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del Pino-Sedeño T, González-Pacheco H, González de León B, Serrano-Pérez P, Acosta Artiles FJ, Valcarcel-Nazco C, Hurtado-Navarro I, Rodríguez Álvarez C, Trujillo-Martín MM. Effectiveness of interventions to improve adherence to antidepressant medication in patients with depressive disorders: a cluster randomized controlled trial. Front Public Health 2024; 12:1320159. [PMID: 38633230 PMCID: PMC11022850 DOI: 10.3389/fpubh.2024.1320159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
Aim To assess the effectiveness of two interventions of knowledge transfer and behavior modification to improve medication adherence in patients with depressive disorders. Methods An open, multicenter, three-arm clinical trial with random allocation by cluster to usual care or to one of the two interventions. The intervention for psychiatrists (PsI) included an educational program based on a patient-centered care model. The intervention for patients and relatives (PtI) included a collaborative care program plus a reminder system that works using an already available medication reminder application. The primary outcome was patient adherence to antidepressant treatment assessed through the Sidorkiewicz Adherence Instrument. Secondary measures were depression severity, comorbid anxiety and health-related quality of life. Mixed regression models with repeated measures were used for data analysis. Results Ten psychiatrists and 150 patients diagnosed with depressive disorder from eight Community Mental Health Units in the Canary Islands (Spain) were included. Compared with usual care, no differences in long-term adherence were observed in either group PsI or PtI. The PsI group had significantly improved depression symptoms (B = -0.39; 95%CI: -0.65, -0.12; p = 0.004) during the follow-up period. The PtI group presented improved depression symptoms (B = -0.63; 95%CI: -0.96, -0.30; p < 0.001) and mental quality of life (B = 0.08; 95%CI: 0.004, 0.15; p = 0.039) during the follow-up period. Conclusion The assessed interventions to improve adherence in patients with depressive disorder were effective for depression symptoms and mental quality of life, even over the long term. However, no effect on antidepressant adherence was observed.
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Affiliation(s)
- Tasmania del Pino-Sedeño
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Beatriz González de León
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Pérez
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
| | - Francisco Javier Acosta Artiles
- Service of Mental Health, General Management of Healthcare Programs, The Canary Islands Health Service, Las Palmas, Gran Canaria, Spain
- Department of Psychiatry, University Hospital of Gran Canaria Doctor Negrín, Las Palmas, The Canary Islands, Spain
| | - Cristina Valcarcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Isabel Hurtado-Navarro
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain
| | | | - María M. Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
- Institute of Biomedical Technologies (ITB), University of La Laguna, Tenerife, Canary Islands, Spain
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González de León B, Abt-Sacks A, Acosta Artiles FJ, del Pino-Sedeño T, Ramos-García V, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists. Int J Environ Res Public Health 2022; 19:16788. [PMID: 36554679 PMCID: PMC9779577 DOI: 10.3390/ijerph192416788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.
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Affiliation(s)
- Beatriz González de León
- Multiprofessional Teaching Unit of Family and Community Care La Laguna-Tenerife Norte, Management of Primary Care of Tenerife, 38320 Santa Cruz de Tenerife, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Francisco Javier Acosta Artiles
- Department of Mental Health, General Management of Healthcare Programs, Canary Islands Health Service, 35071 Las Palmas de Gran Canaria, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Psychiatry, Insular University Hospital of Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Tasmania del Pino-Sedeño
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | | | - Daniel Bejarano-Quisoboni
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Center for Public Health Research (CSISP-FISABIO), 46020 Valencia, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - María M. Trujillo-Martín
- Canary Islands Health Research Institute Foundation, 38320 Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
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González de León B, del Pino-Sedeño T, Serrano-Pérez P, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis. BMC Psychiatry 2022; 22:487. [PMID: 35858887 PMCID: PMC9301839 DOI: 10.1186/s12888-022-04120-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. METHODS We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. RESULTS Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). CONCLUSIONS Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. TRIAL REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723 .
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Affiliation(s)
- Beatriz González de León
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria “La Laguna ‑ Tenerife Norte”, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,grid.467039.f0000 0000 8569 2202Servicio de Evaluación y Planificación del Servicio Canario de La Salud, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Pérez
- grid.411083.f0000 0001 0675 8654Servicio de Psiquiatría, Hospital Universitario Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Departamento de Psiquiatría Y Medicina Legal, Universidad Autónoma de Barcelona, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Grupo de Investigación en Psiquiatría, Salud Mental Y Adicciones, Vall d’Hebron Instituto de Investigación (VHIR), Barcelona, Spain
| | - Cristobalina Rodríguez Álvarez
- grid.10041.340000000121060879Campus Ciencias de La Salud. Área de Medicina Preventiva y Salud Pública. Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Daniel Bejarano-Quisoboni
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - María M. Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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González-Díaz A, Ferrer Dufol A, Nogué Xarau S, Puiguriguer Ferrando J, Dueñas Laita A, Rodríguez Álvarez C, Burillo-Putze G. [Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)]. Rev Esp Salud Publica 2020; 94:e202001007. [PMID: 31942868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS The 10,548 cases studied had a mean age of 38.41 (±22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (±151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (±19.58) (p=0.0001). CONCLUSIONS The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed.
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Affiliation(s)
- Acéysele González-Díaz
- Servicio de Urgencias. Hospital Universitario de Canarias. Tenerife. España
- Universidad de La Laguna. Tenerife. España
| | - Ana Ferrer Dufol
- Fundación Española de Toxicología Clínica. Zaragoza. España
- Unidad de Toxicología Clínica. Hospital Clínico Lozano Blesa. Zaragoza. España
- Universidad de Zaragoza. Zaragoza. España
| | - Santiago Nogué Xarau
- Fundación Española de Toxicología Clínica. Zaragoza. España
- Servicio de Urgencias y Unidad de Toxicología Clínica. Hospital Son Espases. Palma de Mallorca. España
- Universidad de Barcelona. Barcelona. España
| | - Jordi Puiguriguer Ferrando
- Fundación Española de Toxicología Clínica. Zaragoza. España
- Servicio de Urgencias y Unidad de Toxicología Clínica. Hospital Son Espases. Palma de Mallorca. España
| | - Antonio Dueñas Laita
- Fundación Española de Toxicología Clínica. Zaragoza. España
- Unidad Regional de Toxicología Clínica. Hospital Universitario del Río Ortega. Valladolid. España
- Universidad de Valladolid. Valladolid. España
| | | | - Guillermo Burillo-Putze
- Servicio de Urgencias. Hospital Universitario de Canarias. Tenerife. España
- Universidad de La Laguna. Tenerife. España
- Fundación Española de Toxicología Clínica. Zaragoza. España
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González-Díaz A, Ferrer Dufol A, Nogué Xarau S, Puiguriguer Ferrando J, Dueñas Laita A, Rodríguez Álvarez C, Burillo-Putze G. Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETv). Rev Esp Salud Publica 2020. [DOI: 10.4321/s1135-57272020000100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Cabrera de León A, Rodríguez Pérez MC, Domínguez Coello S, Rodríguez Díaz C, Rodríguez Álvarez C, Aguirre Jaime A. Validación del modelo REI para medir la clase social en población adulta. Rev Esp Salud Publica 2009; 83:231-42. [DOI: 10.1590/s1135-57272009000200007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Martínez Bugallo F, Rodríguez Álvarez C, Salgado Parreño FJ, Aguirre-Jaime A. Diabetes gestacional oculta por incumplimiento del protocolo diagnóstico. Med Clin (Barc) 2008; 130:676-7. [DOI: 10.1157/13120704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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