PERSYVE - Design and validation of a questionnaire about adverse effects of antihypertensive drugs

N-of-1 Trials vs. Usual Care in Children With Hypertension: A Pilot Randomized Clinical Trial

BACKGROUND

Blood pressure (BP) is often inadequately controlled in children treated for hypertension, and personalized (n-of-1) trials show promise for tailoring treatment choices. We assessed whether patients whose treatment choices are informed by an n-of-1 trial have improved BP control compared to usual care.

METHODS

A randomized clinical trial was conducted in a pediatric hypertension clinic in Houston from April 2018 to September 2020. Hypertensive adolescents and young adults 10-22 years old were randomized 1:1 to a strategy of n-of-1 trial using ambulatory BP monitoring to inform treatment choice or usual care, with treatment selected by physician preference. The primary outcome was the proportion of patients with ambulatory BP control at 6 months in a Bayesian analysis.

RESULTS

Among 49 participants (23 randomized to n-of-1 trials and 26 to usual care), mean age was 15.6 years. Using skeptical priors, we found a 69% probability that n-of-1 trials increased BP control at 6 months (Bayesian odds ratio (OR) 1.24 (95% credible interval (CrI) 0.51, 2.97), and 74% probability using neutral informed priors (OR 1.45 (95% CrI 0.48, 4.53)). Systolic BP was reduced in both groups, with a 93% probability of greater reduction in the n-of-1 trial group (mean difference between groups = -3.6 mm Hg (95% CrI -8.3, 1.28). There was no significant difference in side effect experience or caregiver satisfaction.

CONCLUSIONS

Among hypertensive adolescents and young adults, n-of-1 trials with ambulatory BP monitoring likely increased the probability of BP control. A large trial is needed to assess their use in clinical practice.

CLINICALTRIALS.GOV

NCT03461003.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov; NCT03461003.

Patient-Reported Adverse Events of Radiopharmaceuticals: Development and Validation of a Questionnaire

Introduction

Radiopharmaceuticals may cause adverse events. Knowledge about adverse events from a patient’s perspective could help healthcare professionals to detect, understand, and manage adverse events more efficiently when using radiopharmaceuticals. Researchers need a validated questionnaire that can be used in patients to assess adverse events with radiopharmaceuticals.

Objective

The aim of this study was to develop, validate the content of, and perform initial testing of a questionnaire assessing patient-reported adverse events of radiopharmaceuticals.

Methods

Based on existing literature, six professionals drafted and evaluated a first version of the questionnaire. Further content validation was performed using cognitive interviews with six patients undergoing a nuclear medicine examination. After adaptations, the questionnaire was developed into a web-based questionnaire. One hundred patients undergoing nuclear examination tested this version, and the results were used to assess its acceptability and evaluate reported adverse events.

Results

Questions and answer options were revised in the initial questionnaire to improve clarity. In addition, some questions were removed. The final version consisted of 18 questions. In the test phase, the acceptability of the questionnaire was demonstrated (e.g. 79% of the patients who received the questionnaire completed it, and the median time to complete the questionnaire was 12 min for patients who reported an adverse event). Of the 100 patients (53% men, median age 64 years), 12 reported a total of 22 adverse events. One of these adverse events had a high causal association.

Conclusion

After validation and testing, the developed questionnaire to study patient-reported adverse events of radiopharmaceuticals is a suitable and valid instrument which can be used in future research.

Electronic supplementary material

The online version of this article (10.1007/s40264-019-00895-2) contains supplementary material, which is available to authorized users.

Adverse effects and non-adherence to antihypertensive medications in University of Gondar Comprehensive Specialized Hospital

Background

A considerable proportion of cardiovascular events could be attributed to poor adherence to antihypertensive medications. Adverse effects can be severe enough to affect adherence to antihypertensive medications. This study aimed to measure the contribution of adverse effects on antihypertensive medications adherence.

Methods

The study was conducted from May 1 to June 30, 2017, at the ambulatory clinic of University of Gondar Comprehensive Specialized Hospital (UOGCSH) in Gondar town. A binary logistic regression was performed to determine the significance of the association between adverse effects and adherence to antihypertensive medications. An institution-based cross-sectional study was conducted by administering a questionnaire to hypertensive patients who came for follow-up at the ambulatory clinic of UOGCSH. Level of adherence to antihypertensive medications was used as outcome measure.

Results

A total of 249 patients were included in the final analysis with a mean age of 56.51 years and a female majority (53%). The following variables were identified as predictors of poor adherence: tiredness [AOR (95% CI): 3.802 (1.723-8.391), p = 0.001], muscle pain [AOR (95% CI): 5.199 (1.407-19.214), p = 0.013], poor sleep [AOR (95% CI): 4.891 (1.578-15.160), p = 0.006] and, believing that the symptoms were caused by antihypertensive medications [AOR (95% CI): 3.249 (1.248-8.456), p = 0.016].

Conclusion

Adverse effect significantly contributes to antihypertensive medication non-adherence among hypertensive patients.

Developmentand Validation of a Questionnaire about Patient Knowledge of Adverse Effects of Statins

Statins are drugs that are well tolerated, but considering their extensive use, there are still concerns regarding their safety. Knowledge of patients about the side effects of statins has not been adequately studied, although timely recognition of the AES is of vital importance for improving the quality of patient care and reducing morbidity and suffering. The aim of this study was to develop and test a questionnaire for measuring the knowledge of patients about statin therapy about adverse effects of statins (AES).

This two-center cross-sectional study was conducted during the period from March 1, 2015 to April 1, 2016, taking place in pharmacies from the city of Belgrade and at the Department of Internal Medicine, Clinical Center in Kragujevac, Serbia. The study included 300 patients and 20 pharmacists.

The questionnaire showed satisfactory internal consistency, with Cronbach’s alpha of 0.898, good construction and homogeneity of questions. After splitting the questionnaire to two parts at random, Cronbach’s alphas were 0.834 and 0.842 for the both parts, respectively. Exploratory factorial analysis revealed two domains. The patients rated their knowledge of the side effects of statins 52.7±19.9 on the visual analogue scale.

Based on the results of this study, we believe that this questionnaire could be a useful tool for testing the knowledge of patients about adverse effects of statins and help physicians to identify patients with insufficient knowledge who should be additionally informed about it.

Qualidade de vida e adesão medicamentosa para pessoas hipertensas

Resumo Objetivo: Analisar a correlação entre adesão medicamentosa e qualidade de vida para pessoas hipertensas assistidas em Unidades Básicas de Saúde. Métodos: Estudo transversal, analítico, com amostra aleatória e representativa. Avaliou-se a correlação entre qualidade de vida e adesão medicamentosa, utilizando-se o Minichal Brasil e a escala Morisky de adesão medicamentosa. Resultados: Participaram do estudo 720 pessoas, acompanhadas em 13 Unidades Básicas de Saúde. A média de idade foi de 62,5 anos. O coeficiente de Spearman revelou uma correlação inversa (Rho = -0,130) e estatisticamente significante (p=0,001), de fraca magnitude. Conclusão: A correlação inversa significa que maior adesão (maiores escores na escala Morisky) equivale a melhor qualidade de vida (menores escores da escala Minichal Brasil). A fraca correlação entre qualidade de vida e adesão medicamentosa reforça a ideia de que qualidade de vida para hipertensos está relacionada a outros fatores, sugerindo novas investigações.

Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ)

Objective:

(i) To develop the Pharmacy Value-Added Services Questionnaire (PVASQ) using emerging themes generated from interviews. (ii) To establish reliability and validity of questionnaire instrument.

Methods:

Using an extended Theory of Planned Behavior as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The PVASQ was constructed initially in English incorporating important themes and later translated into the Malay language with forward and backward translation. Intention (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), knowledge and expectations. Using a 7-point Likert-type scale and a dichotomous scale, test-retest reliability (N=25) was assessed by administrating the questionnaire instrument twice at an interval of one week apart. Internal consistency was measured by Cronbach’s alpha and construct validity between two administrations was assessed using the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was conducted to assess construct validity of the PVASQ.

Results:

The kappa coefficients indicate a moderate to almost perfect strength of agreement between test and retest. The ICC for all scales tested for intra-rater (test-retest) reliability was good. The overall Cronbach’ s alpha (N=25) is 0.912 and 0.908 for the two time points. The result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item was eliminated.

Conclusions:

This study is the first to develop and establish the reliability and validity of the Pharmacy Value-Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The translated Malay language version of PVASQ is reliable and valid to predict Malaysian patients’ intention to adopt pharmacy value-added services to collect partial medicine supply.

Associação entre a qualidade de vida e adesão à medicação de indivíduos hipertensos

Objetivo Avaliar a associação entre a qualidade de vida e a adesão a medicação de indivíduos hipertensos. Métodos Estudo transversal, realizado com 432 hipertensos cadastrados em sistema informatizado público federal. Os dados foram coletados no domicilio por entrevista estruturada com questões relacionadas a variáveis socioeconômicas, clínicas, avaliação da adesão ao tratamento e o WHOQOL-BREF para a qualidade de vida. Utilizou-se o teste de H de Kruskal-Wallis para medir a associação entre as escalas da qualidade de vida e a classificação da adesão ao tratamento. Resultados Os escores mais baixos estavam presente no domínio autoavaliação e os mais altos foram encontrados no social. Os indivíduos que possuíam adesão extrema ao tratamento anti-hipertensivo apresentaram escores mais altos na avaliação da qualidade de vida em comparação com indivíduos classificados como não adesão extrema ao tratamento anti-hipertensivo. Conclusão A associação entre a qualidade de vida e adesão a medicação em indivíduos hipertensos não foi preditiva, sendo que os melhores escores estavam presentes nos indivíduos hipertensos que apresentaram alta adesão a medicação e os piores escores da qualidade de vida se apresentaram nos indivíduos de não adesão extrema e limítrofe a não adesão total.