-Erik Clasen
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Renate Haldsrud
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Sverre E Kjeldsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Cardiology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Basic Medical Sciences University of Oslo Norway
| | - Fadl Elmula M Fadl Elmula
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Mimi S Opdal
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
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Crellin NE, Priebe S, Morant N, Lewis G, Freemantle N, Johnson S, Horne R, Pinfold V, Kent L, Smith R, Darton K, Cooper RE, Long M, Thompson J, Gruenwald L, Freudenthal R, Stansfeld JL, Moncrieff J. An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders. BMC Psychiatry 2022; 22:185. [PMID: 35291964 PMCID: PMC8925064 DOI: 10.1186/s12888-022-03822-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients' views about continuing or discontinuing antipsychotic treatment. AIMS To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. METHODS We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. RESULTS We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. CONCLUSIONS This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued.
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Affiliation(s)
- Nadia E. Crellin
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK
| | - Nicola Morant
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Glyn Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Nick Freemantle
- grid.83440.3b0000000121901201Institute of Clinical Trials and Methodology, University College London, London, WC1V 6LJ UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Rob Horne
- grid.83440.3b0000000121901201School of Pharmacy, University College London, London, WC1N 1AX UK
| | | | - Lyn Kent
- Independent consultant, London, UK
| | | | | | - Ruth E. Cooper
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK ,grid.36316.310000 0001 0806 5472University of Greenwich, Faculty of Education, Health and Human Sciences, London, SE10 9LS UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, Newham Centre for Mental Health, London, E13 8SP UK
| | - Maria Long
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Jemima Thompson
- grid.83440.3b0000000121901201Faculty of Medical Sciences, University College London, London, UK
| | - Lisa Gruenwald
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Robert Freudenthal
- grid.451052.70000 0004 0581 2008Barnet Enfield Haringey Mental Health NHS Trust, London, UK
| | - Jacki L. Stansfeld
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Joanna Moncrieff
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
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Gjerde PB, Steen SW, Vedal TSJ, Steen NE, Reponen EJ, Andreassen OA, Steen VM, Melle I. Lifetime Cannabis Use Is Not Associated With Negative Beliefs About Medication in Patients With First Treatment Psychosis. Front Psychiatry 2022; 13:824051. [PMID: 35422717 PMCID: PMC9001842 DOI: 10.3389/fpsyt.2022.824051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cannabis use is common among patients with psychosis, and along with negative beliefs about medication, it has been found to predict poor adherence to antipsychotic drug treatment. Such lack of adherence to antipsychotic drug treatment increases the risk of poor clinical outcomes and relapse in patients with first treatment for psychosis (FTP). However, to date, it is unclear whether cannabis use may be related to negative perceptions about antipsychotic drug treatment. METHODS A cross-sectional sample of 265 FTP patients with schizophrenia spectrum disorder underwent extensive clinical assessments. Three measures of cannabis use were obtained: lifetime, current and meeting diagnostic criteria for abuse or addiction. For the primary analyses we focused on lifetime cannabis use. The Beliefs about Medication Questionnaire (BMQ) was employed to assess the patients' specific concerns and perceptions of antipsychotic medications, as well as general beliefs about pharmacotherapy. The relationship between lifetime cannabis use and BMQ scores was investigated with general linear model (GLM) analyses, controlling for age and sex. RESULTS Patients with lifetime use of cannabis ≥10 times were more likely to be male, younger at the age of onset of psychosis and with higher levels of alcohol use and daily tobacco smoking, as compared to the non-users (p < 0.05). Neither lifetime use of cannabis, current use nor a cannabis abuse diagnosis was associated with negative beliefs about medicines as measured by the BMQ questionnaire. CONCLUSION Use of cannabis is not linked to negative perceptions about antipsychotic medicines in patients with FTP. Other reasons for poor compliance to antipsychotic drug treatment in cannabis users need to be further investigated.
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Affiliation(s)
- Priyanthi B Gjerde
- Norwegian Centre for Mental Disorders Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Synne W Steen
- Norwegian Centre for Mental Disorders Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Trude S J Vedal
- Division of Mental Health, Akershus University Hospital, Oslo, Norway.,NORMENT, Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ole A Andreassen
- NORMENT, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vidar M Steen
- Norwegian Centre for Mental Disorders Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ingrid Melle
- NORMENT, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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10
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Herrera Guerra EDP, Robles González JR, Bautista Arellano LR. Validez y confiabilidad del Beliefs About Medicines Questionnaire en pacientes hipertensos colombianos. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción. El Beliefs about Medicines Questionnaire (BMQ) permite valorar las representaciones cognitivas que engloban las creencias sobre la medicación de los pacientes, sobre tomar medicamentos para su enfermedad en diferentes culturas. Objetivo. Determinar la validez de constructo y confiabilidad del cuestionario BMQ adaptado a pacientes hipertensos colombianos. Materiales y métodos. Estudio psicométrico de tipo instrumental, realizado en una muestra de 238 pacientes hipertensos en edad promedio de 65 años (DE= 11,4) con predominio del sexo femenino (70%). La validez de constructo se evaluó mediante Análisis Factorial Exploratorio y Confirmatorio. Se calculó la confiabilidad utilizando el método coeficiente de alfa de Cronbach. Resultados. Se obtuvo una versión reducida de 16 ítems; en la sección BMQ-General los 7 ítems se agruparon en dos factores que explicó el 64% de la varianza común y buen ajuste ( = 61.46; gl = 13; p = 0.000; CFI = 0.917; NNFI = 0.89; CFI=0.917; SRMR=0.054; RMSEA = 0.125; IC 90% [0,10, 0,16]). En el BMQ-Específico los 9 ítems agrupados en dos factores que explicaron el 63,17% de la varianza común con un ajuste aceptable ( = 122.4; gl = 26; p = 0.000; CFI = 0.88; NNFI = 0.84; CFI=0.88; SRMR=0.106; RMSEA = 0.125; IC 90% [0.10, 0.15]). La confiabilidad por alfa de Cronbach para el BMQ-General y Específico fue de 0.82 y 0.78 respectivamente. Discusión y conclusiones. La versión del BMQ adaptada a pacientes hipertensos colombianos, poseen características psicométricas adecuadas, su uso es recomendado en la investigación.
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11
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Mundal I, Gråwe RW, Hafstad H, De Las Cuevas C, Lara-Cabrera ML. Effects of a peer co-facilitated educational programme for parents of children with ADHD: a feasibility randomised controlled trial protocol. BMJ Open 2020; 10:e039852. [PMID: 33268416 PMCID: PMC7713204 DOI: 10.1136/bmjopen-2020-039852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Significant numbers of children with attention deficit hyperactivity disorder (ADHD) display problems that cause multiple disabilities, deficits and handicaps that interfere with social relationships, development and school achievement. They may have multiple problems, which strain family dynamics and influence the child's treatment. Parent activation, described as parents' knowledge, skills and confidence in dealing with their child's health and healthcare, has been shown to be an important factor in improving health outcomes. Research suggests that parents need edification to learn skills crucial to the treatment and management of their children's healthcare. Promoting positive parenting techniques may reduce negative parenting factors in families. This study aims to assess the acceptability, feasibility and estimated sample size of a randomised controlled trial (RCT) comparing an ADHD peer co-led educational programme added to treatment as usual (TAU). METHODS AND ANALYSIS Using a randomised waitlist controlled trial, parents of children aged 6-12 years newly diagnosed with ADHD, and referred to a child mental health outpatient clinic in Mid-Norway, will receive TAU concomitant with a peer co-facilitated parental engagement educational programme (n=25). Parents in the control group will receive TAU, and the educational programme treatment within a waitlist period of 3-6 months (n=25). Parent activation, satisfaction, well-being, quality of life and treatment adherence, will be assessed at baseline (T0), 2 weeks (T1) pre-post intervention (T2, T3) and at 3 months follow-up (T4). Shared decision making, parents preferred role in health-related decisions and involvement, parent-reported symptoms of ADHD and child's overall level of functioning will be assessed at T0 and T4. Such data will be used to calculate the required sample size for a full-scale RCT. ETHICS AND DISSEMINATION Approval was obtained from the Regional Committee for Medicine and Health Research Ethics in Mid-Norway (ref: 2018/1196). The findings of this study are expected to provide valuable knowledge about how to optimise family education and management of ADHD and will be disseminated through presentations at conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04010851.
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Affiliation(s)
- Ingunn Mundal
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- Division of Psychiatry, Kristiansund Community Mental Health Centre, Møre og Romsdal Hospital Trust, Kristiansund, Norway
| | - Rolf W Gråwe
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Nidaros Community Mental Health Centre, St Olav's University Hospital, Trondheim, Norway
| | - Hege Hafstad
- Division of Mid-Norway, Vårres Regional User Involvement Centre, Trondheim, Norway
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal deLa Laguna, Tenerife, Spain
| | - Mariela Loreto Lara-Cabrera
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Tiller Community Mental Health Centre, St Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Mental Health, St Olav's University Hospital, Trondheim, Norway
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12
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West LM, Borg Theuma R, Cordina M. The 'Necessity-Concerns Framework' as a means of understanding non-adherence by applying polynomial regression in three chronic conditions. Chronic Illn 2020; 16:253-265. [PMID: 30235934 DOI: 10.1177/1742395318799847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The 'Necessity-Concerns Framework' is an important framework which can support healthcare professionals in targeting patients' medication beliefs and decisions on adherence. Our aim was to determine how the interdependence of 'necessity' and 'concerns' beliefs for medication adherence compares across three chronic conditions. METHODS Patients diagnosed with asthma, cardiovascular conditions or diabetes attending out-patient clinics completed a self-administered questionnaire. The questionnaire gathered information regarding demographics, medication adherence using the 'Tool for Adherence Behaviour Screening', presence of unused medication in households and medication beliefs using the 'Beliefs about Medicines Questionnaire-Specific'. Polynomial regression was applied to determine the multidimensional interdependence of 'necessity' and 'concerns' beliefs for adherence. P-values ≤ 0.05 were taken to be significant. RESULTS Confirmatory polynomial regression rejected the differential score model in all three groups. For each condition, exploratory polynomial regression found that linear terms indicated the best fitting model for predicting adherence. In all groups, adherence increased as necessity beliefs increased and concerns decreased. Patients suffering from cardiovascular conditions and diabetes with low necessity and low concerns beliefs reported higher medication adherence compared to those with high necessity and high concerns beliefs. DISCUSSION Alleviating patients' concerns can enhance medication adherence and potentially curb the issue of medication wastage.
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Affiliation(s)
- Lorna M West
- Medicines Use Research Group, Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ruth Borg Theuma
- Medicines Use Research Group, Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Maria Cordina
- Medicines Use Research Group, Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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13
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Wisting L, Siegwarth C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. The impact of psychological aspects, age, and BMI on eating disorder psychopathology among adult males and females with type 1 diabetes. Health Psychol Open 2020; 7:2055102920975969. [PMID: 33282331 PMCID: PMC7691919 DOI: 10.1177/2055102920975969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study investigated correlates of eating disorder (ED) psychopathology among
adults with type 1 diabetes (T1D). A total of 282 males (n =
112) and females (n = 170) with T1D (18–79 years) participated.
Overall, psychological aspects (i.e. illness perceptions, coping strategies,
insulin beliefs, anxiety, and depression) were associated with ED
psychopathology. Associations were generally stronger among females than males.
In a regression model, age, BMI, personal control, and anxiety explained 51% of
the variance in ED psychopathology among females, whereas BMI, personal control,
and anxiety explained 47% of the variance among males. Greater clinical
awareness of health psychological aspects may contribute to reduce the risk of
developing ED.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Cecilie Siegwarth
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, University of Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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14
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Marrero RJ, Fumero A, de Miguel A, Peñate W. Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2116-2131. [PMID: 32402489 DOI: 10.1016/j.pec.2020.04.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Psychopharmacological medication adherence is essential for psychiatric patients' treatment and well-being. OBJECTIVE This review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients. METHODS A literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included. RESULTS The search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence. CONCLUSION Psychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors. PRACTICE IMPLICATIONS These findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.
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Affiliation(s)
- Rosario J Marrero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain.
| | - Ascensión Fumero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Adelia de Miguel
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Wenceslao Peñate
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
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15
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Chakrabarti S. Treatment Attitudes and Adherence Among Patients with Bipolar Disorder: A Systematic Review of Quantitative and Qualitative Studies. Harv Rev Psychiatry 2020; 27:290-302. [PMID: 31385812 DOI: 10.1097/hrp.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systematic reviews about treatment attitudes of patients influencing adherence in bipolar disorder (BD) are rare. METHODS A systematic review was conducted according to the PRISMA guidelines and principles of thematic synthesis. Selectively identified quantitative and qualitative studies were used to examine the attitude-adherence relationship in BD, the types and correlates of treatment attitudes, and the impact of psychosocial interventions on attitudes. RESULTS The final list of 163 articles included 114 observational reports (incorporating 21 psychosocial intervention trials), 45 qualitative/descriptive studies, and 4 patient surveys. A positive association between treatment attitudes and adherence was found in most quantitative and qualitative studies, though the strength of the relationship was unclear. Thematic analysis of qualitative studies suggested that patient attitudes influencing adherence were based on perceived advantages and disadvantages of treatment. The principal correlates of patients' attitudes were family attitudes, the clinician-patient alliance, social support, and patients' knowledge of BD. Though negative attitudes such as denial, concerns about adverse treatment consequences, and stigmatizing effects of treatment were common, many patients believed treatment to be beneficial and necessary. The limited data on the effect of psychosocial interventions indicated that treatments selectively targeting attitudes enhanced adherence. LIMITATIONS The studies were heterogeneous in design; the quality was uneven (fair to poor); and the risk of bias moderate to high. CONCLUSIONS Despite these flaws, awareness of the existing evidence on the attitude-adherence association and other aspects of treatment attitudes in BD can help in efforts to address nonadherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- From the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh (India)
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16
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Roldan Munoz S, Lupattelli A, de Vries ST, Mol PGM, Nordeng H. Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study. BMJ Open 2020; 10:e034529. [PMID: 32029496 PMCID: PMC7044950 DOI: 10.1136/bmjopen-2019-034529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases. DESIGN Cross-sectional web-based survey. SETTING Multinational study in Europe. PARTICIPANTS Pregnant women or women with children less than 1 year old from European countries and with asthma, allergy, cardiovascular, rheumatic diseases, diabetes, epilepsy and/or inflammatory bowel diseases (IBD). PRIMARY AND SECONDARY OUTCOME MEASURE Differences in scores of the Beliefs about Medicines Questionnaire (BMQ). RESULTS In total, 1219 women were included (ranging from 736 for allergy to 49 for IBD). Women using medication for their chronic disease (n=770; 63%) had higher scores on the BMQ subscales necessity (16.6 vs 12.1, p<0.001) and benefits (16.2 vs 15.4, p<0.001), and lower values on the subscales overuse (12.5 vs 13.1; p=0.005) and harm (9.8 vs 10.7, p<0.001) than women not using medication. No significant differences were shown for the concerns subscale (12.5 vs 12.3, p=0.484). Beliefs varied somewhat across diseases but in general more positive beliefs among women using medication were shown. Epilepsy was the disease where less differences were observed between women using and not using medication. CONCLUSION Women's beliefs were associated with medication use during pregnancy with only small differences across the diseases. Knowing pregnant women's beliefs could help identify women who are reluctant to use medication and could guide counselling to support making well-informed treatment decisions.
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Affiliation(s)
- Sonia Roldan Munoz
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Angela Lupattelli
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Sieta T de Vries
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedvig Nordeng
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
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Elisabeth Stømer U, Klopstad Wahl A, Gunnar Gøransson L, Hjorthaug Urstad K. Health Literacy in Kidney Disease: Associations with Quality of Life and Adherence. J Ren Care 2020; 46:85-94. [DOI: 10.1111/jorc.12314] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Une Elisabeth Stømer
- Faculty of Health ScienceUniversity of StavangerStavanger Norway
- Department of NephrologyStavanger University HospitalStavanger Norway
| | | | - Lasse Gunnar Gøransson
- Department of NephrologyStavanger University HospitalStavanger Norway
- Department of Clinical Medicine, Faculty of MedicineUniversity of BergenBergen Norway
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18
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Drivenes K, Vederhus JK, Haaland VØ, Ruud T, Hauge YL, Regevik H, Falk RS, Tanum L. Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine (Baltimore) 2020; 99:e18635. [PMID: 31895824 PMCID: PMC6946431 DOI: 10.1097/md.0000000000018635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.
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Affiliation(s)
- Karin Drivenes
- Division of Mental Health and Addiction Services Sørlandet Hospital
- South Eastern Norway Hospital Pharmacy Enterprise, Kristiansand
| | | | - Vegard Øksendal Haaland
- Addiction Unit, Sørlandet Hospital
- Clinical Neuroscience Research Group, Department of Psychology, The Faculty of Social Sciences
| | - Torleif Ruud
- Clinic for Health Services Research and Psychiatry, Institute of clinical medicine, University of Oslo
- Department of R&D in Mental health service, Akershus university hospital
| | - Yina Luk Hauge
- South Eastern Norway Hospital Pharmacy Enterprise, Kristiansand
| | - Hilde Regevik
- Division of Mental Health and Addiction Services Sørlandet Hospital
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo
| | - Lars Tanum
- Department of R&D in Mental health service, Akershus university hospital
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway
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19
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Hovland R, Bremer S, Frigaard C, Henjum S, Faksvåg PK, Saether EM, Kristiansen IS. Effect of a pharmacist-led intervention on adherence among patients with a first-time prescription for a cardiovascular medicine: a randomized controlled trial in Norwegian pharmacies. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:337-345. [PMID: 31886591 PMCID: PMC7384053 DOI: 10.1111/ijpp.12598] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023]
Abstract
Objective To examine whether a pharmacist‐led intervention improves medication adherence among patients who have filled a first‐time prescription for a cardiovascular medicine. Methods Design: Unblinded randomized controlled trial. Setting: 67 Norwegian pharmacies, October 2014–June 2015. Participants: 1480 adults with a first‐time prescription for a cardiovascular medicine. Intervention: Participants in the intervention group received two consultations with a pharmacist 1–2 and 3–5 weeks after filling the prescription. Participants in the control group received care according to usual practice. Main outcome measure: The primary outcome was self‐reported adherence as measured by the 8‐item Morisky Medication Adherence Scale (MMAS‐8), at 7 and 18 weeks after filling the prescription. Adherence from baseline to week 52 was estimated using data from the Norwegian Prescription Database (NPD). Key Findings Data from MMAS‐8 showed that 91.3% of the patients in the intervention group were adherent after 7 weeks versus 86.8% in the control group (4.5% difference, 95% CI 0.8–8.2, P = 0.017). The corresponding proportions were 88.7% versus 83.7% after 18 weeks (5.0% difference, 95% CI 0.8–9.2, P = 0.021). NPD data (n = 1294) showed no significant difference in adherence after 52 weeks (95% CI −2.0 to 7.8, P = 0.24). However, adherence among statin users (n = 182) was 66.5% in the intervention group versus 57.4% among new statin users in the general population (n = 1500) (difference 9.1%, 95% CI 1.5–16.0, P = 0.019). Conclusion The main outcome measure indicates that a short, structured pharmacist‐led intervention may increase medication adherence for patients starting on chronic cardiovascular medication. However, these findings could not be confirmed by the NPD data analysis.
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Affiliation(s)
- Ragnar Hovland
- Apokus, National Centre for Development of Pharmacy Practice, Oslo, Norway
| | - Sara Bremer
- Apokus, National Centre for Development of Pharmacy Practice, Oslo, Norway
| | - Christine Frigaard
- Apokus, National Centre for Development of Pharmacy Practice, Oslo, Norway
| | | | | | | | - Ivar Sønbø Kristiansen
- Oslo Economics, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Hjemås BJ, Bøvre K, Mathiesen L, Lindstrøm JC, Bjerknes K. Interventional study to improve adherence to phosphate binder treatment in dialysis patients. BMC Nephrol 2019; 20:178. [PMID: 31101020 PMCID: PMC6525353 DOI: 10.1186/s12882-019-1334-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/12/2019] [Indexed: 01/28/2023] Open
Abstract
Background Adherence to phosphate binder treatment is important to prevent high serum phosphate level in chronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels. Methods A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including chronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the proportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in the patient’s knowledge, beliefs and adherence after the intervention measured by completion of questionnaires ‘Patient Knowledge’, Medication Adherence Report Scale (MARS− 5) and Beliefs about Medicines Questionnaire (BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their phosphate binders. Other medicines used by the patient was also registered. Results A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate being below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean serum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and the patients’ beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect did not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the intervention. Conclusions Short term one-to-one individualized pharmacist-led education and counselling about phosphate binders increased the probability of serum phosphate concentrations being below the target threshold level 1.80 mmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate level or increase the patients’ self-reported adherence. The patients increased their knowledge about the phosphate binder and their understanding of adherence, and were less concerned about the side effects of the medication. Trial registration ISRCTN52852596, registered 11 April 2019. The trial was registered retrospectively.
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Affiliation(s)
- Bodil Jahren Hjemås
- Hospital Pharmacies Enterprise, South Eastern Norway, Stenersgate 1, PB. 79, 0050, Oslo, Norway.
| | - Katrine Bøvre
- Hospital Pharmacies Enterprise, South Eastern Norway, Stenersgate 1, PB. 79, 0050, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Jonas Christoffer Lindstrøm
- Health Services Research Units, Akershus University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kathrin Bjerknes
- Hospital Pharmacies Enterprise, South Eastern Norway, Stenersgate 1, PB. 79, 0050, Oslo, Norway
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Svensberg K, Nordeng H, Gaffari S, Faasse K, Horne R, Lupattelli A. Perceived sensitivity to medicines: a study among chronic medicine users in Norway. Int J Clin Pharm 2019; 41:804-812. [DOI: 10.1007/s11096-019-00826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 04/10/2019] [Indexed: 01/19/2023]
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Wisting L, Rø A, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. J Health Psychol 2019; 26:688-700. [DOI: 10.1177/1359105319840688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Oslo Diabetes Research Centre, Norway
| | - Astrid Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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Inder M, Lacey C, Crowe M. Participation in decision-making about medication: A qualitative analysis of medication adherence. Int J Ment Health Nurs 2019; 28:181-189. [PMID: 29956441 DOI: 10.1111/inm.12516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/28/2022]
Abstract
Rates of relapse in BD are high with medication nonadherence identified as an important contributor to relapse. Psychopharmacology remains a key component to the treatment of BD; therefore, increased understanding of medication use and ways to promote greater adherence is essential. The aim of the study was to identify how participants with BD experience taking prescribed medication. Participants had BD I or BD II, were users of specialist mental health services, aged 18-64 years, euthymic, mildly hypomanic or depressed, and on any combination of medication. Exclusion criteria were minimal. A semistructured interview was completed exploring patients' views of BD and factors influencing adherence based on the Subjective Experience of Medication Interview. An inductive thematic analysis was used to identify themes. The study participants (n = 36) had predominantly bipolar I (78%) and were female (69%), and of New Zealand European ethnicity (67%) with 14% Maori. The mean age was 41 years (SD: 12.0). Findings from the thematic analysis generated three themes: Learning about the clinical meaning of having BD, Understanding how to use medication, and Understanding what works for me. The qualitative nature of our study limits the generalizability of our findings to a broader population of individuals with BD. The participants developed confidence in being in charge of their BD through a process of learning about BD and medication and understanding what this meant for them. The findings support greater emphasis on collaborative approaches that recognize the expertise of the individual with BD and the clinician.
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Affiliation(s)
- Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Waaseth M, Adan A, Røen IL, Eriksen K, Stanojevic T, Halvorsen KH, Garcia BH, Holst L, Ulshagen KM, Blix HS, Ariansen H, Nordeng HME. Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers - a cross-sectional study. BMC Public Health 2019; 19:66. [PMID: 30646892 PMCID: PMC6332570 DOI: 10.1186/s12889-019-6409-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a global health threat. Public knowledge is considered a prerequisite for appropriate use of antibiotics and limited spread of antibiotic resistance. Our aim was to examine the level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, and to assess to which degree beliefs, attitudes and sociodemographic factors are associated with this knowledge. METHODS A questionnaire based, cross-sectional study was conducted among pharmacy customers in three Norwegian cities. The questionnaire covered 1) knowledge of antibiotics (13 statements) and antibiotic resistance (10 statements), 2) the general beliefs about medicines questionnaire (BMQ general) (three subdomains, four statements each), 3) attitudes toward antibiotic use (four statements), and 4) sociodemographic factors, life style and health. High knowledge level was defined as > 66% of maximum score. Factors associated with knowledge of antibiotics and antibiotic resistance were investigated through univariate and multiple linear regression. Hierarchical model regression was used to estimate a population average knowledge score weighted for age, gender and level of education. RESULTS Among 877 participants, 57% had high knowledge of antibiotics in general and 71% had high knowledge of antibiotic resistance. More than 90% knew that bacteria can become resistant against antibiotics and that unnecessary use of antibiotics can make them less effective. Simultaneously, more than 30% erroneously stated that antibiotics are effective against viruses, colds or influenza. Factors positively associated with antibiotic knowledge were health professional background, high education level, and a positive view on the value of medications in general. Male gender, a less restrictive attitude toward antibiotic use, and young age were negatively associated with antibiotic knowledge. The mean overall antibiotic knowledge score was relatively high (15.6 out of maximum 23 with estimated weighted population score at 14.8). CONCLUSIONS Despite a high level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, there are obvious knowledge gaps. We suggest that action is taken to increase the knowledge level, and particularly target people in vocational, male dominated occupations outside the health service, and primary/secondary school curricula.
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Affiliation(s)
- Marit Waaseth
- Department of Pharmacy, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Abdifatah Adan
- Department of Pharmacy, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Ingrid L. Røen
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020 Bergen, Norway
| | - Karoline Eriksen
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020 Bergen, Norway
| | - Tijana Stanojevic
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, PO Box 1068 Blindern, N-0316 Oslo, Norway
| | - Kjell H. Halvorsen
- Department of Pharmacy, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Beate H. Garcia
- Department of Pharmacy, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Lone Holst
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020 Bergen, Norway
| | - Karen M. Ulshagen
- Norwegian Medicines Agency, PO Box 6167 Etterstad, N-0602 Oslo, Norway
| | - Hege S. Blix
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway
| | - Hilde Ariansen
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, PO Box 1068 Blindern, N-0316 Oslo, Norway
| | - Hedvig M. E. Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, PO Box 1068 Blindern, N-0316 Oslo, Norway
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Abdullah-Koolmees H, Gardarsdottir H, Minnema LA, Elmi K, Stoker LJ, Vuyk J, Goedhard LE, Egberts TCG, Heerdink ER. Predicting rehospitalization in patients treated with antipsychotics: a prospective observational study. Ther Adv Psychopharmacol 2018; 8:213-229. [PMID: 30065813 PMCID: PMC6058452 DOI: 10.1177/2045125318762373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prediction of rehospitalization in patients treated with antipsychotics is important for identifying patients in need of additional support to prevent hospitalization. Our aim was to identify factors that predict rehospitalization in patients treated with antipsychotics at discharge from a psychiatric hospital. METHODS Adult patients suffering from schizophrenia, psychotic or bipolar I disorders who had been hospitalized in a psychiatric hospital for ⩾7 days and were treated with oral antipsychotics at discharge were included. The main outcome was rehospitalization within 6 months after discharge. A prediction model for rehospitalization was constructed including: patient/disease and medication characteristics, patients' beliefs about medicines, and healthcare-professional-rated assessment for all patients. The patients were stratified by diagnosis (schizophrenia and nonschizophrenia). Area under the receiver operating characteristic curve (AUCROC) was also assessed. RESULTS A total of 87 patients were included and 33.3% of them were rehospitalized within 6 months after discharge. The variables that predicted rehospitalization were duration of hospitalization, patients' attitude towards medicine use, and healthcare-professional-rated assessment with an AUCROC of 0.82. Rehospitalization for patients with schizophrenia could be predicted (AUCROC = 0.71) by the Global Assessment of Functioning score, age, and harm score. Rehospitalization was predicted (AUCROC = 0.73) for nonschizophrenia patients with, for example rehospitalization predicted by the nurse. CONCLUSIONS Rehospitalization was predicted by a combination of variables from the patient/disease and medication characteristics, patients' attitude towards medicine use, and healthcare-professional-rated assessment. These variables can be assessed relatively easily at discharge to predict rehospitalization within 6 months.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lotte A Minnema
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Kamjar Elmi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Lennart J Stoker
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Judith Vuyk
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | | | - Toine C G Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands
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Samalin L, Honciuc M, Boyer L, de Chazeron I, Blanc O, Abbar M, Llorca PM. Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD). BMC Psychiatry 2018; 18:103. [PMID: 29653535 PMCID: PMC5899333 DOI: 10.1186/s12888-018-1686-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. SDM has raised great interest in mental healthcare over the last decade, as it is considered a fundamental part of patient-centered care. However, there is no research evaluating the efficacy of SDM compared to usual care (CAU), as it relates to quality of care and more specifically treatment adherence, in bipolar disorder (BD). METHODS/DESIGN This is a 12-month multi-centre, cluster-randomized controlled trial comparing the efficacy of SDM to CAU. Adult BD patients (n = 300) will be eligible after stabilization for at least 4 weeks following an acute mood episode. The intervention will consist of applying the standardized SDM process as developed by the Ottawa Hospital Research Institute in order to choose the maintenance treatment of BD. A multidisciplinary team developed a decision aid "choose my long-term treatment with my doctor" for BD patients to clarify possible therapeutic options. Primary outcome will assess the patient's level of adherence (based on hetero-evaluation) of ongoing treatment at 12 months. Secondary outcomes will assess the difference between the 2 groups of patients in terms of adherence to maintenance drug therapy based on other measures (self-assessment scale and plasma levels of mood stabilizers). Additionally, other dimensions will be assessed: decisional conflict, satisfaction with care and involvement in decision making, beliefs about treatment, therapeutic relationship, knowledge about information for medical decision and clinical outcomes (depression, mania, functioning and quality of life). The primary endpoint will be analysed without adjustment by comparison of adherence scores between the two groups using Student t-tests or Mann-Whitney tests according to the variable distribution. A set of secondary analyses will be adjusted for covariates of clinical interest using generalized linear mixed regression models. DISCUSSION This will be the first study evaluating the effect of an SDM intervention on patient adherence in BD. This is also an innovative protocol because it proposes the development of an evidence-based tool that should help patients and clinicians to initiate discussions regarding the use of BD treatment. TRIAL REGISTRATION The study has been registered with ClinicalTrials.gov as NCT03245593 .
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Affiliation(s)
- L. Samalin
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - M. Honciuc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - L. Boyer
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life research Unit, EA 3279 Marseille, France
| | - I. de Chazeron
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | - O. Blanc
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
| | | | - P. M. Llorca
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA7280 Clermont-Ferrand, France
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De las Cuevas C, Motuca M, Baptista T, de Leon J. Skepticism and pharmacophobia toward medication may negatively impact adherence to psychiatric medications: a comparison among outpatient samples recruited in Spain, Argentina, and Venezuela. Patient Prefer Adherence 2018; 12:301-310. [PMID: 29503532 PMCID: PMC5824753 DOI: 10.2147/ppa.s158443] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cultural differences in attitudes toward psychiatric medications influence medication adherence but transcultural studies are missing. The objective of this study was to investigate how attitudes and beliefs toward psychotropic medications influence treatment adherence in psychiatric outpatients in Spain, Argentina, and Venezuela. METHODS A cross-sectional, cross-cultural psychopharmacology study was designed to assess psychiatric outpatients' attitudes toward their prescribed medication. Patients completed the Drug Attitude Inventory - 10 Item (DAI-10), the Beliefs about Medicines Questionnaire - Specific Scale (BMQ-Specific), the Sidorkiewicz adherence tool, and sociodemographic and clinical questionnaires. The study included 1,291 adult psychiatric outpatients using 2,308 psychotropic drugs from three Spanish-speaking countries, the Canary Islands (Spain) (N=588 patients), Argentina (N=508), and Venezuela (N=195). RESULTS The univariate analyses showed different mean scores on the DAI-10 and the BMQ - Necessity and Concerns subscales but, on the other hand, the percentages of non-adherent and skeptical patients were relatively similar in three countries. Argentinian patients had a very low level of pharmacophobia. Multivariate analyses (logistic regression and chi-squared automatic interaction detector segmentation) showed that pharmacophobia in general and skepticism about specific medications (high concern about adverse reactions and low belief in their necessity) were associated with non-adherence. Pharmacophobia was the major factor associated with non-adherence (Spain and Venezuela) but when pharmacophobia was rare (Argentina), skepticism was the most important variable associated with non-adherence. CONCLUSION Psychiatric patients' attitudes and beliefs about their psychiatric treatment varied in these three Spanish-speaking countries, but pharmacophobia and skepticism appeared to play a consistent role in lack of adherence.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain
| | - Mariano Motuca
- Instituto Vilapriño, Center for Studies, Assistance and Research in Neurosciences, Mendoza, Argentina
| | - Trino Baptista
- Departament of Physiology, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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Deane FP, McAlpine E, Byrne MK, Davis EL, Mortimer C. Are carer attitudes toward medications related to self-reported medication adherence amongst people with mental illness? Psychiatry Res 2018; 260:158-163. [PMID: 29197228 DOI: 10.1016/j.psychres.2017.11.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/03/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
Medication nonadherence among consumers with psychiatric disorders can significantly affect the health and wellbeing of the consumer and their family. Previous research has suggested that carers have an impact on consumer attitudes toward medication and adherence. Yet, how carer attitudes toward medication may be related to consumer attitudes and adherence has received little investigation. This exploratory study aimed to investigate the relationships between carer and consumer attitudes toward medication and consumer adherence behaviour. A cross-sectional survey assessing consumer and carer attitudes toward medication and consumer adherence was conducted amongst 42 consumer-carer dyads. Correlation analyses showed a positive association between consumer and carer attitudes toward medication and between consumer and carer attitudes with adherence. There was a general indication that the greater the difference between consumer and carer attitudes, the lower the level of adherence. Regression analyses revealed that while neither consumer nor carer attitudes were significant predictors of adherence, carer attitudes appeared to have a stronger role in adherence than consumer attitudes. These preliminary results highlight the importance of carer attitudes in relation to patient perceptions and behaviours toward medication, and thus the potential benefits of addressing both consumer and carer attitudes in any intervention for improving adherence.
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Affiliation(s)
- Frank P Deane
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, New South Wales, Australia.
| | - Elizabeth McAlpine
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, New South Wales, Australia
| | - Mitchell K Byrne
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, New South Wales, Australia
| | - Esther L Davis
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, New South Wales, Australia
| | - Christine Mortimer
- School of Psychology and Illawarra Institute for Mental Health, University of Wollongong, New South Wales, Australia
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Arıkan H, Duman D, Kargın F, Ergin G, Horne R, Karakurt S, Eryüksel E. Cross-cultural Adaptation and Validation of Beliefs about Medicines Questionnaire on Asthma and Chronic Obstructive Pulmonary Disease Patients. Turk Thorac J 2018; 19:36-40. [PMID: 29404184 DOI: 10.5152/turkthoracj.2017.17040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/28/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Inadequate adaptation to long-term treatment of chronic illnesses is the most common reason for the inability to obtain the benefits medications can provide. Treatment compliance is influenced by several factors. Beliefs about Medicines Questionnaire (BMQ) developed by Horne et al. in 1999 to evaluate the cognitive representation of medicines have many validation studies, which resulted in good psychometric properties. The aim of the present study was to evaluate the reliability and validity of the BMQ Turkish translation in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS Fifty asthma and 50 COPD patients participated in this methodological study. The scale was adapted to Turkish through translation, comparison with other language versions, back translation, and a pre-test. The structural validity was assessed using factor analysis. RESULTS Similar to the original scale, factor analysis confirmed that BMQ had a four-factor structure that accounts for 58.23% of the total variance. The BMQ showed an acceptable internal consistency (Cronbach's alpha coefficient: specific-necessity, 0.832: specific-concerns, 0.722; general-harm, 0.792; and general-overuse, 0.682). The factor analysis revealed the same patterns for all questions between the Turkish and original scales. CONCLUSION The psychometric properties of the BMQ were consistent with those reported in the original study. We found that the Turkish translation of BMQ is a valid and reliable tool for assessing medicine-related beliefs in patients with asthma and COPD.
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Affiliation(s)
- Hüseyin Arıkan
- Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, İstanbul, Turkey
| | - Dildar Duman
- Department of Pulmonology University of Health Sciences, Süreyyapaşa Chest Diseases and Cheast Surgery Training and Research Hospital, İstanbul, Turkey
| | - Feyza Kargın
- Department of Pulmonology University of Health Sciences, Süreyyapaşa Chest Diseases and Cheast Surgery Training and Research Hospital, İstanbul, Turkey
| | - Gülbin Ergin
- Department of Physiotherapy and Rehabilitation, Lefke European University Faculty of Health Sciences, Lefka, Cyprus
| | - Rob Horne
- UCL School of Pharmacy, Centre for Behavioural Medicine, University College London, United Kingdom
| | - Sait Karakurt
- Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, İstanbul, Turkey
| | - Emel Eryüksel
- Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, İstanbul, Turkey
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Bitonti M, Patel P, Dickinson R, Knapp P, Blalock SJ. The effect of counseling on willingness to use a hypothetical medication and perceptions of medication safety. Res Social Adm Pharm 2017; 14:295-302. [PMID: 28412153 DOI: 10.1016/j.sapharm.2017.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Poor medication adherence is an ongoing issue, and contributes to increased hospitalizations and healthcare costs. Although most adverse effects are rare, the perceived risk of adverse effects may contribute to low adherence rates. OBJECTIVES The objective of this study was to determine how adverse effect likelihood and pharmacist counseling on adverse effect prevention affects individuals': (1) willingness to use a hypothetical medication and (2) perceptions of medication safety. METHODS This study used a 3 × 3 experimental design. Participants (n = 601) viewed a hypothetical scenario asking them to imagine being prescribed an anti-asthma medication that could cause fungal infections of the throat. Participants were randomized to 1 of 9 scenarios that differed on: probability of developing an infection (5%, 20%, no probability mentioned) and whether they were told how to reduce the risk of infection (no prevention strategy discussed, prevention strategy discussed, prevention strategy discussed with explanation for how it works). Participants were recruited through Amazon Mechanical Turk. RESULTS Participants were less willing to take the medication (F = 12.86, p < 0.0001) and considered it less safe (F = 13.11, p < 0.0001) when the probability of fungal infection was presented as 20% compared to 5% or when no probability information was given. Participants were more willing to take the medication (F = 11.78, p < 0.0001) and considered it safer (F = 11.17, p < 0.0001) when a prevention strategy was given. Finally, there was a non-statistically significant interaction between the probability and prevention strategy information such that provision of prevention information reduced the effect of variation in the probability of infection on both willingness to use the medication and perceived medication safety. CONCLUSIONS Optimal risk communication involves more than informing patients about possible adverse effects. Pharmacists could potentially improve patient acceptance of therapeutic recommendations, and allay medication safety concerns, by counseling about strategies patients can implement to reduce the perceived risk of adverse effects.
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Affiliation(s)
- Michael Bitonti
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA.
| | - Payal Patel
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA
| | | | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
| | - Susan J Blalock
- Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA
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Van den Bosch F, Ostor AJK, Wassenberg S, Chen N, Wang C, Garg V, Kalabic J. Impact of Participation in the Adalimumab (Humira) Patient Support Program on Rheumatoid Arthritis Treatment Course: Results from the PASSION Study. Rheumatol Ther 2017; 4:85-96. [PMID: 28361468 PMCID: PMC5443730 DOI: 10.1007/s40744-017-0061-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) who are treated with adalimumab (ADA) are offered a proprietary patient support program (PSP, AbbVie Care®). The main objective of this study was to examine the effectiveness of ADA on RA treatment course over time in the context of PSP utilization. METHODS PASSION was a 78-week post-marketing observational study of RA patients with an insufficient response to ≥1 DMARD newly initiating ADA in routine clinical care that was conducted in Europe, Israel, Mexico, Puerto Rico, and Australia. One prior biologic DMARD was allowed. The primary endpoint was percentage of patients achieving the minimal clinically important difference (MCID; improvement of ≥0.22 compared to baseline) in Health Assessment Questionnaire (HAQ) Disability Index (HAQ-DI) at week 78. Additionally, multiple clinical and patient-reported outcomes (PROs) were evaluated over time. Patients were categorized based on their participation in the PSP: ever (PSP users) vs. never (PSP non-users). Safety events were monitored throughout the study. RESULTS Overall, 42.8% of PSP users achieved the MCID in HAQ-DI at week 78 (improvement of at least 0.22 compared to baseline). From 1025 enrolled, 48.7% of patients were PSP users while treated with ADA. The percentage of patients achieving MCID in the HAQ-DI was higher in PSP users vs. PSP non-users (48.1 vs. 37.8%) at week 78 (p < 0.001, NRI). Most of the studied clinical outcomes and PROs showed significant improvements (p < 0.05) from baseline to week 78 favoring PSP users over PSP non-users. CONCLUSIONS In patients with moderate-to-severe RA who initiated ADA, improvements in clinical, functional, and PROs were achieved in real-world settings with significantly greater improvements among PSP users in comparison with PSP non-users. FUNDING AbbVie. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01383421.
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Affiliation(s)
- Filip Van den Bosch
- Ghent University Hospital and VIB Center for Inflammation Research, Ghent, Belgium.
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Gatt I, West LM, Calleja N, Briffa C, Cordina M. Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language. Pharm Pract (Granada) 2017; 15:886. [PMID: 28503224 PMCID: PMC5386625 DOI: 10.18549/pharmpract.2017.01.886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/27/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs. OBJECTIVE This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties. METHODS Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients' clinics at the main state general hospital in Malta between June and September 2013. Cronbach's alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales. RESULTS The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages. CONCLUSION The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.
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Affiliation(s)
- Ingrid Gatt
- BSc (Hons) Biology & Chemistry, MSc (Clin Pharmacol). Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
| | - Lorna M West
- BPharm (Hons), MSc (Clin Pharm), PhD. Post-Doctoral Researcher. Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
| | - Neville Calleja
- MD, MSc(Melit) MSc, PhD (Open), FFPH. Senior Lecturer. Department of Public Health, Faculty of Medicine and Surgery, University of Malta. Msida (Malta).
| | - Charles Briffa
- BA (Hons), MA, PhD. Professor. Department of Translation, Terminology and Interpreting Studies, Faculty of Arts, University of Malta. Msida, (Malta).
| | - Maria Cordina
- BPharm (Hons) (Melit), PhD. Associate Professor. Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida (Malta).
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Samalin L, de Chazeron I, Belzeaux R, Llorca PM. Exploratory analysis of the French version of the beliefs about medicines questionnaire in patients with severe mental disorders: Factorial structure and reliability in specific populations of schizophrenic, bipolar and depressive patients. PLoS One 2017; 12:e0173267. [PMID: 28257447 PMCID: PMC5336279 DOI: 10.1371/journal.pone.0173267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aims of our study were to explore the factor structure and psychometric properties of the French version of the Beliefs about Medicines Questionnaire (BMQ) in patients with severe mental illness and in specific populations of patients with schizophrenia, bipolar disorder and major depressive disorder. METHODS A cross-sectional study including patients with schizophrenia, bipolar disorder and major depressive disorder was conducted (n = 150). Principal component analysis (PCA), reliability and validity of the French version of the BMQ were performed. RESULTS PCA revealed a two-factor structure similar to the original structure for the BMQ-Specific scale but only a one-component solution for the BMQ-General scale in both the total sample and the three subgroups. These subscales have satisfactory internal consistency. Validity was supported by the significant correlations of all BMQ subscales with the Drug Attitude Inventory. CONCLUSION The French version of the BMQ appears as a three-dimensional scale and presents satisfactory psychometric properties for use in patients with severe mental illness as well as specific populations of patients with schizophrenia, bipolar disorder and major depressive disorder.
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Affiliation(s)
- Ludovic Samalin
- Department of Adult Psychiatry, CHU Clermont-Ferrand, University of Auvergne, EA, Clermont-Ferrand, France
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Fondation FondaMental, Créteil, France
- * E-mail:
| | - Ingrid de Chazeron
- Department of Adult Psychiatry, CHU Clermont-Ferrand, University of Auvergne, EA, Clermont-Ferrand, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France
- Bipolar Disorder Expert Centre, Hôpital Sainte Marguerite, APHM, Marseille, France
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Pierre-Michel Llorca
- Department of Adult Psychiatry, CHU Clermont-Ferrand, University of Auvergne, EA, Clermont-Ferrand, France
- Fondation FondaMental, Créteil, France
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Attitudes toward antipsychotic medications as a useful feature in exploring medication non-adherence in schizophrenia. Schizophr Res 2016; 178:1-5. [PMID: 27637362 DOI: 10.1016/j.schres.2016.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the interest in the attitudes toward antipsychotic medication in exploring medication non-adherence. METHODS Schizophrenic patients (N=120) completed the Beliefs about Medicines Questionnaire and measures of medication adherence, and clinical outcomes. Comparison between four attitudinal groups and logistic regressions were performed. RESULTS High level of adherence varied significantly between attitudinal groups (Accepting, 70%; Indifferent, 63%; Ambivalent, 50%; Sceptical, 14%; p<0.001). Poor insight and psychic side effects were the most significant predictors of negative beliefs. CONCLUSION The attitudinal groups approach could facilitate the identification of patients with non-adherence and determine individual targets of interventions to improve negative beliefs.
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Kalichman SC, Eaton L, Kalichman MO, Cherry C. Medication beliefs mediate the association between medical mistrust and antiretroviral adherence among African Americans living with HIV/AIDS. J Health Psychol 2016; 22:269-279. [PMID: 26311814 DOI: 10.1177/1359105315600239] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Medical mistrust is a significant barrier to medication adherence among African Americans living with HIV. In this study 380 African American people receiving antiretroviral therapy (ART) in a southern US city completed computerized measures at a community-based research site. Multiple mediation modeling showed that medical provider mistrust was associated with medication beliefs and ART adherence. Also, medication beliefs predicted adherence. The indirect effects of medical mistrust on adherence via medication beliefs was significant; the indirect effect was significant for medication concerns beliefs, but not medication necessity beliefs. Medication concerns beliefs therefore mediate the association between medical mistrust and ART adherence.
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Kalichman SC, Eaton L, Kalichman MO, Grebler T, Merely C, Welles B. Race-based medical mistrust, medication beliefs and HIV treatment adherence: test of a mediation model in people living with HIV/AIDS. J Behav Med 2016; 39:1056-1064. [PMID: 27392477 DOI: 10.1007/s10865-016-9767-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
Race-based medical mistrust significantly predicts non-adherence to antiretroviral therapy (ART) in people living with HIV. The current study builds on previous research that shows beliefs about medication necessity (i.e., "My medicines protect me from becoming worse") and concerns (i.e., "Having to take my medicines worries me") mediate the association between race-based medical mistrust and medication adherence. Racial and ethnic minority men and women living with HIV and receiving ART (N = 178) in a southern US city completed computerized measures of demographic and health characteristics, telephone interviews of race-based medical mistrust and medication beliefs, and unannounced phone-based pill counts for ART adherence. Multiple mediation modeling showed that medical mistrust is related to medication necessity and concerns beliefs and ART adherence. Furthermore, medication necessity beliefs predicted ART adherence. The indirect effect of medical mistrust on adherence through medication necessity beliefs was also significant. Results confirm that medication necessity beliefs, although not concerns beliefs, mediate the association between medical mistrust and ART adherence. Medication necessity beliefs offer a viable target for interventions to improve ART adherence in the context of mistrust that patients may have for medical providers and health care systems.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Lisa Eaton
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Tama Grebler
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Cynthia Merely
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Brandi Welles
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Wood ME, Frazier JA, Nordeng HME, Lapane KL. Prenatal triptan exposure and parent-reported early childhood neurodevelopmental outcomes: an application of propensity score calibration to adjust for unmeasured confounding by migraine severity. Pharmacoepidemiol Drug Saf 2016; 25:493-502. [PMID: 26554750 PMCID: PMC5071383 DOI: 10.1002/pds.3902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/17/2015] [Accepted: 09/23/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE Triptan medications are serotonin agonists used to treat migraine, a chronic pain condition highly prevalent in women of reproductive age. Data on the safety of triptans during pregnancy are scant. We sought to quantify the association of prenatal triptan exposure on neurodevelopment in 3-year-old children. METHODS Using data from the Norwegian Mother and Child Cohort Study, we used propensity score matching to examine associations between prenatal triptan exposure and psychomotor function, communication, and temperament. We used an external validation study to perform propensity calibration to adjust effect estimates for confounders unmeasured in the main study (migraine severity, type, and maternal attitudes towards medication use). RESULTS We identified 4204 women who reported migraine headache at baseline, of which 375 (8.9%) reported using a triptan greater than or equal to once during pregnancy. Children with prenatal triptan exposure had 1.37-fold greater unadjusted odds of fine motor problems (95% confidence interval (CI): 1.06-1.77), which decreased after propensity score matching (odds ratio (OR): 1.29, 95%CI 0.97-1.73) and was further attenuated after calibration (OR: 1.25, 95%CI 0.89-1.74). We observed no increased risk for gross motor or communication problems, and no differences in temperament. Adjustment for migraine severity using propensity score calibration had a moderate impact on effect estimates, with percent changes ranging from 2.4% to 50%. CONCLUSIONS Prenatal triptan exposure was not associated with psychomotor function, communication problems, or temperament in 3-year-old children. Adjustment for migraine severity reduced effect estimates and should be considered in future studies of the safety of triptans during pregnancy. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mollie E Wood
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- PharmacoEpidemiology and Drug Safety Research Group, Oslo, Norway
| | - Jean A Frazier
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hedvig M E Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- PharmacoEpidemiology and Drug Safety Research Group, Oslo, Norway
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Illness Representations, Treatment Beliefs, Medication Adherence, and 30-Day Hospital Readmission in Adults With Chronic Heart Failure. J Cardiovasc Nurs 2016; 31:245-54. [DOI: 10.1097/jcn.0000000000000249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Mørch RH, Dieset I, Færden A, Hope S, Aas M, Nerhus M, Gardsjord ES, Joa I, Morken G, Agartz I, Aukrust P, Djurovic S, Melle I, Ueland T, Andreassen OA. Inflammatory evidence for the psychosis continuum model. Psychoneuroendocrinology 2016; 67:189-97. [PMID: 26923849 DOI: 10.1016/j.psyneuen.2016.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Inflammation and immune activation have been implicated in the pathophysiology of severe mental disorders. Previous studies of inflammatory markers, however, have been limited with somewhat inconsistent results. AIMS We aimed to determine the effect sizes of inflammatory marker alterations across diagnostic groups of the psychosis continuum and investigate association to antipsychotic medications. METHODS Plasma levels of soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin 1 receptor antagonist (IL-1Ra), osteoprotegerin (OPG), and von Willebrand factor (vWf) were measured in patients (n=992) with schizophrenia spectrum (SCZ, n=584), schizoaffective disorder (SA, n=93), affective spectrum disorders (AFF, n=315), and healthy controls (HC, n=638). RESULTS Levels of sTNF-R1 (p=1.8×10(-8), d=0.23) and IL-1Ra (p=0.002, d=0.16) were increased in patients compared to HC. The SCZ group had higher levels of sTNF-R1 (p=8.5×10(-8), d=0.27) and IL-1Ra (p=5.9×10(-5), d=0.25) compared to HC, and for sTNF-R1 this was also seen in the SA group (p=0.01, d=0.3) and in the AFF group (p=0.002, d=0.12). Further, IL-1Ra (p=0.004, d=0.25) and vWf (p=0.02, d=0.21) were increased in the SCZ compared to the AFF group. There was no significant association between inflammatory markers and use of antipsychotic medication. CONCLUSION We demonstrate a small increase in sTNF-R1 and IL-1Ra in patients with severe mental disorders supporting a role of inflammatory mechanisms in disease pathophysiology. The increase was more pronounced in SCZ compared to AFF supporting a continuum psychosis model related to immune factors.
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Affiliation(s)
- Ragni H Mørch
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway.
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ann Færden
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Sigrun Hope
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Department of Neuro Habilitation, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Monica Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Mari Nerhus
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Erlend S Gardsjord
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Inge Joa
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Gunnar Morken
- The Department of Psychiatry, St. Olav University Hospital of Trondheim, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
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Foot H, La Caze A, Gujral G, Cottrell N. The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:706-717. [PMID: 26613666 DOI: 10.1016/j.pec.2015.11.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. METHODS An electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. RESULTS Ninety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p<0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. CONCLUSION Necessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. PRACTICE IMPLICATIONS This meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Gina Gujral
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Wisting L, Bang L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Psychological barriers to optimal insulin therapy: more concerns in adolescent females than males. BMJ Open Diabetes Res Care 2016; 4:e000203. [PMID: 27403325 PMCID: PMC4932280 DOI: 10.1136/bmjdrc-2016-000203] [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] [Received: 01/28/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate psychological barriers (illness perceptions, insulin beliefs, and coping strategies) to optimal insulin therapy among adolescents with type 1 diabetes (T1D), with a specific focus on gender differences and mode of treatment (insulin pump vs pen). METHODS A total of 105 males and females (12-20 years) participated in this study. The Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire, and the Adolescent Coping Orientation for Problem Experiences were completed. Additionally, diabetes clinical data were collected by the Norwegian Childhood Diabetes Registry. RESULTS Females had significantly more negative illness perceptions than males on all dimensions (p<0.05), with moderate-to-large effect sizes. Regarding insulin beliefs, females scored significantly higher than males on insulin concern (p<0.001), indicating more concerns about insulin. There were no significant gender differences on perceptions of insulin necessity. Finally, females scored significantly higher on the coping strategies being social and solving family problems (p<0.01), indicating more positive coping among females than males for these subscales. In terms of treatment mode, the only statistically significant difference in the psychological aspects was for the illness perception treatment control, with patients using insulin pen reporting more negative perceptions on this dimension than patients using insulin pump. CONCLUSIONS Addressing psychological aspects may be a clinically important supplement to standard somatic T1D care. The consistent finding of gender differences across the psychological measures implies that a tailored treatment approach for males and females with T1D may be warranted.
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Affiliation(s)
- Line Wisting
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
| | - Lasse Bang
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wisting L, Bang L, Natvig H, Skrivarhaug T, Dahl-Jørgensen K, Lask B, Rø Ø. Metabolic Control and Illness Perceptions in Adolescents with Type 1 Diabetes. J Diabetes Res 2016; 2016:3486094. [PMID: 26682231 PMCID: PMC4670664 DOI: 10.1155/2016/3486094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Disturbed eating behavior and psychosocial variables have been found to influence metabolic control, but little is known about how these variables interact or how they influence metabolic control, separately and combined. OBJECTIVE To explore associations between metabolic control (measured by HbA1c) and eating disorder psychopathology, coping strategies, illness perceptions, and insulin beliefs in adolescents with type 1 diabetes. METHODS A total of 105 patients (41.9% males) with type 1 diabetes (12-20 years) were interviewed with the Child Eating Disorder Examination. In addition, self-report psychosocial questionnaires were completed. Clinical data, including HbA1c, was obtained from the Norwegian Childhood Diabetes Registry. RESULTS Significant gender differences were demonstrated. Among females, HbA1c correlated significantly with eating restriction (.29, p < .05), the illness perception dimensions consequences, personal control, coherence, and concern (ranging from .33 to .48), and the coping strategy ventilating negative feelings (-.26, p < .05). Illness perception personal control contributed significantly to HbA1c in a regression model, explaining 23% of the variance among females (β .48, p < .001). None of the variables were significantly associated with HbA1c among males. CONCLUSIONS Illness perceptions appear to be important contributors to metabolic control in females, but not males, with type 1 diabetes.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- *Line Wisting:
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Henrik Natvig
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Torild Skrivarhaug
- The Norwegian Childhood Diabetes Registry, Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Department of Pediatric Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Rhodes Farm Clinic, The Ridgeway, Barnet, London NW7 1RH, UK
- Gt. Ormond St. Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
- Department of Psychology, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, P.O. Box 1039, Blindern, 0315 Oslo, Norway
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Kalichman S, Kalichman MO, Cherry C. Medication beliefs and structural barriers to treatment adherence among people living with HIV infection. Psychol Health 2015; 31:383-95. [PMID: 26534788 DOI: 10.1080/08870446.2015.1111371] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals' motivations to remain adherent may overcome structural barriers has received limited attention. PURPOSE To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty. METHODS People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence. RESULTS In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors. CONCLUSIONS Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.
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Affiliation(s)
- Seth Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Chauncey Cherry
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
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Wisting L, Bang L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Adolescents with Type 1 Diabetes--The Impact of Gender, Age, and Health-Related Functioning on Eating Disorder Psychopathology. PLoS One 2015; 10:e0141386. [PMID: 26529593 PMCID: PMC4631487 DOI: 10.1371/journal.pone.0141386] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate correlates of eating disorder psychopathology in adolescent males and females with type 1 diabetes. Method A total of 105 adolescents with type 1 diabetes (42% males), aged 12–20 years, were recruited from the Norwegian Childhood Diabetes Registry in this population-based study. All participants were interviewed with the Child Eating Disorder Examination. Additionally, the Brief Illness Perception Questionnaire, the Adolescent Coping Orientation for Problem Experiences and the Beliefs about Medicines Questionnaire were administered to assess health-related functioning. Clinical data were obtained from the Norwegian Childhood Diabetes Registry. Results Significant gender differences were demonstrated in the pattern of correlates of eating disorder pathology. Among females, eating disorder psychopathology was significantly associated with body mass index adjusted for age and gender, age, insulin restriction, coping, illness perceptions, and perceptions of insulin concern. In a regression model, age, illness perceptions, and insulin restriction remained significantly associated with eating disorder psychopathology, explaining 48% of the variance. None of the variables were associated with eating disorder psychopathology among males. Discussion Greater clinical awareness of illness perceptions, attitudes toward insulin, and insulin restriction may potentially decrease the risk of developing eating disorders among female adolescents with type 1 diabetes, and the subsequent increased morbidity and mortality associated with comorbid type 1 diabetes and eating disorders.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
- * E-mail:
| | - Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- The Norwegian Childhood Diabetes Registry, Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abdullah-Koolmees H, Gardarsdottir H, Yazir D, Stoker LJ, Vuyk J, Egberts TCG, Heerdink ER. Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital. Ann Pharmacother 2015; 49:1085-95. [PMID: 26160969 DOI: 10.1177/1060028015593763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients discharged from psychiatric hospitals may be at risk for intentional or unintentional discontinuation of their medication. OBJECTIVE To describe and assess the discontinuation of, and changes to, psychiatric and/or somatic medication in patients after discharge from psychiatric hospitals. METHODS A retrospective follow-up study was conducted in patients discharged from 4 psychiatric hospitals in The Netherlands between 2006 and 2009. Patients' medication use during the last 2 days of hospitalization was compared with medication dispensed during the 3 months following discharge. Changes in psychiatric and somatic medication were investigated and defined as medication discontinuation, start, or switch. Patients were classified as continuing users, when there were no changes to the medication after discharge. Relative risks with 95% confidence intervals to measure differences in discontinuation were estimated using Cox regression analysis. RESULTS This study included 1324 patients, 69.8% of whom discontinued medication, and 9.7% switched one or more medications. Nearly half (47.4%) of all patients started a medication other than that dispensed during the last 2 days of hospitalization, and 13.7% of all patients experienced no changes to their medication regimen. Approximately 40% of the patients discontinued one or more medications for chronic conditions. From these, 68% discontinued psychiatric medications and 49.4% discontinued somatic medications. A quarter (25.2%) of the 644 patients discontinued using antipsychotics. More than a quarter (28.4%) of the 292 patients using medications for cardiovascular problems discontinued. Patients using as-needed medication prior to discharge were more likely to discontinue their medication (relative risk = 1.85; 95% confidence interval = 1.55-2.20). CONCLUSIONS Discharge from a psychiatric hospital led to medication discontinuation in approximately 70% of all patients. Approximately 40% of the patients discontinued medications for chronic conditions. Discontinuation of somatic medication was more frequent than discontinuation of psychiatric medication, and risk of discontinuation was lower for patients with depressive and anxiety disorders. Although medication discontinuation can be deliberate it is alarming that a quarter of our patients using antipsychotics and cardiovascular medications discontinued their use, both of which are meant for chronic conditions.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Utrecht University, Utrecht, The Netherlands Brocacef Ziekenhuisfarmacie, Den Dolder, The Netherlands Diakonessenhuis, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dilek Yazir
- Utrecht University, Utrecht, The Netherlands
| | | | - Judith Vuyk
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Toine C G Egberts
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eibert R Heerdink
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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Lupattelli A, Spigset O, Björnsdóttir I, Hämeen-Anttila K, Mårdby AC, Panchaud A, Juraski RG, Rudolf G, Odalovic M, Drozd M, Twigg MJ, Juch H, Moretti ME, Kennedy D, Rieutord A, Zagorodnikova K, Passier A, Nordeng H. Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study. Depress Anxiety 2015; 32:426-36. [PMID: 25703355 DOI: 10.1002/da.22352] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/15/2014] [Accepted: 12/17/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.
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Affiliation(s)
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland
| | | | - Gorazd Rudolf
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marina Odalovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Mariola Drozd
- Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, UK
| | - Herbert Juch
- Research Unit Human Teratogens, Institute for Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria
| | - Myla E Moretti
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women and University of NSW, Randwick, Australia
| | - Andre Rieutord
- APHP, GH HUPS, Hop Antoine Béclère, Service Pharmacie, Clamart France and Européenne de Formation pour les Pharmaciens, France
| | - Ksenia Zagorodnikova
- Northwest Medical Center for Drug Safety in Pregnancy & Lactation, Northwest State Medical University n.a.I.I.Mechnikov, St. Petersburg, Russia
| | - Anneke Passier
- Teratology Information Service (TIS), Netherlands Pharmacovigilance Centre Lareb, The Netherlands
| | - Hedvig Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Medication adherence in people dually treated for HIV infection and mental health conditions: test of the medications beliefs framework. J Behav Med 2015; 38:632-41. [PMID: 25835435 DOI: 10.1007/s10865-015-9633-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/19/2015] [Indexed: 12/24/2022]
Abstract
Beliefs about medication necessity and concerns predict treatment adherence in people with a wide-array of medical conditions, including HIV infection. However, medication beliefs have not been examined in people dually treated with psychotropic medications and antiretroviral therapy. In the current study, we used a prospective design to investigate the factors associated with adherence to psychotropic medications and antiretrovirals among 123 dually treated persons living with HIV. We used unannounced phone-based pill counts to monitor adherence to psychiatric and antiretroviral medications over a 6-week period. Hierarchical regression models included demographic, health and psychosocial characteristics as predictors of adherence followed by medication necessity and concerns beliefs. Results showed that medication necessity beliefs predicted both antiretroviral and psychiatric medication adherence over and above established predictors of adherence. Medication concerns also predicted psychotropic adherence, but not antiretroviral adherence. These models accounted for 31 and 22 % of the variance in antiretroviral and psychotropic adherence, respectively. Findings suggest that the necessity-concerns medication beliefs framework has utility in understanding adherence to multiple medications and addressing these beliefs should be integrated into adherence interventions.
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Verhoef TI, Redekop WK, Bouvy ML, Dorenbos B, Karwar Z, van Schie RMF, de Boer A, Maitland-van der Zee AH. Beliefs about medicines in Dutch acenocoumarol and phenprocoumon users. Br J Clin Pharmacol 2015; 78:422-9. [PMID: 24528215 DOI: 10.1111/bcp.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/04/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS Adherence to the generally complex regimen of coumarin derivatives is vital in order to keep patients in the adequate International Normalized Ratio range. Patients' beliefs about medicines are associated with the level of therapy adherence. Our first aim was to assess beliefs about coumarins. Secondly, we compared the beliefs about coumarins with the beliefs about other cardiovascular drugs. METHODS The Beliefs about Medicines Questionnaire was used to assess medication beliefs. The questionnaire was completed by new users of coumarins indicated for venous thromboembolism or atrial fibrillation. A necessity score and a concerns score were calculated for all patients. The analyses were repeated for users of antihypertensive drugs or statins (not using coumarins). RESULTS Three hundred and twenty patients were included in the analysis of the beliefs about coumarins. The mean necessity score was 15.3, the concerns score 12.3 and the necessity-concerns differential 3.0. Patients with venous thromboembolism (n = 71) had higher necessity scores than patients with atrial fibrillation (n = 249; 16.8 vs. 14.9, P < 0.001). The mean necessity score in 493 users of other cardiovascular drugs was 16.1, the concerns score 13.5 and the necessity-concerns differential 2.6. The necessity score was higher in chronic cardiovascular drug users (n = 192) than in new users (n = 301; 17.9 vs. 14.9, P < 0.001). CONCLUSIONS Coumarin users score higher on the necessity scale than on the concerns scale, which is also the case in users of other cardiovascular drugs. Patients with atrial fibrillation have a less positive attitude towards these drugs than patients with venous thromboembolism, and could therefore benefit more from specific attention.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Validation of the French version of the Beliefs about Medicines Questionnaire (BMQ) among diabetes and HIV patients. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2014. [DOI: 10.1016/j.erap.2014.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Kalisova L, Raboch J, Nawka A, Sampogna G, Cihal L, Kallert TW, Onchev G, Karastergiou A, Del Vecchio V, Kiejna A, Adamowski T, Torres-Gonzales F, Cervilla JA, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A. Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1619-29. [PMID: 24737189 DOI: 10.1007/s00127-014-0872-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/18/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries. METHODS Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients' sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries' effect. RESULTS The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20-F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries' effect, the risk of being coerced was higher in Poland. Patients' sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model. CONCLUSIONS The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries' effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.
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Affiliation(s)
- Lucie Kalisova
- Department of Psychiatry, 1st Medical School, Charles University, Prague, Czech Republic,
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