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Carbonell-Soliva Á, Nouni-García R, López-Pineda A, Cordero-Fort A, Pérez-Jover V, Quesada JA, Orozco-Beltrán D, Nolasco A, Castellano-Vázquez JM, Mira-Solves JJ, Gil-Guillen VF, Carratala-Munuera C. Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups. BMC PRIMARY CARE 2024; 25:59. [PMID: 38365594 PMCID: PMC10870481 DOI: 10.1186/s12875-024-02286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. METHODS An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. RESULTS Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. CONCLUSIONS Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.
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Affiliation(s)
- Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Rauf Nouni-García
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
| | - Adriana López-Pineda
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain.
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain.
- Foundation for the Promotion of Health and Biomedical Research of the Valencian, Community. N-332, 03550 San Juan de Alicante, Alicante, Spain.
| | - Alberto Cordero-Fort
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
- Biomedical Network Research Center for Cardiovascular Diseases (CIBERCV), Madrid, 28029, Spain
| | - Virtudes Pérez-Jover
- Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Jose A Quesada
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
| | - Domingo Orozco-Beltrán
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, 03550, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Jose Maria Castellano-Vázquez
- Comprehensive Center for Cardiovascular Diseases, Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain
| | | | - Vicente F Gil-Guillen
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
- Institute of Health and Biomedical research of Alicante, Alicante Spain General University Hospital of Alicante, Diagnostic center, Fifth floor. Pintor Baeza street, 12, Alicante, 03110, Spain
- General University Hospital of Elda, Alicante, 03600, Spain
| | - Concepción Carratala-Munuera
- Network for Research on Chronicity, Primary Care. and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Clinical Medicine Department, School of Medicine, University Miguel Hernández de Elche, Alicante, 03550, Spain
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Reach G, Calvez A, Sritharan N, Boubaya M, Lévy V, Sidorkiewicz S, Fiani M. Patients' Perceived Importance of Medication and Adherence in Polypharmacy, a Quantitative, Cross-Sectional Study Using a Questionnaire Administered in Three Doctors' Private Practices in France. Drugs Real World Outcomes 2023:10.1007/s40801-023-00361-7. [PMID: 36997772 DOI: 10.1007/s40801-023-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Among the determinants of nonadherence, polypharmacy (common in people with multiple pathologies and especially in elderly patients), plays a major role. OBJECTIVE In patients who are subject to polypharmacy involving different classes of medications, the first aim is to assess the impact of medication importance given by patients on (i) medication adherence and (ii) the respective effect of intentionality and habit in medication importance and medication adherence. The second objective is to compare the importance given to medication and adherence in the different therapeutic classes. PATIENTS AND METHODS Patients taking 5-10 different medications for at least 1 month were included in a cross-sectional survey in three private practices in one region in France. RESULTS This study included 130 patients (59.2 % female) with 851 medications in total. The mean ± standard deviation (SD) age was 70.5 ± 12.2 years. The mean ± SD of medications taken was 6.9 ± 1.7. Treatment adherence had a strong positive correlation with the patient-perceived medication importance (p < 0.001). Counter-intuitively, taking a large number of medications (≥7) was associated with being fully adherent (p = 0.02). A high intentional nonadherence score was negatively associated with high medication importance (p = 0.003). Furthermore, patient-perceived medication importance was positively associated with taking treatment by habit (p = 0.03). Overall nonadherence more strongly correlated with unintentional nonadherence (p < 0.001) than with intentional nonadherence (p = 0.02). Compared to the antihypertensive class, a decrease in adherence by medication was observed in psychoanaleptics (p < 0.0001) and drugs used in diabetes class (p = 0.002), and a decrease in importance in lipid-modifying agents class (p = 0.001) and psychoanaleptics (p < 0.0001). CONCLUSION The perception of the importance of a medicine is associated with the place of intentionality and habit in patient adherence. Therefore, explaining the importance of a medicine should become an important part of patient education.
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Affiliation(s)
- Gérard Reach
- Health Education and Promotion Laboratory (LEPS UR 3412), Sorbonne Paris Nord University, 74 rue Marcel Cachin 93017, Bobigny Cedex, France.
| | - Aurélie Calvez
- Department of General Practice, University of Picardy Jules Verne, Amiens, France
| | | | - Marouane Boubaya
- Department of Clinical Research, CHU Avicenne, APHP, Bobigny, France
| | - Vincent Lévy
- Department of Clinical Research, CHU Avicenne, APHP, Bobigny, France
| | - Stéphanie Sidorkiewicz
- Department of General Medicine, University of Paris Cité, 75014, Paris, France
- University of Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, UMR 1153, 75004, Paris, France
| | - May Fiani
- Health Education and Promotion Laboratory (LEPS UR 3412), Sorbonne Paris Nord University, 74 rue Marcel Cachin 93017, Bobigny Cedex, France
- Department of General Practice, University of Picardy Jules Verne, Amiens, France
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Mihajlovic M, Simic J, Marinkovic M, Kovacevic V, Kocijancic A, Mujovic N, Potpara TS. Sex-related differences in self-reported treatment burden in patients with atrial fibrillation. Front Cardiovasc Med 2022; 9:1029730. [DOI: 10.3389/fcvm.2022.1029730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTreatment burden (TB) is defined as the patient’s workload of healthcare and its impact on patient functioning and wellbeing. High TB can lead to non-adherence, a higher risk of adverse outcomes and lower quality of life (QoL). We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients.Materials and methodsA single-center, prospective study included consecutive patients with AF under drug treatment for at least 6 months before enrollment from April to June 2019. Patients were asked to voluntarily and anonymously answer the Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation.ResultsOf 331 patients (mean age 65.4 ± 10.3 years, mean total AF history 6.41 ± 6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p < 0.001), and females more frequently reported TB ≥ 59 points than males (37.8% vs. 20.6%, p = 0.001). In females, on multivariable analysis of the highest TB quartile (TB ≥ 59), non-vitamin K Antagonist Oral Anticoagulant (NOAC) use [Odds Ratio (OR) 0.319; 95% Confidence Interval (CI) 0.12–0.83, P = 0.019], while in males, catheter ablation and/or ECV of AF (OR 0.383; 95% CI 0.18–0.81, P = 0.012) were negatively associated with the highest TB quartile.ConclusionOur study was the first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥ 59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than vitamin K antagonist (VKA) in females and a rhythm control strategy in males could decrease TB to acceptable values.
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Wakob I, Schmid GL, Nöhring I, Elze R, Sultzer R, Frese T, Schiek S, Bertsche T. Developing a Mobile Health Application to Communicate Adverse Drug Reactions - Preconditions, Assessment of Possible Functionalities and Barriers for Patients and Their General Practitioners. J Multidiscip Healthc 2022; 15:1445-1455. [PMID: 35837350 PMCID: PMC9275429 DOI: 10.2147/jmdh.s369625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Mobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation. Methods We performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users’ assessment of functionalities and (iii) barriers to mHealth managing ADR communication. Results A total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = −0.231; p < 0.001) and GPs (r = −0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (>60%) included “Rapid feedback on urgency of face-to-face consultations.” GPs valued information on “Patient’s difficulties in medication administration.” (iii) In free-text answers, the barrier reported most frequently by patients was “preferred personal GP contact” (6%), whereas GPs claimed, “uncomplicated use with low expenditure of time and personnel” (19%). Conclusion Older patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs’ time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.
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Affiliation(s)
- Ines Wakob
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Ingo Nöhring
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Romy Elze
- University Computer Center, Department of Research and Development, Leipzig University, Leipzig, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
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Liberman JN, Davis T, Velligan D, Robinson D, Carpenter W, Jaeger C, Waters H, Ruetsch C, Forma F. Mental Health Care Provider's Perspectives Toward Adopting a Novel Technology to Improve Medication Adherence. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:61-70. [PMID: 36254189 PMCID: PMC9558921 DOI: 10.1176/appi.prcp.20210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/28/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To understand perspectives of mental health care providers regarding barriers and drivers of adopting a medication ingestible event monitoring (IEM) system in clinical practice. Methods Between April and October 2019, a cross‐sectional, online survey was conducted among 131 prescribing clinicians and 119 non‐prescribing clinicians providing care to patients with major depressive disorder, bipolar disorder, and schizophrenia. Results Most prescribing clinicians were physicians (79.4%) while most non‐prescribing clinicians (52.9%) were licensed clinical social workers, followed by counselors (30.8%), clinical psychologists (13.4%), and case managers (2.5%). Most respondents (93.2%) reported that clinicians can influence adherence, that the IEM technology was in their patients' best interest (63.6%), and a willingness to beta test the technology (54.8%). Support was positively associated with prescribing clinicians (OR: 2.2; 95% CI: 1.1, 4.5), belief that antipsychotics reduce the health, social, or financial consequences of the condition (OR: 3.8; 95% CI: 1.3, 11.0), concern for patients' well‐being without monitoring (OR: 3.3; 95% CI: 1.2, 8.7), and belief the technology will enhance clinical alliance (OR: 3.1; 95% CI: 1.5, 6.3) or improve patient engagement (OR: 3.0; 95% CI: 1.5, 6.2). Support was inversely related to concerns about appropriate follow‐up actions (OR: 0.4; 95% CI: 0.2, 0.9) and responsibilities (OR: 0.3; 95% CI: 0.1, 0.8) when using the technology. Conclusions Our results suggest that IEM sensor technology adoption will depend upon additional evidence that patients will actively engage in the use of the technology, will benefit from the technology through improved outcomes, and that the additional burden placed upon providers is minimal compared to the potential benefit. Among clinicians with prescribing authority, 91.6% are concerned about the quality of self‐reported medication adherence and 75.6% reported that the IEM sensor technology would be in their patients' “best interest”. Most prescribing (85.5%) and non‐prescribing (74.0%) clinicians believe that the IEM sensor technology will either improve patient outcomes or practice efficiency. A key barrier to adoption appears to be concern about how to incorporate these data into practice.
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Affiliation(s)
- Joshua N. Liberman
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Tigwa Davis
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Dawn Velligan
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Delbert Robinson
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - William Carpenter
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Chris Jaeger
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Heidi Waters
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Charles Ruetsch
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
| | - Felicia Forma
- Health Analytics LLC, Columbia, Maryland, USA (J. N. Liberman, T. Davis, C. Ruetsch); University of Texas Health Science Center, San Antonio, Texas, USA (D. Velligan); Northwell Health, Feinstein Institutes for Medical Research, Hempstead, New York, USA (D. Robinson); University of Maryland, School of Medicine, Baltimore, Maryland, USA (W. Carpenter); JHC Solutions LLC, San Francisco, California, USA (C. Jaeger); Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey, USA (H
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Björk J, Stenfors T, Juth N, Gunnarsson AB. Personal responsibility for health? A phenomenographic analysis of general practitioners' conceptions. Scand J Prim Health Care 2021; 39:322-331. [PMID: 34128751 PMCID: PMC8475098 DOI: 10.1080/02813432.2021.1935048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyse and describe general practitioners' perceptions of the notion of a 'personal responsibility for health'. DESIGN Interview study, phenomenographic analysis. SETTING Swedish primary health care. SUBJECTS General Practitioners (GPs). MAIN OUTCOME MEASURES Using the phenomenographic method, the different views of the phenomenon (here: personal responsibility for health) were presented in an outcome space to illustrate the range of perceptions. RESULTS The participants found the notion of personal responsibility for health relevant to their practice. There was a wide range of perceptions regarding the origins of this responsibility, which was seen as coming from within yourself; from your relationships to specific others; and/or from your relationship with the generalized other. Furthermore, the expressions of this responsibility were perceived as including owning your health problem; not offloading all responsibility onto the GP; taking active measures to keep and improve health; and/or accepting help in health. The GP was described as playing a key role in shaping and defining the patient's responsibility for his/her health. Some aspects of personal responsibility for health roused strong emotions in the participants, especially situations where the patient was seen as offloading all responsibility onto the GP. CONCLUSION The notion of personal responsibility for health is relevant to GPs. However, it is open to a broad range of interpretations and modulated by the patient-physician interaction. This may make it unsuitable for usage in health care priority settings. More research is mandated to further investigate how physicians work with patient responsibility, and how this affects the patient-physician relationship and the physician's own well-being.Key PointsThe notion of personal responsibility for health has relevance for discussions about priority setting and person-centred care.This study, using a phenomenographic approach, investigated the views of Swedish GPs about the notion of personal responsibility for health.The participants found the notion relevant to their practice. They expressed a broad range of views of what a personal responsibility for health entails and how it arises. The GP was described as playing a key role in shaping and defining the patient's responsibilities for his/her health.The notion was emotionally charged to the participants, and when patients were seen as offloading all responsibility onto the GP this gave rise to frustration.
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Affiliation(s)
- Joar Björk
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- CONTACT Joar Björk Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, 171 77, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
| | - A. Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Institute of Neuroscience and Physiology, Section for Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Trakoli A. Treatment burden and ability to work. Breathe (Sheff) 2021; 17:210004. [PMID: 34295408 PMCID: PMC8291924 DOI: 10.1183/20734735.0004-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/05/2022] Open
Abstract
Treatment burden can adversely affect patient functioning and wellbeing, including their ability work. Workers with multimorbidity, such as ageing, are disproportionately affected and their number is set to rise as the workforce ages. Complex treatment regimens and their sequalae can be a barrier to a successful return to work or even incompatible with work demands. Enlightened employers will seek to accommodate the burden of treatment by implementing reasonable adjustments. However, where the employer is unable or unwilling to accommodate such adjustments, the result may be loss of employment, with often devastating consequences to the worker's physical and emotional health and wellbeing. Collaborative action in three key settings: the healthcare system, the workplace and the state can help reduce barriers, thereby enabling working-age people with chronic health conditions or disabilities remain in, and benefit from, employment. Educational aims To raise awareness on how treatment burden can adversely affect health, work and societal outcomes in working age people.To promote good practice in relation to managing treatment burden in healthcare and work settings, so that working age people with chronic health conditions or disabilities can remain in and benefit from work.
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Affiliation(s)
- Anna Trakoli
- Occupational Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Potpara TS, Mihajlovic M, Zec N, Marinkovic M, Kovacevic V, Simic J, Kocijancic A, Vajagic L, Jotic A, Mujovic N, Stankovic GR. Self-reported treatment burden in patients with atrial fibrillation: quantification, major determinants, and implications for integrated holistic management of the arrhythmia. Europace 2020; 22:1788-1797. [DOI: 10.1093/europace/euaa210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Aims
Treatment burden (TB) refers to self-perceived cumulative work patients do to manage their health. Using validated tools, TB has been documented in several chronic conditions, but not atrial fibrillation (AF). We measured TB and analysed its determinants and impact on quality of life (QoL) in an AF cohort.
Methods and results
A single-centre study prospectively included consecutive adult AF patients and non-AF controls managed from 1 April to 21 June 2019, who voluntarily and anonymously answered the TB questionnaire (TBQ) and 5-item EQ-5D QoL questionnaire; TB was calculated as a sum of TBQ points (maximum 170) and expressed as proportion of the maximum value. Of 514 participants, 331 (64.4%) had AF. The mean self-reported TB was 27.6% among AF patients and 24.3% among controls, P = 0.011. The mean TB was significantly higher in patients taking vitamin K antagonists (VKAs) vs. those taking non-VKA antagonist oral anticoagulants (NOAC; 29.5% vs. 24.7%, P = 0.006). The highest item-specific TB was reported for healthcare system organization-related items (e.g. visit appointment), diet, and physical activity modifications. On multivariable analyses, female sex, younger age, and permanent AF were associated with a higher TB, whereas NOACs and electrical AF cardioversion exhibited an inverse association; TB was an independent predictor of decreased QoL (all P < 0.05).
Conclusion
Our study provided clinically relevant insights into self-perceived TB among AF patients. Approximately one in four patients with AF have a high TB. Specific AF treatments and optimization of healthcare system-required patient activities may reduce the self-perceived TB in AF patients.
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Affiliation(s)
- Tatjana S Potpara
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Miroslav Mihajlovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | - Nevena Zec
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | | | | | - Jelena Simic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | | | - Leona Vajagic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | - Aleksandra Jotic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Endocrinology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nebojsa Mujovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran R Stankovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
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Tran VT, Montori VM, Ravaud P. Is My Patient Overwhelmed?: Determining Thresholds for Acceptable Burden of Treatment Using Data From the ComPaRe e-Cohort. Mayo Clin Proc 2020; 95:504-512. [PMID: 31619365 DOI: 10.1016/j.mayocp.2019.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/31/2019] [Accepted: 09/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the highest burden of treatment beyond which patients with chronic conditions consider their current investments of time and effort in health care unsustainable. PATIENTS AND METHODS We used data collected between January 1, 2017 and October 1, 2018 in the Community of Patients for Research (ComPaRe), an ongoing e-cohort of adult patients with chronic conditions in France. We matched participants' answers to the Treatment Burden Questionnaire (TBQ) and to a Yes/No anchor question: "Think about all the things you do to care for yourself. Do you think you could continue investing the same amount of time, energy, and money in your health care lifelong?" We defined the Patient Acceptable Symptom State (PASS) for the burden of treatment as the TBQ score below which 75% of patients reported an acceptable burden state. RESULTS We analyzed data for 2413 patients (1781 [73.8%] women, 1248 [51.7%] multimorbid, median age: 48 (interquartile range, 36-59] years) enrolled in ComPaRe. Of these, 38% (917 of 2413) reported that they would be unable to continue the same investment of energy, time, and money in health care lifelong. The PASS for the burden of treatment was at 39% of the maximal score (ie, TBQ score = 59/150; 95% CI, 52-64) Using these results, clinicians can detect patients at risk for becoming overwhelmed by their medical care by identifying patients with TBQ scores of 59 or higher. CONCLUSION About 40% of patients with chronic conditions report being unable to sustain current investments of energy, time, and money in health care lifelong. The PASS for treatment burden provides a practical yardstick to help clinicians and researchers interpret scores for burden of treatment.
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Affiliation(s)
- Viet-Thi Tran
- Equipe METHODS, Centre de recherche en Epidémiologie et Statistiques (CRESS, Université de Paris, INSERM UMR 1153), France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, France.
| | - Victor M Montori
- Division of Health Care and Policy Research, Department of Health Sciences Research and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Philippe Ravaud
- Equipe METHODS, Centre de recherche en Epidémiologie et Statistiques (CRESS, Université de Paris, INSERM UMR 1153), France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, France; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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Kua KP, Saw PS, Lee SWH. Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study. Int J Clin Pharm 2019; 41:793-803. [PMID: 31020599 DOI: 10.1007/s11096-019-00829-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/10/2019] [Indexed: 12/20/2022]
Abstract
Background Deprescribing describes a process of medication regimen optimization with the aim to reduce adverse events and improve quality of life. There is limited research on perceptions of older adults, defined as those 60 years of age and older, about their willingness to cease a medication in developing countries. Objective To ascertain patients' attitudes, beliefs, perceptions, and experiences regarding the number of medications they were taking and their opinions regarding deprescribing. Setting A primary care health clinic and three community pharmacies in Malaysia. Method A multicenter cross-sectional study was conducted by administering the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to older adults aged 60 years and over or caregivers attending a health clinic and three community pharmacies in Malaysia. Descriptive results were reported for participants' characteristics and questionnaire responses. Analysis of correlation between participant characteristics and their responses was performed using Spearman's correlation. Main outcome measure Patients' and caregivers' attitudes and beliefs towards reducing medications and characteristics of patients such as age, gender, education level, number of medication taken and number of medical center managing the patient. Results 650 participants were approached and the response rate was 85.2%. A total of 554 participants completed the questionnaire (502 older adults and 52 caregivers). Older adults in the study were taking a median of three medications and/or supplements compared to four in caregiver recipients. 88.1% of older adults were satisfied with their current medication regimen and 67.7% would like to try stopping or reducing the dose of their medicines when their doctor recommended. 82.7% of caregivers were satisfied with their care recipient's current medications and 65.4% were willing to stop taking or reduce the number of drugs taken by their care recipient's upon doctor's recommendation. Older adults (p = 0.003) and those with lower education level (p < 0.001) were more willing to have their medications deprescribed. Other demographic characteristics such as gender, number of medication taken or number of doctors managing patient were not found to be correlated with willingness to stop a medication. Conclusion Older adults taking multiple medications for various medical conditions were largely accepting of a trial of cessation of medication.
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Affiliation(s)
- Kok Pim Kua
- Department of Pharmacy, Petaling District Health Office, Ministry of Health, 47301, Petaling Jaya, Selangor, Malaysia
| | - Pui San Saw
- School of Pharmacy, Monash University, Building 2, Level 5, Room 38, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Building 2, Level 5, Room 38, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia. .,Gerontechnology Laboratory, Global Asia, 21st Century (GA21) Platform, Monash University, 47500, Bandar Sunway, Selangor, Malaysia. .,School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
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11
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Tran VT, Mama Djima M, Messou E, Moisan J, Grégoire JP, Ekouevi DK. Avoidable workload of care for patients living with HIV infection in Abidjan, Côte d'Ivoire: A cross-sectional study. PLoS One 2018; 13:e0202911. [PMID: 30142165 PMCID: PMC6108500 DOI: 10.1371/journal.pone.0202911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/10/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE People living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care. METHODS Adult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d'Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients' visits and tests had been grouped on the same days. RESULTS We enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%. CONCLUSION PLWHIV in Côte d'Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients' investment of time and money in their care.
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Affiliation(s)
- Viet-Thi Tran
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- METHODS Team, Centre de recherche en Epidémiologie et Statistiques Sorbonne Paris Cité (CRESS, UMR1153), Paris, France
- * E-mail:
| | - Mariam Mama Djima
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Institut Pasteur, Abidjan, Côte d’Ivoire
- Faculty of Pharmacy of Laval University, Québec, Canada
| | | | | | | | - Didier K. Ekouevi
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Bordeaux Population Health (UMR1219), Bordeaux, France
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Tran VT, Messou E, Mama Djima M, Ravaud P, Ekouevi DK. Patients' perspectives on how to decrease the burden of treatment: a qualitative study of HIV care in sub-Saharan Africa. BMJ Qual Saf 2018; 28:266-275. [PMID: 29706594 PMCID: PMC6860734 DOI: 10.1136/bmjqs-2017-007564] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/09/2018] [Accepted: 04/15/2018] [Indexed: 11/04/2022]
Abstract
Objective Patients living with HIV infection (PLWH) in sub-Saharan Africa face an important burden of treatment related to everything they do to take care of their health: doctor visits, tests, regular refills, travels, and so on. In this study, we involved PLWH in proposing ideas on how to decrease their burden of treatment and assessed to what extent these propositions could be implemented in care. Methods Adult PLWH recruited in three HIV care centres in Côte d’Ivoire participated in qualitative interviews starting with ‘What do you believe are the most important things to change in your care to improve your burden of treatment?’ Two independent investigators conducted a thematic analysis to identify and classify patients' propositions to decrease their burden of treatment. A group of experts involving patients, health professionals, hospital leaders and policymakers evaluated each patient proposition to assess its feasibility. Results Between February and April 2017, 326 participants shared 748 ideas to decrease their burden of treatment. These ideas were grouped into 59 unique patient propositions to improve their personal care and the organisation of their hospital or clinic and/or the health system. Experts considered that 27 (46%), 19 (32%) and 13 (22%) of patients' propositions were easy, moderate and difficult, respectively, to implement. A total of 118 (36%) participants offered at least one proposition considered easily implementable by our experts. Conclusion Asking PLWH in sub-Saharan Africa about how their care could be improved led to identifying meaningful propositions. According to experts, half of the ideas identified could be implemented easily at low cost for minimally disruptive HIV care.
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Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Centre de Recherche Epidemiologie et Statistiques Sorbonne Paris Cité (CRESS UMR 1153), Paris, France.,Centre d'Epidémiologie Clinique-Hôpital Hôtel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Eugene Messou
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Mariam Mama Djima
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Institut Pasteur de Cote d'Ivoire, Abidjan, Côte d'Ivoire
| | - Philippe Ravaud
- Centre d'Epidémiologie Clinique-Hôpital Hôtel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Didier K Ekouevi
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Bordeaux Population Health (UMR1219), INSERM, Bordeaux, France
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Kvarnström K, Airaksinen M, Liira H. Barriers and facilitators to medication adherence: a qualitative study with general practitioners. BMJ Open 2018; 8:e015332. [PMID: 29362241 PMCID: PMC5786122 DOI: 10.1136/bmjopen-2016-015332] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND General practitioners (GPs) manage the drug therapies of people with chronic diseases, and poor adherence to medication remains a major challenge. OBJECTIVE This qualitative study examined GPs' insights into non-adherence and ways of overcoming this problem. METHODS We ran four focus groups comprising 16 GPs at the Kirkkonummi Health Centre (Southern Finland). Interviews were audiotaped, transcribed verbatim and analysed by inductive content analysis. MAIN RESULTS The two main themes in the discussions with the GPs were non-adherence in the care of chronic disease and increased need for medicine information. The medication management challenges identified were related to: patient-specific factors, the healthcare system, characteristics of drug therapies and the function and role of healthcare professionals as a team. To improve the situation, the GPs offered a number of solutions: improved coordination of care, better patient education and IT systems as well as enhanced interprofessional involvement in the follow-up of patients. DISCUSSION AND CONCLUSIONS With an ageing population, the GPs were increasingly confronted with non-adherence in the care of chronic diseases. They had mostly a positive attitude towards organising care in a more interprofessional manner. To support medication adherence and self-management, the GPs appreciated pharmacists' assistance especially with patients with polypharmacy and chronic diseases.
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Affiliation(s)
- Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Helena Liira
- General Practice, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Department of General Practice and Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
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Can clinical practice indicator relating to long-acting benzodiazepine use in the elderly be easily generated in a hospital setting? Eur J Clin Pharmacol 2017; 74:233-241. [PMID: 29147805 DOI: 10.1007/s00228-017-2371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To improve the appropriate use of long-acting benzodiazepine (la.bzd) prescriptions in the elderly, the Haute Autorité de Santé (HAS) has developed clinical practice indicators (CPI). The alert indicator (AI) evaluates the prevalence of la.bzd prescription among older people. The mastering indicator (MI) corresponds to the prevalence of elderly with a justified, i.e., appropriate, la.bzd prescription among all the elderly with la.bzd prescriptions. OBJECTIVE The objective of this study was to test the feasibility of routine generation of CPI regarding la.bzd prescriptions among the elderly in the hospital setting. DESIGN This was a retrospective study. SETTING The study was conducted in two university hospitals located in Paris. SUBJECT Eligible cases were patients aged 65 years and older who were hospitalized in acute care units from January to June 2014. METHOD The AI calculation was based on information extracted from medical databases from these hospitals. The appropriateness of la.bzd prescription was assessed by a physician and a pharmacist and was based on review of computerized patient records and prescriptions, using an ad hoc algorithm. The MI was then calculated. Variation in the level of indicators was explored according to the characteristics of patients and of their hospitalization using chi2 test. Factors associated with a potentially inappropriate prescription (PIP) of la.bzd were studied using univariate and multivariate logistic regression. RESULT Among the 4167 patients included in the study, 362 had la.bzd prescriptions, i.e., the AI was 9%. Prescriptions were found to be appropriate for 83 patients, i.e., the MI was 23% and PIP was 77%. The MI varied between 13 and 31% according to characteristics of patients and of hospitalization. In multivariate analysis, factors associated with PIP were age, number of comorbidities, type of care unit, and concurrent prescription of a neuroleptic or hypnotic. CONCLUSION Generation of the AI was routinely possible but only for acute care units with computerized prescriptions, corresponding to 78% of patients. Production of the MI has required medical record review for all patients with a la.bzd prescription and cannot be automated. However, difficulties in generating the MI have identified areas for significant improvement. Moreover, strategies to improve the care of older people with a la.bzd prescription could be targeted using characteristics of patients and of hospitalization associated with PIP. The future deployment of a single electronic medical record in all care departments would make it easier to mine the data and make possible automated production of CPI.
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Abstract
Current healthcare systems and guidelines are not designed to adapt to care for the large and growing number of patients with complex care needs and those with multimorbidity. Minimally disruptive medicine (MDM) is an approach to providing care for complex patients that advances patients' goals in health and life while minimizing the burden of treatment. Measures of treatment burden assess the impact of healthcare workload on patient function and well-being. At least two of these measures are now available for use with patients living with chronic conditions. Here, we describe these measures and how they can be useful for clinicians, researchers, managers, and policymakers. Their work to improve the care of high-cost, high-use, complex patients using innovative patient-centered models such as MDM should be supported by periodic large-scale assessments of treatment burden.
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Reeve E, Thompson W, Farrell B. Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. Eur J Intern Med 2017; 38:3-11. [PMID: 28063660 DOI: 10.1016/j.ejim.2016.12.021] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/21/2016] [Accepted: 12/25/2016] [Indexed: 12/17/2022]
Abstract
Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs. While the data on the benefits is inconsistent, deprescribing appears to be safe. There are, however, potential harms including return of medical conditions or symptoms and adverse drug withdrawal reactions which emphasise the need for the process to be supervised and monitored by a health care professional. Taking action on deprescribing can be facilitated by knowledge of potential barriers, implementing a deprescribing process (utilising developed tools and resources) and identifying opportunities for deprescribing through engaging with patients and caregivers and other health care professionals and considering deprescribing in a variety of populations. Important areas for future research include the suitability of deprescribing of certain medications in specific populations, how to implement deprescribing processes into clinical care in a feasible and cost effective manner and how to engage consumers throughout the process to achieve positive health and quality of life outcomes.
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Affiliation(s)
- Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Capital Health, Nova Scotia Health Authority, NS, Canada.
| | - Wade Thompson
- Bruyère Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Canada
| | - Barbara Farrell
- Bruyère Research Institute, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada; School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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