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Dilek SO, Çömlek FÖ. Evaluating Treatment Adherence in Children and Adolescents with Type 1 Diabetes: The Impact of the Adherence Starts with Knowledge-12 Score on Metabolic Control. CHILDREN (BASEL, SWITZERLAND) 2025; 12:463. [PMID: 40310133 PMCID: PMC12025722 DOI: 10.3390/children12040463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Revised: 03/31/2025] [Accepted: 04/03/2025] [Indexed: 05/02/2025]
Abstract
Background/Objectives: This study sought to identify key barriers to treatment adherence in children and adolescents with type 1 diabetes (T1D) using the Adherence Starts with Knowledge-12 (ASK-12) questionnaire and to evaluate its impact on metabolic control, providing insights for optimizing T1D management. Methods: A total of 160 children and adolescents with T1D aged 5-18 years who sought treatment from a pediatric endocrinology outpatient clinic between June and August in 2022 were prospectively examined. The patients' low treatment adherence (LTA) or high treatment adherence (HTA) was determined based on their ASK-12 questionnaire scores. Two pediatric endocrinologists reviewed the participants' medical records and then classified them into two groups: tight metabolic control and poor metabolic control. Results: LTA, which was determined based on the participants' ASK-12 scores, was significantly associated with puberty, presence of diabetic ketoacidosis, and daily self-management (p < 0.001, p < 0.001, and p < 0.001, respectively). Those whose ASK-12 scores indicated LTA were older and had a longer duration of T1D, higher hemoglobin A1c levels, and lower BMI-SDS values than those with HTA) (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). A total of 94 (59%) participants were indicated to have HTA, but 24 (25.5%) of them were found by the clinicians to have poor metabolic control. Conclusions: The ASK-12 questionnaire scores can identify pediatric patients with T1D who exhibit LTA and thus may be beneficial for early recognition of low adherence. Approximately 25% of the patients with ASK-12 scores indicating HTA were at risk of poor metabolic control. Puberty, duration of T1D, BMI-SDS, HbA1C, and parental involvement alongside ASK-12 score may be considered to improve treatment compliance. Integrating these variables into adherence assessments may enhance treatment compliance and improve long-term outcomes in pediatric T1D management.
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Affiliation(s)
- Semine Ozdemir Dilek
- Department of Pediatric Endocrinology, Adana City Training and Research Hospital, Adana 01370, Turkey
| | - Fatma Özgüç Çömlek
- Department of Pediatric Endocrinology, Medical Faculty, Selçuk University, Konya 42250, Turkey;
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Inanaga R, Toida T, Aita T, Kanakubo Y, Ukai M, Toishi T, Kawaji A, Matsunami M, Okada T, Munakata Y, Suzuki T, Kurita N. Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis. Clin J Am Soc Nephrol 2024; 19:463-471. [PMID: 38127331 PMCID: PMC11020446 DOI: 10.2215/cjn.0000000000000392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence. METHODS This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association. RESULTS In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors). CONCLUSIONS Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.
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Affiliation(s)
- Ryohei Inanaga
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Tatsunori Toida
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Miyazaki, Japan
| | - Tetsuro Aita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of General Internal Medicine, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yusuke Kanakubo
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Mamiko Ukai
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Takumi Toishi
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Atsuro Kawaji
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Masatoshi Matsunami
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Tadao Okada
- Tessyoukai Kameda Family Clinic Tateyama, Chiba, Japan
| | - Yu Munakata
- Chikuseikai Munakata Clinic, Tokyo, Japan
- Munakata Clinic, Chiba, Japan
| | - Tomo Suzuki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan
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Quirke-McFarlane S, Weinman J, d'Ancona G. A Systematic Review of Patient-Reported Adherence Measures in Asthma: Which Questionnaire Is Most Useful in Clinical Practice? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2493-2503. [PMID: 36997118 DOI: 10.1016/j.jaip.2023.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Suboptimal adherence to inhaled corticosteroid in asthma is a worryingly prevalent yet modifiable factor in uncontrolled disease. Several objective measures of adherence exist, but they are time-consuming. The use of patient-reported adherence measures (PRAMs) could therefore offer a time-efficient pragmatic approach to assessing adherence in clinical practice and potentially the appropriate interventions to improve it. OBJECTIVES To identify the PRAMs available for asthma and assess their psychometric quality, accessibility, and usefulness in clinical practice, as well as to provide recommendations for clinicians based on these findings. METHODS We conducted a systematic review of six databases. Articles included in this study were English language, full-text, original, asthma-specific PRAMs or development/validation studies of a generic PRAM that had been administered to adults with asthma, investigated inhaled corticosteroid adherence in adults (aged 18 years and older), and assessed at least one COnsensus-based Standards for the selection of health Measurement INstruments measurement property. RESULTS We included 15 PRAM developmental and/or validation studies in this systematic review. Studies evaluated a range of COnsensus-based Standards for the selection of health Measurement INstruments measurement properties, but none evaluated all of them. CONCLUSIONS Based on this review, we recommend that when a PRAM is used, it should be the Test of the Adherence to Inhalers. However, the Adherence Starts with Knowledge-20 and Adherence Starts with Knowledge-12 may also be useful. Our results highlight the need for PRAM developers to assess questionnaires robustly and provide guidance for clinicians regarding how to act on PRAM answers by developing materials such as decision support tool kits.
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Affiliation(s)
- Sophia Quirke-McFarlane
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom; School of Psychology, University of Surrey, Surrey, United Kingdom
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Gráinne d'Ancona
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom; Pharmacy Department, Guy's and St Thomas, NHS Foundation Trust, London, United Kingdom.
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Demelash TB, Asmamaw G, Limenh LW, Anagaw YK, Simegn W, Ayenew W. Nonadherence to antiasthmatic medications and its predictors among asthmatic patients in public hospitals of Bahir Dar City, North West Ethiopia: using ASK-12 tool. Asthma Res Pract 2023; 9:2. [PMID: 37143111 PMCID: PMC10161619 DOI: 10.1186/s40733-023-00091-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Globally, adequate asthma control is not yet achieved. The main cause of uncontrollability is nonadherence to prescribed medications. OBJECTIVES The objective of this study is to assess asthmatic patients' non-adherence to anti-asthmatic medications and the predictors associated with non-adherence. METHODS An institution-based cross-sectional study was conducted in three governmental hospitals in Bahir Dar city from September 5 to December 12, 2021. The data was collected using the Adherence Starts with Knowledge-12 tool (ASK-12). Systematic random sampling was applied to select study participants. Bivariable and multivariable logistic regression analyses were used to identify predictors of non-adherence. All statistical tests were analyzed using STATA version 16. P-values less than 0.05 were considered statistically significant. RESULTS A total of 422 asthmatic patients were included in the study. Most of the study participants (55.4%) did not adhere to their prescribed anti-asthmatic medicines. The educational status of the study participants (AOR = 0.03, 95% CI = 0.00-0.05), family history of asthma (AOR = 0.13, 95% CI = 0.04-0.21), and disease duration that the patients were living with (AOR = 0.01, 95% CI = 0.00-0.01) were the predictors of non-adherence to anti-asthmatic medications. CONCLUSIONS The level of nonadherence to treatment among patients with asthma was high. Religion, educational status of study participants, family history of asthma, and duration of the disease were the predictors of non-adherence of asthmatic patients to their antiasthmatic medications. Therefore, the Ministry of health, health policy makers, clinicians, and other healthcare providers should pay attention to strengthening the adherence level to antiasthmatic medications, and country-based interventions should be developed to reduce the burden of non-adherence to anti-asthmatic medications.
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Affiliation(s)
- Teshome Bitew Demelash
- Department of Pharmaceutics and Social Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getahun Asmamaw
- Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia
| | | | | | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Wondim Ayenew
- Department of Social and Administrative Pharmacy, University of Gondar, Gondar, Ethiopia.
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Klinedinst TC, Opsasnick L, Benavente JY, Wolf M, O'Conor R. The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults. J Appl Gerontol 2022; 41:2566-2573. [PMID: 35950560 DOI: 10.1177/07334648221120246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Busyness (the density of activities) and daily routine (patterns of organizing time) are two understudied factors that likely impact medication-taking behaviors. We examined the association between busyness and routine with medication adherence (MA) in 405 older adults with adequate cognition using multivariable models. The final model included an interaction term between daily routine and busyness. MA scores (measured by the ASK-12, higher scores mean more barriers to adherence) were higher for individuals reporting low and moderate levels of daily routine versus those with high daily routine. MA scores were higher for individuals reporting moderate and high busyness versus those reporting low busyness. The busyness/routine interaction term was significant for MA; among highly busy individuals, those with high daily routine had lower MA scores than those with low routine. A daily routine may be a modifiable factor for improving MA among older adults, particularly among those with busy lives.
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Affiliation(s)
- Tara C Klinedinst
- Occupational Therapy Department, School of Rehabilitation Sciences, 6186University of Oklahoma Health Sciences Center Schusterman Center, Tulsa, OK, USA.,605473Department of Family Medicine, OU-TU School of Community Medicine, Tulsa, OK, USA
| | - Lauren Opsasnick
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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Balakrishnan A, Bailey S, Mroczek D, Serper M, Ladner D, Wolf M. Describing Predictors Of Regimen Nonadherence Among Kidney Recipients Using Multiple Measures. Prog Transplant 2022; 32:226-232. [PMID: 35686344 DOI: 10.1177/15269248221107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Many kidney recipients struggle with medication adherence and are at greater risk for adverse post-transplant outcomes. Historically, research has focused on single immunosuppressants alone, though all medications within a prescribed regimen are essential for positive outcomes. Research question: Explore predictors of medication regimen nonadherence among a diverse sample of adult kidney recipients by using multiple measures of adherence. Design: A cross-sectional analysis was performed using data from an ongoing clinical trial that enrolled 234 kidney recipients from a large transplant center. We used linear and logit regression models to examine associations of demographic characteristics, social determinants of health, and clinical characteristics with (a) self-reported regimen adherence, measured by the Adherence Starts with Knowledge 12 scale, and (b) immunosuppressant adherence, captured by calculated risk score based on Tacrolimus measurements. Results: Kidney recipients with limited health literacy, overall poorer health, and higher levels of depression demonstrated significantly poorer regimen adherence. Recipients who had dual public/private insurance, took a greater number of medications, and had shorter time since transplant demonstrated significantly poorer immunosuppressant adherence. Conclusion: Social determinants (health literacy and insurance status), and clinical characteristics (overall health status, depression, number of medications, and time since transplant) played significant roles in regimen and immunosuppressant adherence among kidney recipients in our sample. Self-reported adherence, particularly in relation to full medication regimens, can highlight modifiable barriers that might otherwise be overlooked by focusing on adherence to a single immunosuppressant. Depression and health literacy can be assessed and addressed to improve adherence among adult kidney recipients.
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Affiliation(s)
| | - Stacy Bailey
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,370797Institute for Public Health and Medicine - Center for Applied Health Research on Aging, Northwestern University, Chicago, IL, USA
| | - Daniel Mroczek
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,166948Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Marina Serper
- 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniela Ladner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,12244Northwestern Feinberg Comprehensive Transplant Center, Chicago, IL, USA
| | - Michael Wolf
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,370797Institute for Public Health and Medicine - Center for Applied Health Research on Aging, Northwestern University, Chicago, IL, USA
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Ekbom K, Strandqvist A, Lajic S, Hirschberg A, Falhammar H, Nordenström A. The impact of adherence and therapy regimens on quality of life in patients with congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 2022; 96:666-679. [PMID: 34994970 PMCID: PMC9303581 DOI: 10.1111/cen.14676] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Varying outcomes regarding the quality of life (QoL) have been reported in patients with congenital adrenal hyperplasia (CAH). To assess the impact of adherence rate to medical therapy regimens on QoL in patients with CAH. PATIENTS Adolescents and adults aged 15-72 years with CAH due to 21-hydroxylase deficiency at Karolinska University Hospital, Stockholm, Sweden. MEASUREMENTS QoL was assessed using the Addison QoL (n = 72) and RAND 36 questionnaires (n = 75). Adherence to therapy regimens was measured using the Adherence Starts with Knowledge questionnaire (ASK-12). Associations between QoL, type of glucocorticoid therapy prescribed and ASK-12 results were examined. Results were compared to reference RAND 36 data obtained from a representative sample from the general Swedish population. RESULTS A good adherence rate to therapy regimens and a younger age were key factors for a better QoL in study participants with CAH. Younger patients on hydrocortisone and with good adherence had higher RAND 36 scores than older patients on prednisolone independently adherence. Participants with classic CAH (both the salt-wasting and simple virilizing form) reported higher QoL than those with nonclassic CAH. Patients with CAH, especially nonclassic, more frequently reported an impaired QoL than the general population, especially regarding limitations related to body pain, vitality and mental health. CONCLUSION A poor adherence rate to therapy regimens, rather than type of glucocorticoid was associated with impaired QoL in adolescents and adults with CAH.
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Affiliation(s)
- Kerstin Ekbom
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric Endocrinology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Anna Strandqvist
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Division of Psychology, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Svetlana Lajic
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric Endocrinology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Angelica Hirschberg
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Gynecology and Reproductive MedicineKarolinska University HospitalStockholmSweden
| | - Henrik Falhammar
- Department of EndocrinologyKarolinska University HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Anna Nordenström
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric Endocrinology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
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Mohamed R, Abdul Rahman AH, Masra F, Abdul Latiff Z. Barriers to adherence to iron chelation therapy among adolescent with transfusion dependent thalassemia. Front Pediatr 2022; 10:951947. [PMID: 36275066 PMCID: PMC9582426 DOI: 10.3389/fped.2022.951947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
STUDY BACKGROUND Thalassemia is the commonest genetic blood disorder in Malaysia which requires life-long blood transfusions. From a total of 7,984 thalassemia patients in Malaysia, adolescent age group account for the highest number of patients (2,680 patients, 33.57%). In developed countries, the average rate of adherence to long-term treatment among children and adolescents is only 58%. Sub-optimal adherence to iron chelation therapy may impact the outcome and quality of life in these patients. Thus, assessing adherence level and identification of risk factors for non-adherence is essential in optimizing management. OBJECTIVES To determine the association between mean serum ferritin level with self-reported level of adherence to iron chelation therapy in transfusion dependent thalassemia (TDT) adolescents in Hospital Tengku Ampuan Afzan (HTAA), Kuantan and Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Cheras; to determine the association between socio-demographic factors and patients' knowledge on thalassemia and iron chelation therapy with the level of adherence. MATERIALS AND METHODS This was a cross-sectional study conducted between 1st March 2019 and 31st March 2020. Data was collected through face-to-face interview by a single interviewer during the thalassemia clinic follow up, with content validated questionnaires. The questionnaires comprised four sections which included socio-demographic data, medication adherence questionnaire, knowledge of disease, and clinical characteristics of the participants. RESULTS A total of 70 participants were recruited. Results showed that only 51.4% of participants had good adherence to iron chelation therapy. There was a significant association between monthly household incomes of the family with the level of adherence to iron chelation (p-value 0.006). There was also an association between the mean serum ferritin levels with total Adherence Starts with Knowledge (ASK-12) score (p-value 0.001). However, there was no association between knowledge on thalassemia with the level of adherence. CONCLUSION Adherence to iron chelation was generally unsatisfactory amongst adolescents with TDT as only 51.4% had good adherence. Low monthly household income of the family may affect adherence to iron chelation therapy in TDT patients. As adherence remains to be an issue amongst adolescent thalassemia patients, management should include regular and objective assessments to address this problem so as to optimize patient outcome.
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Affiliation(s)
- Rafaa Mohamed
- Department of Pediatrics, Tengku Ampuan Rahimah Hospital, Klang, Malaysia
| | | | - Farin Masra
- Department of Pediatrics, National University of Malaysia, Bangi, Malaysia
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Monteiro C, Maricoto T, Prazeres F, Augusto Simões P, Augusto Simões J. Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature. Respir Med 2021; 191:106724. [PMID: 34954637 DOI: 10.1016/j.rmed.2021.106724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. METHODS Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. RESULTS 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03-1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28-1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12-1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17-1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05-2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83-0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79-0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. CONCLUSIONS Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.
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Affiliation(s)
- Constança Monteiro
- Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal
| | - Tiago Maricoto
- Aveiro Healthcare Centre, Aradas Health Unit, Aveiro, Portugal; Faculty of Health Sciences, GRUBI - Systematic Reviews Group, University of Beira Interior, 6200-506, Covilhã, Portugal.
| | - Filipe Prazeres
- Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal; Family Health Unit Beira Ria, 3830-596, Gafanha da Nazaré, Portugal; Centre for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450, Porto, Portugal
| | - Pedro Augusto Simões
- Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal; Pulsar Family Health Unit, Coimbra, Portugal
| | - José Augusto Simões
- Faculty of Health Sciences, University of Beira Interior, 6200-506, Covilhã, Portugal; Centre for Health Technology and Services Research (CINTESIS), University of Porto, 4200-450, Porto, Portugal; USF Caminhos do Certoma, do ACeS Baixo Mondego, Portugal
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Müller S, Maywald U, Timmermann H, Unmüßig V, Welte R, Hardtstock F, Wilke T. Identifying the Causes Increasing the Risk of Non-Adherence in Adult Patients with Asthma: An Analysis Combining Patient Survey Data with German Claims Data. Drugs Real World Outcomes 2021; 8:207-214. [PMID: 33629279 PMCID: PMC8128956 DOI: 10.1007/s40801-021-00236-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There exists a range of treatments in the management of asthma. Non-adherence to these medications has been identified as a factor negatively impacting the effects of treatment. OBJECTIVE The objective of this study was to identify the potential barriers to medication adherence among adult patients with asthma in Germany. PATIENTS AND METHODS A multi-center observational study was conducted addressing adult patients with asthma who were prescribed regular maintenance medication between 2014 and 2016. Data were derived from physicians' documentation as well as claims data, which were linked to the above primary observational data, and patient survey data. Adherence barriers were assessed by the validated Adherence Barriers Questionnaire, both descriptively and in a logistic regression framework. Cluster analysis identified distinct patient groups with respect to the relevance of specific adherence barriers. RESULTS We included 524 patients with asthma (mean age 53.1 years, 74.6% female, 43.1% allergic asthma, 37.6% nonallergic, 19.3% mixed). Most of the participants reported to face at least three barriers (61.1%). Frequently reported barriers were the perception that medications are all harmful (53.6% of the participants), the burden of medication co-payment (44.1%), positive perception about current health status (39.9%), feeling of depression (30.9%), and the fear of side effects (27.5%). Four distinct patient clusters could be identified: cluster 1 with a low number of barriers (28.6% of participants), cluster 2 (11.6%) with a comparably high number of existing barriers, cluster 3 with high importance of depression as a barrier (27.3% of participants), and cluster 4 that was dominated by the perception that medications are all harmful (32.5% of participants). CONCLUSIONS Results of this study provide important insights for further development of adherence programs, which should focus on distinct patients' clusters that differ substantially in the relevance of specific adherence barriers.
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Affiliation(s)
- Sabrina Müller
- Ingress-Health HWM GmbH, Alter Holzhafen 19, 23966, Wismar, Germany.
| | | | | | | | | | | | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik e.V, Wismar, Germany
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Ekbom K, Strandqvist A, Lajic S, Hirschberg AL, Falhammar H, Nordenström A. Assessment of medication adherence in children and adults with congenital adrenal hyperplasia and the impact of knowledge and self-management. Clin Endocrinol (Oxf) 2021; 94:753-764. [PMID: 33346381 PMCID: PMC8246868 DOI: 10.1111/cen.14398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is caused by a deficiency of one of the enzymes required for cortisol biosynthesis. The disease is classified as either classic (severe phenotype), subdivided into simple virilizing (SV) and salt-wasting (SW), or non-classic (NC) CAH. The treatment regime involves life-long glucocorticoid replacement, especially in classic phenotype. OBJECTIVES We aimed to assess medication adherence, endocrine knowledge and self-management in patients with CAH and to compare patients' and physicians' assessments of medication adherence. METHODS A prospective cross-sectional study of 108 patients with CAH (52 children and 56 adults) and 45 parents/caregivers. Two adherence measures were used, a self-reported questionnaire named Adherence Starts with Knowledge (ASK-12) with a cut-off level > 22 defined as poor adherence rate, and an assessment by a physician based on growth rate, 17-hydroxyprogesterone profile, and medical history, ranked using a five-point Likert scale. Measurements of the patients'/parents' knowledge and self-management were performed using Endocrine Society Clinical Practice Guidelines. RESULTS Self-reported medication adherence was good with 74% of the participants reported good adherence with higher adherence in patients with the SW form. The highest endocrine knowledge and self-management were found in parents compared with children and adults with classic CAH. There was 30% discordance between the assessments by a physician and the self-reported ASK-12 scores independent of the severity of CAH. CONCLUSION Patients and endocrinologists reported high medication adherence, however, discordance was found in 30% of the studied patients. Patients with the more severe form of CAH had higher adherence rates and demonstrated good endocrine knowledge/self-management.
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Affiliation(s)
- Kerstin Ekbom
- Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric EndocrinologyAstrid Lindgren Children HospitalKarolinska University HospitalStockholmSweden
| | - Anna Strandqvist
- Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
- Division of PsychologyDepartment of Clinical NeuroscienceKarolinska InstitutetStocholmSweden
| | - Svetlana Lajic
- Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric EndocrinologyAstrid Lindgren Children HospitalKarolinska University HospitalStockholmSweden
| | - Angelica L Hirschberg
- Department of Gynecology and Reproductive MedicineKarolinska University HospitalStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Anna Nordenström
- Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden
- Department of Paediatric EndocrinologyAstrid Lindgren Children HospitalKarolinska University HospitalStockholmSweden
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12
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Harada N, Harada S, Ito J, Atsuta R, Hori S, Takahashi K. Mobile Health App for Japanese Adult Patients With Asthma: Clinical Observational Study. J Med Internet Res 2020; 22:e19006. [PMID: 32795993 PMCID: PMC7455863 DOI: 10.2196/19006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inappropriate asthma control reduces quality of life and causes increased exacerbations. Mobile health (mHealth) employs information and communication technology for surveying health-related issues. OBJECTIVE This noninterventional, observational study assessed current real-world asthma control levels among Japanese patients with asthma and cough variant asthma (CVA) using the Zensoku-Log app. METHODS We developed the app using the ResearchKit platform and conducted a mobile-based, self-reporting, observational survey among patients with asthma and CVA. The app was downloaded 7855 times between February 2016 and February 2018, and enabled collection of data on symptoms, comorbidities, quality of life, medications, asthma control, and adherence. RESULTS Of the 1744 eligible participants (median age 33 years; range 20-74 years; male-to-female ratio 38.7:61.3), 50.97% (889/1744) reported unscheduled visits, 62.84% (1096/1744) reported regularly scheduled visits, 23.14% (402/1737) smoked, and 40.75% (705/1730) had pets. In addition, 91.89% (1598/1739) of participants had atopic predisposition, including allergic rhinitis and atopic dermatitis. Daily inhaled corticosteroid and oral corticosteroid treatment had been prescribed for 89.45% (1552/1735) and 22.07% (383/1735) of participants, respectively. Although an asthma control questionnaire demonstrated poor asthma control in 58.48% (1010/1727), a leukotriene receptor antagonist, theophylline, and a long-acting muscarinic antagonist had been prescribed for only 30.66% (532/1735), 15.91% (276/1735), and 4.38% (76/1735), respectively. The Adherence Starts with Knowledge 12 total score was 29. In the 421 participants who repeated the questionnaire, asthma control increased significantly between the initial and last rounds (P=.002). CONCLUSIONS Users of this mHealth app in Japan had poorly controlled asthma and may need more treatment for asthma and their comorbidities. Repeated app users demonstrated improved asthma control. TRIAL REGISTRATION UMIN Clinical Trial Registry UMIN000021043; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023913.
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Affiliation(s)
- Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Sonoko Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Atopy (Allergy) Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Jun Ito
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ryo Atsuta
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Hori
- Department of Electric Medical Intelligence Management, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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13
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Characterization of low adherence population in asthma patients from Japan using Adherence Starts with Knowledge-12. Allergol Int 2020; 69:61-65. [PMID: 31420174 DOI: 10.1016/j.alit.2019.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/04/2019] [Accepted: 07/13/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adherence Starts with Knowledge-12 (ASK-12) is a useful indicator of drug adherence. In this study, we analyzed patient background including social and psychological factors in a low-adherence group of patients with asthma defined using ASK-12. METHODS From a questionnaire survey for patients with asthma from the Niigata Prefecture, Japan, conducted in the fall of 2016, we enrolled patients who answered all ASK-12 items and underwent a measured respiratory function test within 1 year. The low-adherence group (ASK-12 ≥ 28) was compared with the control group (ASK-12 < 28), and we conducted a cluster analysis of the low-adherence group. RESULTS There were 170 patients in the low-adherence group and 402 patients in the control group. There was a significant difference between age, gender, working status, smoking history, the percentage of forced expiratory volume in one second (%FEV1), asthma control test (ACT), and Patient Health Questionnaire-9 (PHQ-9) score between the two groups. Logistic analysis revealed that working status (working), % FEV1 (<90%), and PHQ-9 score (>5) were independent factors for the low-adherence group. The cluster analysis identified three clusters in the low-adherence group. Among these, one cluster was characterized by elderly males with chronic obstructive pulmonary disease and another by middle-aged nonsmoking females with a depression tendency, had problems with asthma control. CONCLUSIONS Several factors were considered to be attributed to low drug-adherence. There were several phenotypes in the low-adherence population correlated with incomplete asthma control. Intervention with drug adherence should be a future goal for asthma treatment.
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14
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Furuhashi K, Fujisawa T, Hashimoto D, Kamiya Y, Yasui H, Karayama M, Suzuki Y, Hozumi H, Enomoto N, Nakamura Y, Inui N, Suda T. Once-daily fluticasone furoate/vilanterol combination versus twice-daily budesonide/formoterol combination in the treatment of controlled stable asthma: a randomized crossover trial. J Asthma Allergy 2019; 12:253-261. [PMID: 31571932 PMCID: PMC6756272 DOI: 10.2147/jaa.s223093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Fluticasone furoate (FF)/vilanterol (VI) dry powder inhaler (DPI) is the only once-daily maintenance inhaled corticosteroid (ICS)/long-acting β2 adrenergic agonist (LABA) combination for asthma. We aimed to compare the clinical effects of once-daily FF/VI and twice-daily budesonide (BUD)/formoterol (FM) DPI in patients with controlled stable asthma. Methods We performed a randomized crossover trial in which stable asthmatic patients controlled on ICS/LABA received 8 weeks of FF/VI (100/25 μg 1 puff once-daily) or BUD/FM (160/4.5 μg 2 puffs twice-daily) DPI treatment. After a 4–8-week washout period, patients received another crossover treatment for 8 weeks. We assessed pulmonary function, the 5-item version asthma control questionnaire (ACQ5), the asthma control test (ACT), and fractional exhaled nitric oxide (FeNO) at baseline and after 8 weeks of treatment (week 8). As the primary outcome was change in force expiratory volume in 1 s (FEV1) between baseline and week 8, we evaluated the incidence of asthma exacerbation and adherence barrier questionnaire (Ask-12) at week 8. Results Twenty-three patients were initially enrolled in this study; however, one patient had to be excluded. The FF/VI DPI treatment group showed a similar magnitude of change in FEV1 between baseline and week 8 as the BUD/FM DPI treatment group. In addition, there were no significant differences in pulmonary function tests, ACQ5 scores, ACT scores, and FeNO between baseline and week 8 in both groups. Although the incidence of exacerbation did not differ between groups, the Ask-12 score in the FF/VI DPI group was significantly lower than that in the BUD/FM DPI group. Conclusions The present study indicates that once-daily FF/VI DPI is not inferior to twice-daily BUD/FM DPI in clinical effect and more likely to improve inconvenience and forgetfulness in inhalation adherence barriers for stable asthma control therapy. Once-daily FF/VI DPI may be an effective alternative for asthma maintenance treatment.
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Affiliation(s)
- Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yousuke Kamiya
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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15
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Yamazaki H, Matsuoka K, Fernandez J, Hibi T, Watanabe M, Hisamatsu T, Fukuhara S. Ulcerative colitis outcomes research in Japan: protocol for an observational prospective cohort study of YOURS (YOu and Ulcerative colitis: Registry and Social network). BMJ Open 2019; 9:e030134. [PMID: 31501121 PMCID: PMC6738732 DOI: 10.1136/bmjopen-2019-030134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Ulcerative colitis (UC) is a chronic inflammatory disease that mainly affects the colon in young patients. Typical symptoms of UC are bloody diarrhoea and faecal urgency, which disturb the quality of life (QOL) of patients, and intractable UC leads to hospitalisation and colectomy. To improve relevant outcomes such as symptoms, QOL and colectomy, many clinical questions need to be resolved regarding what the ideal lifestyle, psychosocial burden and optimal practice patterns are. In this YOu and Ulcerative colitis: Registry and Social network (YOURS) study, we will investigate the effect of lifestyle, psychosocial factors and practice patterns on patient-reported outcomes (PRO), hospitalisation rate and colectomy rate in Japanese patients with UC. METHODS AND ANALYSIS For this prospective cohort study, we recruited 2006 patients from five hospitals (Tokyo and Chiba; May 2018-January 2019). Patients will be able to access their own data and compare them with summarised data from all patients on the website beyond the YOURS study. At baseline, patients will answer a questionnaire regarding lifestyle (diet, exercise, sleep and work), psychosocial factors (stress, depression and social support) and PRO (symptoms and QOL). Information on practice patterns (eg, medications, endoscopy frequency) will be collected from electronic medical records. Gaps between patients' needs and healthcare professionals' practice will be identified. Follow-up surveys will be conducted periodically for approximately 3 years. Research questions suggested by patients and healthcare professionals may be used in subsequent surveys. Results from the YOURS study will demonstrate optimal UC management strategies to improve relevant outcomes.The study was approved by the ethics committees of five investigational sites before starting the study. The results will be submitted to journals.UMIN000031995.
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Affiliation(s)
- Hajime Yamazaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Makhinova T, Barner JC, Brown CM, Richards KM, Rascati KL, Rush S, Nag A. Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma. J Pharm Pract 2019; 34:515-522. [PMID: 30947599 DOI: 10.1177/0897190019840117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics. METHODS Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective. RESULTS The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively (P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP (P < 0.0001). CONCLUSIONS The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.
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Affiliation(s)
- Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Jamie C Barner
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Carolyn M Brown
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Kristin M Richards
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Karen L Rascati
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
| | - Sharon Rush
- College of Pharmacy, 441903The University of Texas at Austin, Austin, TX, USA
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17
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Baiardini I, Novakova S, Mihaicuta S, Oguzulgen IK, Canonica GW. Adherence to treatment in allergic respiratory diseases. Expert Rev Respir Med 2018; 13:53-62. [PMID: 30518277 DOI: 10.1080/17476348.2019.1554438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent literature on adherence in asthma and AR, focused on the following areas: adherence extent, barriers and consequences, effects of educational interventions and use of new technologies to improve the level of adherence. Expert commentary: Despite the extent, reasons and effects of this problem being well known, non-adherence in asthma and allergic AR remains worryingly high. Poor adherence leads to unsatisfactory health outcomes, with a negative impact on patients and society. Recent literature suggests that successful programs to improve adherence should include a combination of strategies. The new technologies represent a promising tool to improve adherence.
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Affiliation(s)
- Ilaria Baiardini
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy
| | - Silviya Novakova
- b Allergy Unit of Internal Consulting Department , University Hospital "St. George" , Plovdiv , Bulgaria
| | - Stefan Mihaicuta
- c Pulmonology Department, CardioPrevent Foundation , University of Medicine and Pharmacy "Dr Victor Babes" , Timisoara , Romania
| | | | - Giorgio Walter Canonica
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy.,e Personalized Medicine, Asthma and Allergy Clinic , Humanitas Research Hospital, Milano, Italy
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18
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Li ZY, Tian CY, Wang XH, Liu YF. Effectiveness of Chinese herbal medicine Ping Chuan Ke Li for the management of mild/moderate persistent asthma. Medicine (Baltimore) 2018; 97:e12829. [PMID: 30407283 PMCID: PMC6250504 DOI: 10.1097/md.0000000000012829] [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: 11/26/2022] Open
Abstract
This study assessed the effectiveness and safety of Chinese herbal medicine Ping Chuan Ke Li (PCKL) for the treatment of patients with mild/ moderate persistent asthma.A total of 108 eligible patients with persistent asthma were included and were divided into a treatment group and a control group in this retrospective study. All 108 patients underwent oral montelukast. Additionally, subjects in the treatment group also received PCKL therapy. All patients in both groups were treated for a total of 1 month. The primary outcome of lung function was evaluated by the forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (FVC). The secondary outcome of quality of life was assessed by St. George's Respiratory Questionnaire (SGRQ). Moreover, adverse events (AEs) were also recorded in this study. All outcome measurements were assessed after 1-month treatment.After 1-month treatment, patients in the treatment group did not demonstrate better outcome in the improvement of lung function, measured by FEV1 (P =.57, table 2), and FEV1/FVC (P =.29); and enhancement of quality of life, measured by SGRQ scale (total, P =.37; symptom, P =.32; activity, P =.39; impact, P =.83). In addition, no AEs differ between 2 groups.The results of this study showed that Chinese herbal PCKL may not benefit for patients with mild/moderate persistent asthma after 1-month treatment.
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Affiliation(s)
- Zhu-Ying Li
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine
| | - Chun-Yan Tian
- Department of Graduate, Heilongjiang University of Chinese Medicine
| | - Xue-Hui Wang
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine
| | - Ya-Fang Liu
- Department of Science and Technology, Heilongjiang University of Chinese Medicine, Harbin, China
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