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Caballero J, Patel N, Waldrop D, Ownby RL. Patient activation and medication adherence in adults. J Am Pharm Assoc (2003) 2024; 64:102025. [PMID: 38320653 PMCID: PMC11081861 DOI: 10.1016/j.japh.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Patients' level of medication adherence provides conflicting results in its relationship to patient activation. Multiple factors may be contributing to these mixed results. OBJECTIVES The primary purpose was to assess the association of patient activation to medication adherence in adults with chronic health conditions and low health literacy (HL). Secondary objectives were to determine whether age, education, gender, and race were associated with activation. METHODS Participants completed self-report questionnaires regarding chronic disease self-management. Patient activation was measured using Hibbard's Patient Activation Measure (PAM). Self-report of medication adherence was determined using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables and education to adherence and then the added relation of patient activation in a second model. RESULTS The analyses included 301 participants (mean age 58 years; 53% female; mean chronic conditions of 6.6). Some of the most common chronic conditions included hypertension (60%), arthritis (51%), depression (49%), and hyperlipidemia (43%). The relation of older age to greater medication adherence was significant (P < 0.05) in both models. The addition of PAM was significantly related to better adherence (P < 0.001) and also increased the R squared value from 0.04 to 0.09. This change resulted in a moderate effect size (d = 0.50). CONCLUSION Evaluating patient activation at baseline may predict those more likely to be medication adherent in patients with low HL.
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Saragih ID, Everard G, Saragih IS, Lee BO. The beneficial effects of transitional care for patients with stroke: A meta-analysis. J Adv Nurs 2024; 80:789-806. [PMID: 37727124 DOI: 10.1111/jan.15850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Transitional care interventions have emerged as a promising method of ensuring treatment continuity and health care coordination when patients are discharged from hospital to home. However, few studies have investigated the frequency and duration of interventions and the effects of interventions on physical function. Therefore, this study aimed to determine the efficacy of transitional care for patients with stroke. METHODS Six databases and the grey literature were searched to obtain relevant articles from October 1, 2022 to March 10, 2023. The primary outcomes studied were motor performance, walking speed, activities of daily living (ADLs) and caregiver burden following hospital-to-home transitional care. The quality of the studies was assessed with Cochrane risk of bias version 2. The quality and sensitivity of the evidence were assessed to ensure rigour of the findings. Meta-analyses were performed using stata 17.0. RESULTS A total of 2966 patients were identified from 23 studies. Transitional care improved post-stroke motor performance, walking speed and ADLs, and reduced caregiver burden. CONCLUSION The findings suggest that provision of transitional care model implementation in patients with stroke is important because it reduces disability in stroke patients and helps to decrease caregivers' burden. IMPACT The findings of the study emphasize the importance of transitional care programmes for stroke patients after they are discharged from the hospital and returned to their homes. To meet the needs of patients, all levels of health professionals including nurses should be aware of the discharge process and care plan.
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Affiliation(s)
| | - Gauthier Everard
- Centre Interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, QC, Canada
- Pole d'Hépato-Gastro-Entérologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgium
| | - Ice Septriani Saragih
- Department of Medical Surgical Nursing, STIkes Santa Elisabeth Medan, Medan, Indonesia
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
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Almalag HM, Alshehri MM, Altokhais NA, Aljanobi GA, Dessougi MIE, AlHarthi A, Omair MA, Attar SM, Bahlas SM, Alfurayj AS, Alazmi MS, Asiri AM, AlOmair MM, Al Juffali LI, Omair MA. Exploring factors influencing patient activation in Saudi rheumatoid arthritis patients: A Nationwide Cross-Sectional Survey-Results from the COPARA study. Immun Inflamm Dis 2023; 11:e1101. [PMID: 38018573 PMCID: PMC10681035 DOI: 10.1002/iid3.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To evaluate patient activation in rheumatoid arthritis (RA) patients using patient activation measure 13 (PAM-13) on a national level in Saudi Arabia. METHOD A national survey was administered across multiple centers in Saudi Arabia. Patient activation was assessed using the PAM-13. The Compliance Questionnaire for Rheumatology (CQR) and the RA Impact of Disease (RAID) tool were also administered. The data from the survey were analyzed, and the results were stratified based on activation level. All factors affecting patient activation were explored and reported. RESULTS A total of 1241 participants were included. Most of the patients were females (85%), the mean age was 47 (±14), and most patients lived in the central region (47%). The mean (±standard deviation) patient activation score was 578.7 (±13.0). Patient activation was affected by multiple factors: demographic characteristics, such as education, with a beta value of 1.11 (95% confidence interval [CI] 0.64 ̶1.58, p < .001). Higher CQR scores were associated with higher activation levels, with a beta value of 2.61 (95% CI 0.80 ̶4.44, p = .005), and higher RAID scores were associated with lower activation levels, with a beta value of 3.13 (95% CI 1.36 ̶4.91, p = .001). CONCLUSIONS Patient activation was affected by several demographic characteristics and the impact of RA. A higher activation may improve compliance. Future longitudinal studies are required to confirm these findings and should explore the underlying mechanism of these effects.
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Affiliation(s)
- Haya M. Almalag
- Department of Clinical Pharmacy, College of PharmacyKing Saud UniversityRiyadhSaudi Arabia
| | | | | | - Ghada A. Aljanobi
- Department of Medicine, Rheumatology UnitJohns Hopkins Aramco Healthcare, Dhahran Saudi ArabiaDhahranSaudi Arabia
| | - Maha I. El Dessougi
- Department of Medicine, Rheumatology UnitSecurity Forces HospitalRiyadhSaudi Arabia
| | - Amal AlHarthi
- Department of Medicine, Rheumatology UnitSecurity Forces HospitalRiyadhSaudi Arabia
| | - Maha A. Omair
- Department of Statistics and Operations Research, College of ScienceKing Saud UniversityRiyadhSaudi Arabia
| | - Suzan M. Attar
- Department of Medicine, Rheumatology UnitKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Sami M. Bahlas
- Department of Medicine, Rheumatology UnitKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Abdullah S. Alfurayj
- Department of Medicine, Rheumatology UnitBuraidah Central HospitalBuraidahSaudi Arabia
| | - Mansour S. Alazmi
- Department of Medicine, Rheumatology UnitPrince Mohammed Medical CitySakaka‐AljoufSaudi Arabia
| | - Alhussain M. Asiri
- Department of Medicine, Rheumatology UnitAseer Central HospitalAbhaSaudi Arabia
| | - Mohammed M. AlOmair
- Department of Medicine, Rheumatology UnitAseer Central HospitalAbhaSaudi Arabia
| | - Lobna I. Al Juffali
- Department of Clinical Pharmacy, College of PharmacyKing Saud UniversityRiyadhSaudi Arabia
| | - Mohammed A. Omair
- Department of Medicine, Rheumatology UnitKing Saud UniversityRiyadhSaudi Arabia
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Dammery G, Vitangcol K, Ansell J, Ellis LA, Smith CL, Carrigan A, Braithwaite J, Zurynski Y. The Patient Activation Measure (PAM) and the pandemic: Predictors of patient activation among Australian health consumers during the COVID-19 pandemic. Health Expect 2023; 26:1107-1117. [PMID: 36810854 PMCID: PMC10154866 DOI: 10.1111/hex.13725] [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: 10/16/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap. METHODS A representative, population-based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID-19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler-6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1-participants disengaged with their health; 2-becoming aware of how to manage their health; 3-acting on their health; and 4-engaging with preventative healthcare and advocating for themselves. RESULTS Of 5100 participants, 7.8% scored at PAM level 1; 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25-44 (p < .001) or people aged over 65 years (p < .05). Speaking a language other than English at home was significantly associated with having low PAM (p < .05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores (p < .001). CONCLUSION Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID-19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns. PATIENT OR PUBLIC CONTRIBUTION The study and survey questions were co-designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey.
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Affiliation(s)
- Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Kathryn Vitangcol
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia.,Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - James Ansell
- Consumers Health Forum of Australia, Deakin West, Australian Capital Territory, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
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Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, Packer TL, Lofters AK, Hahn-Goldberg S, McCarthy LM, Guilcher SJT. Medication self-management interventions for persons with stroke: A scoping review. PLoS One 2023; 18:e0285483. [PMID: 37200316 DOI: 10.1371/journal.pone.0285483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Kitchener, ON, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- OpenLab, University Health Network, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Chang X, Wang K, Wang Y, Tu H, Gong G, Zhang H. Medication Literacy in Chinese Patients with Stroke and Associated Factors: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:620. [PMID: 36612941 PMCID: PMC9819866 DOI: 10.3390/ijerph20010620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In China, stroke is characterized by high incidence, recurrence, disability, economic burden, and mortality. Regular and effective medication therapy can reduce stroke recurrence. High medication literacy is vital for the success of tertiary prevention measures aimed at preventing recurrence and minimizing disability. A cross-sectional survey using a medication literacy questionnaire was conducted between January and May 2022 on 307 inpatients of a Class III Grade A hospital in Hefei, Anhui Province, China. The demographic and clinical data of the patients were obtained from medical records. The health literacy of the patients was moderate, with 36.8% exhibiting adequate medication literacy. Univariate analysis identified significant differences in the medication literacy of the patients, depending on education level, annual income, family history of stroke, number of health problems, age, daily medication times, and brain surgery history. Multiple regression analysis revealed that education level, annual income, family history of stroke, and number of health problems significantly influenced medication literacy. In patients with stroke who are older and have a low education level, more health problems, no history of surgery, or no family history of stroke or medication guidance, medication knowledge and attitude can be improved to enhance medication safety and guarantee tertiary-level prevention of stroke.
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Affiliation(s)
- Xiao Chang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Kai Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Yuting Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Houmian Tu
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Guiping Gong
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Haifeng Zhang
- School of Health Management, Anhui Medical University, Hefei 230032, China
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Patient activation during the first 6 months after the start of stroke rehabilitation. Arch Phys Med Rehabil 2022; 103:1360-1367. [DOI: 10.1016/j.apmr.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
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