|
1
|
Alysha D, Blair C, Thomas P, Pham T, Nguyen T, Cordato TR, Badge H, Chappelow N, Lin L, Edwards L, Thomas J, Hodgkinson S, Cappelen-Smith C, McDougall A, Cordato DJ, Parsons M. Comparative Prevalence of Cerebrovascular Disease in Vietnamese Communities in South-Western Sydney. J Cardiovasc Dev Dis 2024; 11:164. [PMID: 38921664 PMCID: PMC11203452 DOI: 10.3390/jcdd11060164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in these communities may improve health outcomes. We aimed to compare the rates of transient ischaemic attack (TIA), ischaemic stroke (IS), intracerebral haemorrhage (ICH), intracranial atherosclerosis (ICAD), and stroke risk factors in Vietnamese-born residents of South-Western Sydney (SWS) with those of an Australian-born cohort. A 10-year retrospective analysis (2011-2020) was performed using data extracted from the Health Information Exchange database characterising stroke presentations and risk factor profiles. The rates of hypertension (83.7% vs. 70.3%, p < 0.001) and dyslipidaemia (81.0% vs. 68.2%, p < 0.001) were significantly higher in Vietnamese patients, while the rates of ischaemic heart disease (10.4% vs. 20.3%, p < 0.001), smoking (24.4% vs. 40.8%, p < 0.001), and alcohol abuse (>1 drink/day) (9.6% vs. 15.9%, p < 0.001) were lower. The rates of ICAD and ICH were higher in Vietnamese patients (30.9% vs. 6.9%, p < 0.001 and 24.7% vs. 14.4%, p = 0.002). Regression analysis revealed that diabetes (OR: 1.86; 95% CI: 1.14-3.04, p = 0.014) and glycosylated haemoglobin (OR: 1.51; 95% CI: 1.15-1.98, p = 0.003) were predictors of ICAD in Vietnamese patients. Vietnamese patients had higher rates of symptomatic ICAD and ICH, with unique risk factor profiles. Culturally specific interventions arising from these findings may more effectively reduce the community burden of disease.
Collapse
Affiliation(s)
- Deena Alysha
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Christopher Blair
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Timmy Pham
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Tram Nguyen
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Theodore Ross Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Helen Badge
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Nicola Chappelow
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Longting Lin
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
| | - Leon Edwards
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - James Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Suzanne Hodgkinson
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Alan McDougall
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Dennis John Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Mark Parsons
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW 2170, Australia; (D.A.); (C.B.); (T.P.); (T.N.); (T.R.C.); (N.C.); (J.T.); (S.H.); (M.P.)
- Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- South-Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| |
Collapse
|
|
2
|
Janssen A, Shah K, Rabbets M, Nagrial A, Pene C, Zachulski C, Phillips JL, Harnett P, Shaw T. Feasibility of Microlearning for Improving the Self-Efficacy of Cancer Patients Managing Side Effects of Chemotherapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1697-1709. [PMID: 37452227 PMCID: PMC10509055 DOI: 10.1007/s13187-023-02324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Lung cancer patients have a high symptom burden that negatively affects their quality of life. Increasing patient self-efficacy to deal with treatment side effects can ameliorate their symptom burden. Education programs can help enhance patient self-efficacy by giving patients more control over their condition through increased disease literacy. This study aimed to evaluate the feasibility of microlearning for delivering lung cancer patients' information on side effects of chemotherapy. Secondary objectives of the program are to understand the acceptability of microlearning for delivery this type of education to lung cancer patients and the potential impact of microlearning on patient self-efficacy, knowledge and confidence managing side effects of chemotherapy. A mixed-methods prepost test (or quasi-experimental) study design was used to better enable patients to identify and manage the side effects of their condition and chemotherapy. Participants were patients diagnosed with stage II to stage IV lung cancer, who had a life expectancy of greater than 3 months and were aged 18 years or older. Multiple validated scales were used to assess patient self-efficacy pre- and post-intervention. The online program was evaluated using quantitative data of completion rates extracted from the online platform. Semi-structured interviews were used to explore the impact of the online program on perceived self-efficacy and quality of life. Twenty-three participants agreed to participate in the study and five agreed to complete a semi-structured interview. Participants found the content comprehensive, relevant and engaging. The program improved perceived disease literacy and helped participants develop coping strategies to manage side effects. Participants also found the platform easy to use and navigate. Additional courses and features were requested. Patients with a diagnosis of cancer receive a large amount of information about the side effects of chemotherapy and how to manage them. This information is often provided soon after diagnosis or upon commencement of therapy, which can be overwhelming for some patients. Microlearning, a method of online learning that spaces distributing of content over several weeks, may be a useful tool for supporting delivering of health information to this group of patients.
Collapse
Affiliation(s)
- Anna Janssen
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Kavisha Shah
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melanie Rabbets
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Christopher Pene
- Sacred Heart Service, St Vincent's Hospital, Sydney, NSW, Australia
| | - Clare Zachulski
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Jane L Phillips
- Faculty of Health, School of Nursing, Queensland University of Technology, QLD, Brisbane, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Paul Harnett
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
|
3
|
Cordato D, Blair C, Thomas P, Firtko A, Miller M, Edwards LS, Thomas J, Balabanski AH, Dos Santos A, Lin L, Hodgkinson S, Cappelen-Smith C, Beran RG, McDougall A, Parsons M. Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales. Cerebrovasc Dis 2022; 51:744-754. [PMID: 35551130 DOI: 10.1159/000524242] [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: 01/20/2022] [Accepted: 02/15/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Culturally and linguistically diverse (CALD) communities are growing globally. Understanding patterns of cerebrovascular disease in CALD communities may improve health outcomes through culturally specific interventions. We compared rates of transient ischaemic attack (TIA)/stroke (ischaemic stroke, intracerebral haemorrhage) and stroke risk factor prevalence in overseas and Australian-born people in South Western Sydney (SWS) and New South Wales (NSW). METHODS This was a 10-year retrospective analysis (2011-2020) of SWS and NSW age-standardized rates per 100,000 person-years of TIA/stroke. Data were extracted from Health Information Exchange and Secure Analytics for Population Health Research and Intelligence systems. Rates of hypertension, type 2 diabetes mellitus (T2DM), atrial fibrillation (AF), smoking, and obesity were also calculated. RESULTS The SWS and NSW age-standardized rate of TIA/stroke for people born in Australia was 100 per 100,000 person-years (100/100,000/year). In SWS, 56.6% of people were overseas-born compared to 29.8% for NSW. The age-standardized rate of TIA/stroke for Polynesian-born people was more than double that of Australian-born people (p < 0.001). Hypertension (33 [SWS] vs. 27/100,000/year [NSW]) and T2DM (36 [SWS] vs. 26/100,000/year [NSW]) were the most common risk factors with rates >50/100,000/year (hypertension) and >80/100,000/year (T2DM) for people born in Polynesia, Melanesia, and Central America. Rates of T2DM, AF, and obesity for Polynesian-born people were over threefold greater than people born in Australia. DISCUSSION/CONCLUSION Greater rates of TIA/stroke were observed in specific CALD communities, with increased rates of cerebrovascular risk factors. Culturally specific, targeted interventions may bridge health inequalities in cerebrovascular disease.
Collapse
Affiliation(s)
- Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Blair
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia,
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia,
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia,
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia,
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Angela Firtko
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Megan Miller
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Leon Stephen Edwards
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna H Balabanski
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Angela Dos Santos
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Longting Lin
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Hodgkinson
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Roy G Beran
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Medicine, Griffith University, Broadbeach, Queensland, Australia
- Sechenov Moscow First State University, Moscow, Russian Federation
| | - Alan McDougall
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Mark Parsons
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Stroke and Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
|
4
|
Anderson LJ, Nuckols TK, Coles C, Le MM, Schnipper JL, Shane R, Jackevicius C, Lee J, Pevnick JM. A systematic overview of systematic reviews evaluating medication adherence interventions. Am J Health Syst Pharm 2020; 77:138-147. [PMID: 31901098 DOI: 10.1093/ajhp/zxz284] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics. SUMMARY MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non-disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality. RESULTS Of 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs. CONCLUSION Despite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors' conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.
Collapse
Affiliation(s)
- Laura J Anderson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Teryl K Nuckols
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Courtney Coles
- Department of Health Policy and Management, Johnathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Michael M Le
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jeff L Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rita Shane
- Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cynthia Jackevicius
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada, and University Health Network, Toronto, Canada
| | - Joshua Lee
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua M Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | |
Collapse
|
|
5
|
Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
Collapse
Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| |
Collapse
|
|
6
|
Schoenthaler A, Leon M, Butler M, Steinhaeuser K, Wardzinski W. Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e17135. [PMID: 32965230 PMCID: PMC7542413 DOI: 10.2196/17135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Research has underscored the need to develop socioculturally tailored interventions to improve adherence behaviors in minority patients with hypertension (HTN) and type 2 diabetes (T2D). Novel mobile health (mHealth) approaches are potential methods for delivering tailored interventions to minority patients with increased cardiovascular risk. OBJECTIVE This study aims to develop and evaluate the acceptability and preliminary efficacy of a tailored mHealth adherence intervention versus attention control (AC) on medication adherence, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemoglobin A1c (HbA1c) at 3 months in 42 Black patients with uncontrolled HTN and/or T2D who were initially nonadherent to their medications. METHODS This was a two-phase pilot study consisting of a formative phase and a clinical efficacy phase. The formative phase consisted of qualitative interviews with 10 members of the target patient population (7/10, 70% female; mean age 65.8 years, SD 5.6) to tailor the intervention based on the Information-Motivation-Behavioral skills model of adherence. The clinical efficacy phase consisted of a 3-month pilot randomized controlled trial to evaluate the tailored mHealth intervention versus an AC. The tablet-delivered intervention included a tailoring survey, an individualized adherence profile, and a personalized list of interactive adherence-promoting modules, whereas AC included the tailoring survey and health education videos delivered on the tablet. Acceptability was assessed through semistructured exit interviews. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale, whereas blood pressure and HbA1c were assessed using automated devices. RESULTS In phase 1, thematic analysis of the semistructured interviews revealed the following 5 major barriers to adherence: disruptions in daily routine, forgetfulness, concerns about adverse effects, preference for natural remedies, and burdens of medication taking. Patients recommended the inclusion of modules that address improving patient-provider communication, peer vignettes, and stress reduction strategies to facilitate adherence. A total of 42 Black patients (23/42, 55% male; mean age 57.6 years, SD 11.1) participated in the clinical efficacy pilot trial. At 3 months, both groups showed significant improvements in adherence (mean 1.35, SD 1.60; P<.001) and SBP (-4.76 mm Hg; P=.04) with no between-group differences (P=.50 and P=.10). The decreases in DBP and HbA1c over time were nonsignificant (-1.97 mm Hg; P=.20; and -0.2%; P=.45, respectively). Patients reported high acceptability of the intervention for improving their adherence. CONCLUSIONS This pilot study demonstrated preliminary evidence on the acceptability of a tailored mHealth adherence intervention among a sample of Black patients with uncontrolled HTN and T2D who were initially nonadherent to their medications. Future research should explore whether repeated opportunities to use the mHealth intervention would result in improvements in behavioral and clinical outcomes over time. Modifications to the intervention as a result of the pilot study should guide future efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT01643473; http://clinicaltrials.gov/ct2/show/ NCT01643473.
Collapse
Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, NYU school of Medicine, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States
| | - Michelle Leon
- Department of Clinical Psychology, Fordham University, New York, NY, United States
| | - Mark Butler
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | | | | |
Collapse
|
|
7
|
Singh C, Crawford K, Willey S, Hall H, Harder K, Plummer V, Williams A. Medication adherence among people of Indian ethnicity living with chronic disease following migration to Australia. Collegian 2020. [DOI: 10.1016/j.colegn.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
|
8
|
Warren-Findlow J, Coffman MJ, Thomas EV, Krinner LM. ECHO: A Pilot Health Literacy Intervention to Improve Hypertension Self-Care. Health Lit Res Pract 2019; 3:e259-e267. [PMID: 31893258 PMCID: PMC6901363 DOI: 10.3928/24748307-20191028-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/20/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Medication adherence and diet and weight control are essential contributors to blood pressure management. Low health literacy is also associated with poor health behaviors and outcomes among adults with hypertension. Objective: This study aims to pilot test the acceptability and feasibility of a brief health literacy intervention focused on hypertension self-care and to assess changes in self-care activities. Methods: We recruited patients with hypertension who were treated at a low-cost clinic. A 2-hour evidence-based class was delivered in Spanish and English, and a telephone follow-up survey was conducted 1 month later. Intervention content included health literacy activities, nutrition education, and medication use. Participants engaged in reading, writing, a group activity, and critical discussion. Health literacy was measured using the Newest Vital Sign and the Test of Functional Health Literacy in Adults. Key Results: The intervention was delivered to 52 English- (52%) and Spanish-speaking adults (48%) with a mean age of 52.3 years (SD 7.9). More than one-half had Stage 1 or 2 hypertension (54%), and 56% had inadequate health literacy. At 1-month follow-up, participants showed improvement on all self-care measures with significant mean differences (p < .05) on diet adherence and weight management activities. These improvements were largely among Hispanics and those with low health literacy. Conclusions: Results suggest that teaching targeted self-care skills in a brief health literacy intervention can be effective in improving self-care activities relating to diet and weight management among vulnerable populations. [HLRP: Health Literacy Research and Practice. 2019;3(4):e259–e267.] Plain Language Summary: This study explored the effects of a 2-hour health education class on self-care behaviors. At the follow-up, participants reported better self-care behaviors. Effects were more pronounced among those with low health literacy, suggesting brief exposure to health education may improve high blood pressure in this population.
Collapse
Affiliation(s)
- Jan Warren-Findlow
- Address correspondence to Jan Warren-Findlow, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001;
| | | | | | | |
Collapse
|
|
9
|
Herrera H, Alsaif M, Khan G, Barnes N, Rutter P. Provision of Bilingual Dispensing Labels to Non-Native English Speakers: An Exploratory Study. PHARMACY 2019; 7:pharmacy7010032. [PMID: 30934609 PMCID: PMC6473342 DOI: 10.3390/pharmacy7010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with limited English proficiency living in the U.K. receive prescribed medication labels in English. These patients are at risk of worse health outcomes compared with the general population. This article describes a service evaluation of the use of bilingual dispensing labels to facilitate patient understanding of medicine administration instructions. Recruited patients answered two questionnaires to assess engagement with and understanding of their medicine labels. The first was completed at the point of dispensing, and the second within six weeks. Questionnaires were either self-completed or via facilitation over the telephone. A total of 151 participants completed the first questionnaire, and 130 completed the follow-up. Key findings highlighted the lack of engagement by participants with English-language labels and their reliance on asking for help from pharmacy staff, friends, or family to understand the information. However, when provided with information in their preferred language, they reported high levels of understanding and sought help less frequently from a third party. This study has shown that this service has improved understanding of labelling information in this target group.
Collapse
Affiliation(s)
- Helena Herrera
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, White Swan Road, Portsmouth PO1 2DT, UK.
| | | | - Ghalib Khan
- Written Medicine, 51 Star St., London W2 1QQ, UK.
| | - Nicola Barnes
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, White Swan Road, Portsmouth PO1 2DT, UK.
| | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, White Swan Road, Portsmouth PO1 2DT, UK.
| |
Collapse
|
|
10
|
Balli ML, Dickey TA, Purvis RS, Warmack TS, Riklon S, McElfish PA. "You Want to Give the Best Care Possible, and You Know When They Leave Your Pharmacy, You Didn't Give the Best Care Possible Most of the Time": Pharmacist- and Community Health Worker-Identified Barriers and Facilitators to Medication Adherence in Marshallese Patients. J Racial Ethn Health Disparities 2019; 6:652-659. [PMID: 30737733 DOI: 10.1007/s40615-019-00563-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Marshallese experience high rates of chronic diseases including hypertension and diabetes. Medication adherence is crucial to successful disease management, and healthcare providers play a crucial role in assisting their patients with medication adherence. METHODS A qualitative study design was used with individual interviews and focus groups with pharmacists and community health workers (CHWs) serving the Marshallese community in Northwest Arkansas. Participants were asked about their experiences with and perceptions of barriers and facilitators to medication adherence among Marshallese adults in Northwest Arkansas. RESULTS Eight pharmacists and nine CHWs were interviewed. Five themes emerged regarding barriers to medication adherence: (1) financial, (2) transportation, (3) language, (4) health literacy and understanding of Western medicine, and (5) mistrust. Four themes emerged regarding facilitators to medication adherence: (1) in-depth patient education strategies, (2) efforts to address the language barrier, (3) family engagement, and (4) public transportation and prescription home delivery. DISCUSSION Pharmacists and CHWs identified the same barriers to medication adherence, which are consistent with those documented in previous studies. Pharmacists also reported distress over their inability to confirm Marshallese patient understanding in relation to the use of prescribed medications.
Collapse
Affiliation(s)
- Michelle L Balli
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Tiffany A Dickey
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
| |
Collapse
|
|
11
|
Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP. Assessing methods of measuring medication adherence in chronically ill children-a narrative review. Patient Prefer Adherence 2019; 13:1175-1189. [PMID: 31413546 PMCID: PMC6660631 DOI: 10.2147/ppa.s200058] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/13/2019] [Indexed: 12/24/2022] Open
Abstract
Nonadherence in children who use long-term medication is a serious problem and assessing adherence is an important step to provide solutions to this problem. Medication adherence can be measured by several methods, including (a) self-report questionnaires or structured interviews, (b) therapeutic drug monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates. The objective of this narrative review is to provide an overview of the literature about methods for the measurement of medication adherence in chronically ill children and adolescents. Therefore, we conducted a literature search by using multiple databases. Four methods of monitoring medication adherence are presented for the most described chronic diseases: asthma, HIV/AIDS, epilepsy, diabetes mellitus and ADHD. First, 10 commonly used self-report questionnaires and structured interviews are described, including the main characteristics, (dis)advantages and their validation studies. Second, the use of TDM in pediatric trials for medication adherence measurement is discussed. New sampling methods (e.g. dried blood spot) and sampling matrices (e.g. hair, saliva and urine) have shown their benefits for TDM in children. Third, electronic devices to measure medication adherence in children are presented, being developed for several drug administration routes. Fourth, the analyses, advantages and disadvantages of pharmacy data are discussed. The usage of this data requires specific calculations and interpretations to assess adherence. As presented in this review, every adherence method has specific (dis)advantages. When deciding which adherence method is applicable, validity and generalizability should be taken into account. Combining multiple methods seems to offer the best solution in the daily clinical practice.
Collapse
Affiliation(s)
- Linda Al-Hassany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
- Correspondence: Linda Al-HassanyDepartment of Hospital Pharmacy, University Medical Center Rotterdam, Postal Box 2040, Rotterdam3000 CA, The NetherlandsTel +3 110 703 3202Email
| | - Sanne M Kloosterboer
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
| | - Bram Dierckx
- Erasmus MC, University Medical Center Rotterdam, Department Child and Adolescent Psychiatry, Rotterdam, The Netherlands
| | - Birgit CP Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
| |
Collapse
|
|
12
|
Spoelstra SL, Sansoucie H. Putting evidence into practice: evidence-based interventions for oral agents for cancer. Clin J Oncol Nurs 2017; 19:60-72. [PMID: 26030394 DOI: 10.1188/15.s1.cjon.60-72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The limited evidence available suggests that adherence to oral agents for cancer is a significant clinical problem and may have a substantial impact on treatment success or failure. Adherence is a difficult issue among patients who are very sick with a life-threatening disease who often must adhere to complex treatment protocols independently at home. OBJECTIVES This article aims to identify effective interventions for the promotion, treatment, and management of adherence to oral agents for cancer and to synthesize the literature for use in clinical practice. METHODS As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for patients prescribed oral agents for cancer. The ONS PEP weight-of-evidence classification schema levels of evidence were used to categorize interventions to assist nurses in identifying strategies that are effective at improving adherence. FINDINGS The majority of evidence found was conducted in conditions other than cancer; therefore, research is needed to identify whether these interventions are effective at promoting adherence in patients with cancer.
Collapse
|
|
13
|
Ippolito M, Chary A, Daniel M, Barnoya J, Monroe A, Eakin M. Expectations of health care quality among rural Maya villagers in Sololá Department, Guatemala: a qualitative analysis. Int J Equity Health 2017; 16:51. [PMID: 28288633 PMCID: PMC5348769 DOI: 10.1186/s12939-017-0547-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts. Differences in access to and use of biomedical resources may explain some of the observed disparities. Efforts to address these differences could be aided in part by better understanding the socio-medical contexts in which they occur. METHODS We performed a qualitative analysis of field notes collected during a 2008 program evaluation of a health post in a rural Maya village in Sololá Department, Guatemala. Forty-one interviews were conducted among a community-based convenience sample of adult men and women. Interviews focused on experiences, perceptions, and behaviors related to the local biomedical and ethnomedical health care resources. RESULTS Penetrance of the local health post was high, with most (90%) of respondents having accessed it within the prior five years. The prevailing attitude toward the health post was positive. We identified facilitators and barriers to health post use that corresponded with three thematic areas: clinic operations, visits and consultations, and medical resources. Proximity to the home, free consultations and medications, and social support services were among the most commonly cited facilitators. Barriers included limited clinic hours, medication stock-outs, provision of care that did not meet patient expectations, and unavailability of diagnostic tests. CONCLUSIONS In a rural Maya community in Guatemala, operational and quality-based factors, independent of sociocultural considerations, informed the perception of and decision to access biomedical resources. Interventions that address these factors may increase health care utilization and alleviate some of the health disparities that accompany indigeneity in Guatemala and similar contexts.
Collapse
Affiliation(s)
- Matthew Ippolito
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St Rm 450-B, Baltimore, MD, 21287, USA.
| | - Anita Chary
- Department of Anthropology, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1114, St. Louis, MO, 63130, USA
| | - Michael Daniel
- Johns Hopkins University School of Medicine, 1000 Eager Street, Baltimore, MD, 21202, USA
| | - Joaquin Barnoya
- Department of Surgery, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Anne Monroe
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St Rm 8060, Baltimore, MD, 21287, USA
| | - Michelle Eakin
- Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| |
Collapse
|
|
14
|
Vitamin D status in patients attending a Danish migrant health clinic: a clinical retrospective study. J Immigr Minor Health 2016; 17:474-81. [PMID: 24791701 DOI: 10.1007/s10903-014-0031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Non-western migrants and ethnic minority populations in western countries are particularly at risk of vitamin D deficiency due to darker skin color and low sun exposure. The aim of this study was to examine levels of 25-OH vitamin D in patients attending a Danish health clinic for migrants. Patients attending the clinic represent a distinct group of migrants with longstanding, unresolved symptoms and often multiple illnesses. In this retrospective study, data on patient demographics and vitamin D levels were extracted from the medical records of 156 patients attending a Migrant Health Clinic in 2008-2011 who were considered at-risk for low vitamin D, mainly due to symptoms of diffuse pain in the muscles, bones or joints. Over the follow-up period of 1 year, the number of patients with vitamin D below 50 nmol/L decreased from 80 to 56%. The median vitamin D level increased from 27 nmol/L [(interquartile ranges (IQR 14.5-45.0)] at baseline to 45 nmol/L (IQR 26.5-64.5) at follow-up. Patient consultations with a holistic approach and close follow-up can help patients with complex symptoms and language barriers to overcome barriers to treatment and adherence, thus leading to improved levels of vitamin D.
Collapse
|
|
15
|
Wolf MS, Davis TC, Curtis LM, Bailey SC, Knox JP, Bergeron A, Abbet M, Shrank WH, Parker RM, Wood AJJ. A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence. J Gen Intern Med 2016; 31:1482-1489. [PMID: 27542666 PMCID: PMC5130952 DOI: 10.1007/s11606-016-3816-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/25/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. OBJECTIVE To test the effectiveness of a patient-centered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. DESIGN Two-arm, multi-site patient-randomized pragmatic trial. PARTICIPANTS English- and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. INTERVENTION A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which uses standard intervals for expressing when to take medicine (morning, noon, evening, bedtime). MAIN MEASURES Demonstrated proper use of a multi-drug regimen; medication adherence measured by self-report and pill count at 3 and 9 months. KEY RESULTS A total of 845 patients participated in the study (85.6 % cooperation rate). Patients receiving the PCL demonstrated slightly better proper use of their drug regimens at first exposure (76.9 % vs. 70.1 %, p = 0.06) and at 9 months (85.9 % vs. 77.4 %, p = 0.03). The effect of the PCL was significant for English-speaking patients (OR 2.21, 95 % CI 1.13-4.31) but not for Spanish speakers (OR 1.19, 95 % CI 0.63-2.24). Overall, the intervention did not improve medication adherence. However, significant benefits from the PCL were found among patients with limited literacy (OR 5.08, 95 % CI 1.15-22.37) and for those with medications to be taken ≥2 times a day (OR 2.77, 95 % CI 1.17-6.53). CONCLUSIONS A simple modification to pharmacy-generated labeling, with minimal investment required, can offer modest improvements to regimen use and adherence, mostly among patients with limited literacy and more complex regimens. Trial Registration (ClinicalTrials.gov): NCT00973180, NCT01200849.
Collapse
Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA.
| | - Terry C Davis
- Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | - Stacy Cooper Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Ashley Bergeron
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA
| | | | | | - Ruth M Parker
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alastair J J Wood
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
|
16
|
Yang S, He C, Zhang X, Sun K, Wu S, Sun X, Li Y. Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model. PATIENT EDUCATION AND COUNSELING 2016; 99:1894-1900. [PMID: 27378081 DOI: 10.1016/j.pec.2016.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM). METHODS A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. RESULTS 745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence. CONCLUSIONS Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings. PRACTICE IMPLICATIONS Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.
Collapse
Affiliation(s)
- Shuaishuai Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Xuxi Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Kaige Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Shiyan Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China.
| |
Collapse
|
|
17
|
Tsuruta H, Karim D, Sawada T, Mori R. Trained medical interpreters in a face-to-face clinical setting for patients with low proficiency in the local language. Hippokratia 2016. [DOI: 10.1002/14651858.cd010421.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hirofumi Tsuruta
- Fujita Planning Co. Ltd.; 1-8-7 Kita-Shinjuku Shinjuku-ku Tokyo Japan 169-0074
| | - Dilruba Karim
- Namidabashi Lab Co Ltd; 1-1-10 Nihonzutsumi Taito-ku Tokyo Japan 111-0021
| | - Takashi Sawada
- Minatomachi Clinic; Kuwan Fukushi Center 7-6 Kinko-cho Kanagawa-ku Yokohama-shi Kanagawa-ken Japan 221-0056
| | - Rintaro Mori
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura Setagaya-ku Tokyo Tokyo Japan 157-0074
| |
Collapse
|
|
18
|
Conn VS, Enriquez M, Ruppar TM, Chan KC. Meta-analyses of Theory Use in Medication Adherence Intervention Research. Am J Health Behav 2016; 40:155-71. [PMID: 26931748 DOI: 10.5993/ajhb.40.2.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This systematic review applied meta-analytic procedures to integrate primary research that examined theory- or model-linked medication adherence interventions. METHODS Extensive literature searching strategies were used to locate trials testing interventions with medication adherence behavior outcomes measured by electronic event monitoring, pharmacy refills, pill counts, and self-reports. Random-effects model analysis was used to calculate standardized mean difference effect sizes for medication adherence outcomes. RESULTS Codable data were extracted from 146 comparisons with 19,348 participants. The most common theories and models were social cognitive theory and motivational interviewing. The overall weighted effect size for all interventions comparing treatment and control participants was 0.294. The effect size for interventions based on single-theories was 0.323 and for multiple-theory interventions was 0.214. Effect sizes for individual theories and models ranged from 0.041 to 0.447. The largest effect sizes were for interventions based on the health belief model (0.477) and adult learning theory (0.443). The smallest effect sizes were for interventions based on PRECEDE (0.041) and self-regulation (0.118). CONCLUSION These findings suggest that theory- and model-linked interventions have a significant but modest effect on medication adherence outcomes.
Collapse
Affiliation(s)
- Vicki S Conn
- University of Missouri School of Nursing, Columbia, MO, USA
| | | | - Todd M Ruppar
- University of Missouri School of Nursing, Columbia, MO, USA
| | - Keith C Chan
- University of Missouri School of Nursing, Columbia, MO, USA
| |
Collapse
|
|
19
|
Conn VS, Ruppar TM, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis. Res Social Adm Pharm 2016; 12:218-46. [PMID: 26164400 PMCID: PMC4679728 DOI: 10.1016/j.sapharm.2015.06.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. OBJECTIVE This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. METHODS Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. RESULTS Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked medication taking with existing habits compared to interventions that did not (0.574 vs. 0.222). Effect sizes were largest among studies that measured adherence by pill counts or electronic event monitoring systems. Analysis of study design features identified several potential risks of bias. Statistically significant publication bias was detected, but adherence effect sizes were not significantly associated with other risks of bias. CONCLUSIONS These findings document that interventions targeting individuals with medication adherence problems can have modest but significant effects on medication-taking behavior. The findings support the use of behavioral strategies such as prompts and linking medications to habits to increase medication adherence in adults with adherence challenges. Face-to-face interventions appear to be critical for patients who have experienced past problems with medication adherence.
Collapse
Affiliation(s)
- Vicki S. Conn
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Todd M. Ruppar
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Maithe Enriquez
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Pam Cooper
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| |
Collapse
|
|
20
|
Schoenthaler A, De La Calle F, Barrios-Barrios M, Garcia A, Pitaro M, Lum A, Rosal M. A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial. Trials 2015; 16:290. [PMID: 26134837 PMCID: PMC4488119 DOI: 10.1186/s13063-015-0815-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/22/2015] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Latinos experience disproportionately higher rates of uncontrolled hypertension as compared to Blacks and Whites. While poor adherence is a major contributor to disparities in blood pressure control, data in Latino patients are scant. More importantly, translation of interventions to improve medication adherence in community-based primary care practices, where the majority of Latino patients receive their care is non-existent. METHODS Using a randomized controlled design, this study evaluates the effectiveness of a culturally tailored, practice-based intervention compared to usual care on medication adherence, among 148 Latino patients with uncontrolled hypertension who are non-adherent to their antihypertensive medications. Bilingual medical assistants trained as Health Coaches deliver the intervention using an electronic medical record system-embedded adherence script. Patients randomized to the intervention group receive patient-centered counseling with a Health Coach to develop individualized self-monitoring strategies to overcome barriers and improve adherence behaviors. Health Coach sessions are held biweekly for the first 3 months (6 sessions total) and then monthly for the remaining 3 months (3 sessions total). Patients randomized to the usual care group receive standard hypertension treatment recommendations as determined by their primary care providers. The primary outcome is the rate of medication adherence at 6 months. The secondary outcome is reduction in systolic and diastolic blood pressure at 6 months. DISCUSSION If successful, findings from this study will provide salient information on the translation of culturally tailored, evidence-based interventions targeted at medication adherence and blood pressure control into practice-based settings for this high-risk population. TRIAL REGISTRATION NCT01643473 on 16 July 2012.
Collapse
Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA.
| | - Franzenith De La Calle
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA.
| | - Miguel Barrios-Barrios
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA.
| | - Aury Garcia
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA.
| | | | - Audrey Lum
- Union Health Center, New York, NY, 10001, USA.
| | - Milagros Rosal
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| |
Collapse
|
|
21
|
Conn VS, Enriquez M, Ruppar TM, Chan KC. Cultural relevance in medication adherence interventions with underrepresented adults: systematic review and meta-analysis of outcomes. Prev Med 2014; 69:239-47. [PMID: 25450495 PMCID: PMC4312199 DOI: 10.1016/j.ypmed.2014.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 10/14/2014] [Accepted: 10/19/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This meta-analysis systematically compiles intervention research designed to increase medication adherence among underrepresented adults. METHOD Comprehensive searching located published and unpublished studies with medication adherence behavior outcomes. Studies were included if samples were adults living in North America who had any of the following backgrounds or identities: African American, Native American, Latino, Latino American, Asian, Asian American, Pacific Islander, Native Alaskan, or Native Hawaiian. Random-effect analyses synthesized data to calculate effect sizes as a standardized mean difference and variability measures. Exploratory moderator analyses examined the association between specific efforts to increase the cultural relevance of medication adherence studies and behavior outcomes. RESULTS Data were synthesized across 5559 subjects in 55 eligible samples. Interventions significantly improved medication adherence behavior of treatment subjects compared to control subjects (standardized mean difference=0.211). Primary studies infrequently reported strategies to enhance cultural relevance. Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes. CONCLUSION The modest magnitude of improvements in medication adherence behavior documents the need for further research with clear testing of cultural relevance features.
Collapse
Affiliation(s)
- Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Maithe Enriquez
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Todd M Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Keith C Chan
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| |
Collapse
|
|
22
|
Williams A, Manias E, Cross W, Crawford K. Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy. J Clin Nurs 2014; 24:1269-79. [PMID: 25265991 DOI: 10.1111/jocn.12700] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the perceptions of a group of culturally and linguistically diverse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. BACKGROUND These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically diverse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically diverse people to improve their medication self-efficacy. DESIGN A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. METHODS Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. RESULTS The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. CONCLUSION This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically diverse backgrounds have the appropriate skills to self-manage their complex medical conditions. RELEVANCE TO CLINICAL PRACTICE Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.
Collapse
Affiliation(s)
- Allison Williams
- Peninsula Campus School of Nursing and Midwifery, Monash University Health Sciences, Frankston, Vic., Australia
| | | | | | | |
Collapse
|
|
23
|
Abstract
INTRODUCTION Access to antiretroviral treatment (ART) has substantially improved over the past decade. In this new era of HIV as a chronic disease, the continued success of ART will depend critically on sustained high ART adherence. The objective of this review was to systematically review interventions that can improve adherence to ART, including individual-level interventions and changes to the structure of ART delivery, to inform the evidence base for the 2013 WHO consolidated antiretroviral guidelines. DESIGN A rapid systematic review. METHODS We conducted a rapid systematic review of the global evidence on interventions to improve adherence to ART, utilizing pre-existing systematic reviews to identify relevant research evidence complemented by screening of databases for articles published over the past 2 years on evidence from randomized controlled trials (RCTs). We searched five databases for both systematic reviews and primary RCT studies (Cochrane Library, EMBASE, MEDLINE, Web of Science, and WHO Global Health Library); we additionally searched ClinicalTrials.gov for RCT studies. We examined intervention effectiveness by different study characteristics, in particular, the specific populations who received the intervention. RESULTS A total of 124 studies met our selection criteria. Eighty-six studies were RCTs. More than 20 studies have tested the effectiveness of each of the following interventions, either singly or in combination with other interventions: cognitive-behavioural interventions, education, treatment supporters, directly observed therapy, and active adherence reminder devices (such as mobile phone text messages). Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some settings, each intervention has also been found not to produce significant effects in several studies. Almost half (55) of the 124 studies investigated the effectiveness of combination interventions. Combination interventions tended to have effects that were similar to those of single interventions. The evidence base on interventions in key populations was weak, with the exception of interventions for people who inject drugs. CONCLUSION Tested and effective adherence-enhancing interventions should be increasingly moved into implementation in routine programme and care settings, accompanied by rigorous evaluation of implementation impact and performance. Major evidence gaps on adherence-enhancing interventions remain, in particular, on the cost-effectiveness of interventions in different settings, long-term effectiveness, and effectiveness of interventions in specific populations, such as pregnant and breastfeeding women.
Collapse
|
|
24
|
Tsuruta H, Karim D, Sawada T, Mori R. Trained medical interpreters in a face-to-face clinical setting for patients with low proficiency in the local language. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
|
25
|
Barbara S, Krass I. Self management of type 2 diabetes by Maltese immigrants in Australia: can community pharmacies play a supporting role? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:305-13. [DOI: 10.1111/ijpp.12011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/18/2012] [Indexed: 01/09/2023]
Abstract
Abstract
Objectives
This study aimed to identify issues in diabetes self-management in an Australian Maltese community with type 2 diabetes mellitus, and to identify opportunities for community pharmacies to offer self-management support to these populations.
Methods
Individual, semi-structured interviews were conducted. A maximum variation sample was recruited from La Vallette Social Centre, Sydney, and interviewed by the investigator. Interviews were audio recorded, transcribed verbatim, and iteratively coded into themes by constant comparison using computer software. Cultural predictors of adherence were analysed.
Key findings
Twenty-four participants were interviewed. Themes included diabetes knowledge, self-management behaviours, cultural predictors of adherence and interest in community pharmacy disease management services. Diabetes knowledge was generally limited. Although most participants practised some self-monitoring of blood glucose they lacked knowledge of practice recommendations. Participants generally undertook regular physical activity, though adherence to diet varied according to social influences. Cultural influences on perceptions included attitudes to practitioners, treatment and peer experiences. Enablers included attitudes towards financial independence and social integration while nurturers included family and community support. Participants expressed interest in accessing more support from their community pharmacy due to ease of access and interest in learning more about diabetes.
Conclusions
Patients from different backgrounds experience unique barriers to care, including poor written literacy and limited access to diabetes education, many of which are unrecognised by patients or practitioners. Pharmacists should become more proactive in offering culturally appropriate diabetes self-management support to these populations. Research into pharmacist perspectives of patient issues could identify training needs and guide strategies to improve their cultural competence.
Collapse
Affiliation(s)
- Sarah Barbara
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
|
26
|
Baldwin HE, Friedlander SF, Eichenfield LF, Mancini AJ, Yan AC. The effects of culture, skin color, and other nonclinical issues on acne treatment. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2011; 30:S12-5. [PMID: 21943562 DOI: 10.1016/j.sder.2011.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The effective and safe treatment of acne vulgaris often is affected by individual patient characteristics, including skin color and cultural background. Skin of color is especially prone to hyperpigmentation, both from lesions and from irritating therapy. Clinicians also should be aware of cultural attitudes and folk remedies that may adversely affect dermatologic conditions such as acne.
Collapse
|