1
|
Heijman J, Wouters H, Schouten KA, Haeyen S. Effectiveness of trauma-focused art therapy (TFAT) for psychological trauma: study protocol of a multiple-baseline single-case experimental design. BMJ Open 2024; 14:e081917. [PMID: 38286685 PMCID: PMC10826536 DOI: 10.1136/bmjopen-2023-081917] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Treatments such as eye movement desensitisation and reprocessing and (narrative) exposure therapies are commonly used in psychological trauma. In everyday practice, art therapy is also often used, although rigorous research on its efficacy is lacking. Patients seem to benefit from the indirect, non-verbal experiential approach of art therapy. This protocol paper describes a study to examine the effectiveness of a 10-week individual trauma-focused art therapy (TFAT) intervention. METHODS AND ANALYSIS A mixed-methods multiple-baseline single-case experimental design will be conducted with 25-30 participants with psychological trauma. Participants will be randomly assigned to a baseline period lasting 3-5 weeks, followed by the TFAT intervention (10 weeks) and follow-up (3 weeks). Quantitative measures will be completed weekly: the Beck Depression Inventory-II, the Mental Health Continuum Short Form, the Resilience Scale, the Rosenberg Self-Esteem Scale and the Self-expression and Emotion Regulation in Art Therapy Scale. The Post-Traumatic Stress Disorder Checklist-5 will be completed at week 1 and week 10. Qualitative instruments comprise a semistructured interview with each individual patient and therapist, and a short evaluation for the referrer. Artwork will be used to illustrate the narrative findings. Quantitative outcomes will be analysed with linear mixed models using the MultiSCED web application. Qualitative analyses will be performed using thematic analysis with ATLAS.ti. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the HAN University of Applied Sciences (ECO 394.0922). All participants will sign an informed consent form and data will be treated confidentially. Findings will be published open access in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05593302.
Collapse
Affiliation(s)
- Jackie Heijman
- Research Group Arts & Psychomotor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hans Wouters
- Research Group Arts & Psychomotor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Bartimeus, Zeist, The Netherlands
| | - Karin Alice Schouten
- Research Centre of the Arts Therapies, KenVaK, Heerlen, The Netherlands
- ARQ Centre '45, Diemen, The Netherlands
| | - Suzanne Haeyen
- Research Group Arts & Psychomotor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Scelta Expert Centre for Personality Disorders, GGNet Centre for Mental Health, Apeldoorn, The Netherlands
| |
Collapse
|
2
|
Flokstra-de Blok B, Kocks J, Wouters H, Arling C, Chatelier J, Douglass J, Heaney LG, Holmes J, Humbert M, Kolanowski M, Landsman JJA, Lugogo N, Malpass A, Meijer J, Metz B, de Mul B, Postma F, Leving M. Perceptions on Home-Administration of Biologics in the Context of Severe Asthma: An International Qualitative Study. J Allergy Clin Immunol Pract 2022; 10:2312-2323.e2. [PMID: 35487370 DOI: 10.1016/j.jaip.2022.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/21/2021] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Biologics are an effective therapy for severe asthma. Home administration of biologics by patients is likely to facilitate their accessibility. Yet little is known about patients' and health care providers' (HCPs) perceptions regarding home administration of biologics. OBJECTIVE The aim of this study is to create more insight into the perceptions and experiences of patients and HCPs regarding home administration of biologics in the context of the treatment of severe asthma. METHODS A qualitative international study was performed in the Netherlands, United States, Australia, and United Kingdom. In each country, 2 focus groups were held with potential/recent and long-term users of biologics at home. Prior to the focus groups, patients were prompted with themes on online forums. For triangulation purposes, interviews were held with HCPs to discuss salient findings from forums and focus groups. Data were analyzed with qualitative content analysis. RESULTS In total, 75 patients participated in the forums, of which 40 participated in the focus groups. Furthermore, 12 HCPs were interviewed. The following overarching themes were identified: living with severe asthma; practical aspects of using biologics; the role of HCPs regarding biologics; social support from family, friends, and others; effectiveness of biologics and other treatments; side effects of biologics. CONCLUSIONS This study showed that, for those using biologics for severe asthma, the benefits of home administration of biologics usually outweigh inconvenience and side effects. Guided practice, accessible support contact, and monitoring including social support should be central in the transition from hospital to home administration of asthma biologics.
Collapse
Affiliation(s)
- Bertine Flokstra-de Blok
- General Practitioners Research Institute, Groningen, The Netherlands; Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.
| | - Janwillem Kocks
- General Practitioners Research Institute, Groningen, The Netherlands; Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Observational and Pragmatic Research Institute, Singapore, Singapore; Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Chantal Arling
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Josh Chatelier
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Jo Douglass
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Liam G Heaney
- Wellcome Wolfson Centre for Experimental Medicine, Queens University, Belfast, Northern Ireland
| | - Joshua Holmes
- Wellcome Wolfson Centre for Experimental Medicine, Queens University, Belfast, Northern Ireland
| | - Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique - Hôpitaux de Paris, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mary Kolanowski
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Jeanet J A Landsman
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Njira Lugogo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Alice Malpass
- Bristol Medical School, Centre for Academic Primary Care (CAPC), University of Bristol, Bristol, UK
| | - Jiska Meijer
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Boyd Metz
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Bibicha de Mul
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Frank Postma
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Marika Leving
- General Practitioners Research Institute, Groningen, The Netherlands
| |
Collapse
|
3
|
Wiersema C, Oude Voshaar RC, van den Brink RHS, Wouters H, Verhaak P, Comijs HC, Jeuring HW. Determinants and consequences of polypharmacy in patients with a depressive disorder in later life. Acta Psychiatr Scand 2022; 146:85-97. [PMID: 35435249 PMCID: PMC9321061 DOI: 10.1111/acps.13435] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 03/27/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Polypharmacy and late-life depression often congregate in the geriatric population. The primary objective is to identify determinants of polypharmacy in patients with depression, and second to examine polypharmacy in relation to various clinical phenotypes of depression and its course. METHODS A longitudinal observational study using data of the Netherlands Study of Depression in Older persons (NESDO) including 375 patients with depression ≥ 60 years and 132 non-depressed comparisons. Linear and logistic regression were used to analyze both polypharmacy (dichotomous: ≥5 medications) and number of prescribed drugs (continuous) in relation to depression, various clinical phenotypes, and depression course. RESULTS Polypharmacy was more prevalent among patients with depression (46.9%) versus non-depressed comparisons (19.7%). A lower level of education, lower cognitive functioning, and more chronic diseases were independently associated with polypharmacy. Adjusted for these determinants, polypharmacy was associated with a higher level of motivational problems, anxiety, pain, and an earlier age of onset. A higher number of drugs was associated with a worse course of late-life depression (OR = 1.24 [95% CI: 1.03-1.49], p = 0.022). CONCLUSION Older patients with depression have a huge risk of polypharmacy, in particular among those with an early onset depression. As an independent risk factor for chronic depression, polypharmacy needs to be identified and managed appropriately. Findings suggest that depression moderates polypharmacy through shared risk factors, including motivational problems, anxiety, and pain. The complex interaction with somatic health burden requires physicians to prescribe medications with care.
Collapse
Affiliation(s)
- Carlijn Wiersema
- Department: University Center of Psychiatry, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Richard C. Oude Voshaar
- Department: University Center of Psychiatry, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Rob H. S. van den Brink
- Department: University Center of Psychiatry, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Hans Wouters
- Department of General PracticeUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Peter Verhaak
- Department of General PracticeUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands,Research Department, NIVEL, Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Hannie C. Comijs
- Department Psychiatry, Amsterdam Public Health Research InstituteVU University Medical CenterAmsterdamThe Netherlands
| | - Hans W. Jeuring
- Department: University Center of Psychiatry, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
4
|
W H Kocks J, Wouters H, Bosnic-Anticevich S, van Cooten J, Correia de Sousa J, Cvetkovski B, Dekhuijzen R, Dijk L, Dvortsin E, Garcia Pardo M, Gardev A, Gawlik R, van Geer-Postmus I, van der Ham I, Harbers M, de la Hoz A, Janse Y, Kerkhof M, Lavorini F, Maricoto T, Meijer J, Metz B, Price D, Roman-Rodriguez M, Schuttel K, Stoker N, Tsiligianni I, Usmani O, Leving MT. Factors associated with health status and exacerbations in COPD maintenance therapy with dry powder inhalers. NPJ Prim Care Respir Med 2022; 32:18. [PMID: 35618739 PMCID: PMC9135702 DOI: 10.1038/s41533-022-00282-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/10/2022] [Indexed: 01/25/2023] Open
Abstract
The study aimed to determine the associations of Peak Inspiratory Flow (PIF), inhalation technique and adherence with health status and exacerbations in participants with COPD using DPI maintenance therapy. This cross-sectional multi-country observational real-world study included COPD participants aged ≥40 years using a DPI for maintenance therapy. PIF was measured three times with the In-Check DIAL G16: (1) typical PIF at resistance of participant’s inhaler, (2) maximal PIF at resistance of participant’s inhaler, (3) maximal PIF at low resistance. Suboptimal PIF (sPIF) was defined as PIF lower than required for the device. Participants completed questionnaires on health status (Clinical COPD Questionnaire (CCQ)), adherence (Test of Adherence to Inhalers (TAI)) and exacerbations. Inhalation technique was assessed by standardised evaluation of video recordings. Complete data were available from 1434 participants (50.1% female, mean age 69.2 years). GOLD stage was available for 801 participants: GOLD stage I (23.6%), II (54.9%), III (17.4%) and IV (4.1%)). Of all participants, 29% had a sPIF, and 16% were shown able to generate an optimal PIF but failed to do so. sPIF was significantly associated with worse health status (0.226 (95% CI 0.107–0.346), worse units on CCQ; p = 0.001). The errors ‘teeth and lips sealed around mouthpiece’, ‘breathe in’, and ‘breathe out calmly after inhalation’ were related to health status. Adherence was not associated with health status. After correcting for multiple testing, no significant association was found with moderate or severe exacerbations in the last 12 months. To conclude, sPIF is associated with poorer health status. This study demonstrates the importance of PIF assessment in DPI inhalation therapy. Healthcare professionals should consider selecting appropriate inhalers in cases of sPIF.
Collapse
Affiliation(s)
- Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands. .,Observational and Pragmatic Research Institute, Singapore, Singapore. .,Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Joyce van Cooten
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
| | - Biljana Cvetkovski
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | | | - Lars Dijk
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Evgeni Dvortsin
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Marina Garcia Pardo
- Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma de Mallorca, Spain
| | - Asparuh Gardev
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Radosław Gawlik
- Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | | | - Iris van der Ham
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Marten Harbers
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Ymke Janse
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Marjan Kerkhof
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Tiago Maricoto
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - Jiska Meijer
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Boyd Metz
- General Practitioners Research Institute, Groningen, The Netherlands
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Miguel Roman-Rodriguez
- Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma de Mallorca, Spain
| | - Kirsten Schuttel
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Nilouq Stoker
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece
| | - Omar Usmani
- Airway Disease, National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK
| | - Marika T Leving
- General Practitioners Research Institute, Groningen, The Netherlands
| |
Collapse
|
5
|
Wanders L, Bakker EA, van Hout HPJ, Eijsvogels TMH, Hopman MTE, Visser LNC, Wouters H, Thijssen DHJ. Association between sedentary time and cognitive function: A focus on different domains of sedentary behavior. Prev Med 2021; 153:106731. [PMID: 34280406 DOI: 10.1016/j.ypmed.2021.106731] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Studies which examined the association between sedentary behavior (SB) and cognitive function have presented equivocal findings. Mentally active/inactive sedentary domains may relate differently to cognitive function. We examined associations between SB and cognitive function, specifically focusing on different domains. Participants were recruited from the Nijmegen Exercise Study 2018 in the Netherlands. SB (h/day) was measured with the Sedentary Behavior Questionnaire. Cognitive function was assessed with a validated computer self-test (COST-A), and a z-score calculated for global cognitive function. Multivariate linear regression assessed associations between tertiles of sedentary time and cognitive function. Cognition tests were available from 2821 participants, complete data from 2237 participants (43% female), with a median age of 61 [IQR 52-67] and a mean sedentary time of 8.3 ± 3.2 h/day. In fully adjusted models, cognitive function was significantly better in participants with the highest total sedentary time (0.07 [95% CI 0.02-0.12], P = 0.01), work-related sedentary time (0.13 [95% CI 0.07-0.19], P < 0.001), and non-occupational computer time (0.07 [95% CI 0.02-0.12], P = 0.01), compared to the least sedentary. Leisure sedentary time and time spent sedentary in the domains TV, reading or creative time showed no association with cognitive function in final models (all P > 0.05). We found a strong, independent positive association between total SB and cognitive function in a heterogenous population. This relation was not consistent across different domains, with especially work- and computer-related SB being positively associated with cognitive function. This highlights the importance of assessing the various sedentary domains in understanding the relation between sedentary time and cognitive function.
Collapse
Affiliation(s)
- Lisa Wanders
- Radboud Institute for Health Sciences, Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands; TiFN, P.O. Box 557, 6700 AN Wageningen, the Netherlands
| | - Esmée A Bakker
- Radboud Institute for Health Sciences, Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Hein P J van Hout
- Departments of General Practice and Medicine for Older Persons, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, the Netherlands
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Dick H J Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud university medical center, Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
| |
Collapse
|
6
|
Leving M, Wouters H, de la Hoz A, Bosnic-Anticevich S, Dekhuijzen R, Gardev A, Lavorini F, Meijer J, Price D, Rodríguez MR, Tsiligianni I, Usmani O, Wijnsma B, Kocks J. Impact of PIF, Inhalation Technique and Medication Adherence on Health Status and Exacerbations in COPD: Protocol of a Real-World Observational Study (PIFotal COPD Study). Pulm Ther 2021; 7:591-606. [PMID: 34533772 PMCID: PMC8445793 DOI: 10.1007/s41030-021-00172-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dry powder inhalers (DPIs), a commonly prescribed inhaler type for respiratory diseases, require patients to generate sufficient peak inspiratory flow (PIF) to ensure optimal drug delivery to the airways. Effectiveness of therapy also requires a good inhalation technique and adequate medication adherence. For patients with chronic obstructive pulmonary disease (COPD), recent studies conducted in tertiary care suggest that DPI users with suboptimal PIF have poorer COPD-related health status and increased exacerbation risk versus those with optimal PIF. The PIFotal study will investigate the impact of PIF, inhalation technique and medication adherence on patient-reported outcomes in patients with COPD in primary care using a DPI for their maintenance therapy. METHODS AND ANALYSIS This cross-sectional observational study will assess 1200 patients (aged ≥ 40 years, diagnosed with COPD and using a DPI for COPD maintenance therapy for ≥ 3 months) from the Netherlands, Spain, Portugal, Poland, Greece and Australia. Assessments will consist of (1) PIF measurements (usual patient inhalation manoeuvre, maximal PIF against resistance of own inhaler, and maximal PIF against low resistance); (2) Clinical COPD Questionnaire (CCQ), COPD Assessment Test and Test of Adherence to Inhalers scores; and (3) video recordings of patient inhalation technique. Dependent variables include health status (CCQ score), number of self-reported exacerbations in previous 12 months, and healthcare resource utilisation in previous 6 months. Independent variables include PIF values, inhalation technique errors, medication adherence, and demographic and clinical characteristics. In the primary analysis, the mean difference in CCQ score between patients (1) with optimal/suboptimal PIF, (2) exhibiting/not exhibiting inhalation technique errors, and (3) adhering/not adhering to medication will be examined in a multivariable linear mixed model. ETHICS The study protocol was approved by ethics committees/institutional review boards of all participating sites prior to enrolment; written informed consent was obtained from all study participants. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT04532853.
Collapse
Affiliation(s)
- Marika Leving
- General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands.
| | - Hans Wouters
- General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands
| | - Alberto de la Hoz
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
| | | | - Asparuh Gardev
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Jiska Meijer
- General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Miguel Román Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Omar Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Birgit Wijnsma
- General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands
| | - Janwillem Kocks
- General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- University Medical Center Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
7
|
Visser LN, Dubbelman MA, Verrijp M, Wanders L, Pelt S, Zwan MD, Thijssen DH, Wouters H, Sikkes SA, van Hout HP, van der Flier WM. The Cognitive Online Self-Test Amsterdam (COST-A): Establishing norm scores in a community-dwelling population. Alzheimers Dement (Amst) 2021; 13:e12234. [PMID: 34541288 PMCID: PMC8438682 DOI: 10.1002/dad2.12234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Heightened public awareness about Alzheimer's disease and dementia increases the need for at-home cognitive self-testing. We offered Cognitive Online Self-Test Amsterdam (COST-A) to independent groups of cognitively normal adults and investigated the robustness of a norm-score formula and cutoff. METHODS Three thousand eighty-eight participants (mean age ± standard deviation = 61 ± 12 years, 70% female) completed COST-A and evaluated it. Demographically adjusted norm scores were the difference between expected COST-A scores, based on age, gender, and education, and actual scores. We applied the resulting norm-score formula to two independent cohorts. RESULTS Participants evaluated COST-A to be of adequate difficulty and duration. Our norm-score formula was shown to be robust: ≈8% of participants in two cognitively normal cohorts had abnormal scores. A cutoff of -1.5 standard deviations proved optimal for distinguishing normal from impaired cognition. CONCLUSION With robust norm scores, COST-A is a promising new tool for research and clinical practice, providing low cost and minimally invasive remote assessment of cognitive functioning.
Collapse
Affiliation(s)
- Leonie N.C. Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
- Division of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Mark A. Dubbelman
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
| | - Merike Verrijp
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
| | - Lisa Wanders
- Radboud Institute for Health SciencesDepartment of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
- Top Institute Food and NutritionWageningenThe Netherlands
| | - Sophie Pelt
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
| | - Marissa D. Zwan
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
| | - Dick H.J. Thijssen
- Radboud Institute for Health SciencesDepartment of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Hans Wouters
- General Practitioners Research InstituteGroningenThe Netherlands
| | - Sietske A.M. Sikkes
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
- Faculty of Behavioural and Movement SciencesClinical Developmental Psychology & Clinical NeuropsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Hein P.J. van Hout
- Department of General Practice and Medicine for Older PersonsAmsterdam Institute for Public Health Care ResearchVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam NeuroscienceAmsterdam UMCVU University Medical CenterAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMCAmsterdamThe Netherlands
| |
Collapse
|
8
|
Klaver M, van den Hoofdakker BJ, Wouters H, de Kuijper G, Hoekstra PJ, de Bildt A. Exposure to challenging behaviours and burnout symptoms among care staff: the role of psychological resources. J Intellect Disabil Res 2021; 65:173-185. [PMID: 33331049 PMCID: PMC7839462 DOI: 10.1111/jir.12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Staff supporting individuals with intellectual disabilities are at risk of burnout symptoms. Evidence suggests an association between exposure to challenging behaviours of individuals with intellectual disabilities and burnout symptoms of staff, but the protective role of staff psychological resources in this relation has been understudied. METHOD We investigated the association between exposure to challenging behaviours and burnout symptoms of staff and the direct and moderating effects of several psychological resources. Staff (N = 1271) completed an online survey concerning burnout symptoms (subscale Emotional Exhaustion of the Maslach Burnout Inventory), exposure to challenging behaviours and a range of potential psychological resources. We examined main and moderating effects with multilevel analyses. In order to control for the multiple comparisons, P values corrected for false discovery rate (PFDR ) were reported. RESULTS We found a direct relation between exposure to challenging behaviours and increased levels of burnout symptoms in staff (b = .15, t(670) = 4.466, PFDR < .0001). Perceived supervisor social support (b = -.97, t(627) = -7.562, PFDR < .0001), staff self-efficacy (b = -.23, t(673) = -3.583, PFDR < .0001), resilience (b = -.19, t(668) = -2.086, PFDR < .05) and extraversion (b = -.20, t(674) = -3.514, PFDR < .05) were associated with reduced burnout symptoms. None of the proposed psychological resources moderated the association between exposure to challenging behaviours and burnout symptoms of staff. CONCLUSIONS Of the psychological resources found to be associated with reduced risk of burnout symptoms, staff self-efficacy and access of staff to supervisor social support seem to be the factors that can be influenced best. These factors thus may be of importance in reducing the risk of developing burnout symptoms and improving staff well-being, even though the current study was not designed to demonstrate causal relations between psychological resources and burnout symptoms.
Collapse
Affiliation(s)
- M. Klaver
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - B. J. van den Hoofdakker
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - H. Wouters
- General Practitioners Research InstituteGroningenThe Netherlands
| | - G. de Kuijper
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - P. J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - A. de Bildt
- Centre for Intellectual Disability and Mental HealthGGZ DrentheAssenThe Netherlands
- Department of Child and Adolescent PsychiatryUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
- AccareUniversity Centre for Child and Adolescent PsychiatryGroningenThe Netherlands
| |
Collapse
|
9
|
Holtman GA, Burger H, Verheij RA, Wouters H, Berger MY, Rosmalen JG, Verhaak PF. Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study. BMJ Open 2021; 11:e040730. [PMID: 33419906 PMCID: PMC7799137 DOI: 10.1136/bmjopen-2020-040730] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS. DESIGN AND SETTING Records from the longitudinal population-based ('Lifelines') cohort study were linked to electronic health records from general practitioners (GPs). PARTICIPANTS We included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort. OUTCOME MEASURES The outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed. RESULTS 18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29-0.47). CONCLUSIONS Several theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.
Collapse
Affiliation(s)
- Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Verheij
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Hans Wouters
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith Gm Rosmalen
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Fm Verhaak
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- NIVEL, Netherlands Institute of Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
10
|
Bock NW, Wouters H, Lammers AJ, Blanker MH. Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study. Front Psychiatry 2021; 12:775738. [PMID: 34803781 PMCID: PMC8600358 DOI: 10.3389/fpsyt.2021.775738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines. Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases. Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31-60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0-14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely "type of question," "cases in relation to current clinical guidelines," "case complexity" and "the doctor being pressured." Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients. Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.
Collapse
Affiliation(s)
- Nynke W Bock
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, Groningen, Netherlands
| | - Anne J Lammers
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, Netherlands
| |
Collapse
|
11
|
Wouters H, Hilmer SN, Gnjidic D, Van Campen JP, Teichert M, Van Der Meer HG, Schaap LA, Huisman M, Comijs HC, Denig P, Lamoth CJ, Taxis K. Long-Term Exposure to Anticholinergic and Sedative Medications and Cognitive and Physical Function in Later Life. J Gerontol A Biol Sci Med Sci 2020; 75:357-365. [PMID: 30668633 DOI: 10.1093/gerona/glz019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined whether over 20 years cumulative exposure to these medications was related to poorer cognitive and physical functioning. METHODS Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992 to 2012. On seven measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the drug burden index (DBI), a linear additive pharmacological dose-response model. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), Alphabet Coding Task (ACT, three trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, two trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, comorbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications. RESULTS Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the three ACT trials, AVLT learning condition, and the two RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI). CONCLUSIONS This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning.
Collapse
Affiliation(s)
- Hans Wouters
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sarah N Hilmer
- Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital
| | - Danijela Gnjidic
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Australia
| | - Jos P Van Campen
- Department of Geriatric Medicine, Onze Lieve Vrouwe Gasthuis (OLVG) hospital, Amsterdam, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, The Netherlands
| | - Helene G Van Der Meer
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Location VUmc, The Netherlands.,Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Hannie C Comijs
- Department Psychiatry, Amsterdam UMC, Location VUmc, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology
| | - Claudine J Lamoth
- Center of Human Movement Science, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, The Netherlands
| |
Collapse
|
12
|
Wouters H, Hilmer SN, Twisk J, Teichert M, Van Der Meer HG, Van Hout HPJ, Taxis K. Drug Burden Index and Cognitive and Physical Function in Aged Care Residents: A Longitudinal Study. J Am Med Dir Assoc 2020; 21:1086-1092.e1. [PMID: 32736845 DOI: 10.1016/j.jamda.2020.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Anticholinergic/antimuscarinic and sedative medications (eg, benzodiazepines) have been found to be associated with poorer cognitive and physical function and mobility impairment in older age. However, previous studies were mostly conducted among community-dwelling older individuals and had often a cross-sectional design. Accordingly, our aim was to examine longitudinal associations between cumulative exposure to anticholinergic and sedative medications and cognitive and physical function among residents from aged care homes. DESIGN Longitudinal study. SETTING AND PARTICIPANTS A total of 4624 residents of Dutch aged care homes of whom data were collected between June 2005 and April 2014. METHODS Outcome measures were collected with the Long-Term Care Facilities assessment from the international Residential Assessment Instrument (interRAI-LTCF) and included the Cognitive Performance Scale, the Activities of Daily Living (ADL) Hierarchy scale, a timed 4-meter walk test, distance walked, hours of physical activity, and days being outside. Cumulative exposure to anticholinergic and sedative medications was calculated with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. Associations were examined with linear mixed models to take the potential dependence of observations into account (ie, data were collected at repeated assessment occasions of residents who were clustered in aged care homes). Analyses were adjusted for sex, age, dementia, comorbidity (neurological, psychiatric, cardiovascular, oncological, and pulmonary), fractures, depressive symptoms, and medications excluded from the DBI. RESULTS We observed significant longitudinal associations between a higher DBI and poorer ADLs, fewer hours of physical activity, and fewer days being outside. We found no significant longitudinal association between a higher DBI and poorer cognitive function. CONCLUSIONS AND IMPLICATIONS Over time, cumulative exposure to anticholinergic and sedative medications is associated with poorer physical but not cognitive function in aged care residents. Careful monitoring of aged care residents with high cumulative anticholinergic and sedative medication exposure is needed.
Collapse
Affiliation(s)
- Hans Wouters
- Department of PharmacoTherapy, PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands; General Practitioners Research Institute, Groningen, the Netherlands.
| | - Sarah N Hilmer
- Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, the Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helene G Van Der Meer
- Department of PharmacoTherapy, PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
| | - Hein P J Van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, the Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
| |
Collapse
|
13
|
van der Veen W, Taxis K, Wouters H, Vermeulen H, Bates DW, van den Bemt PMLA. Factors associated with workarounds in barcode-assisted medication administration in hospitals. J Clin Nurs 2020; 29:2239-2250. [PMID: 32043705 PMCID: PMC7328795 DOI: 10.1111/jocn.15217] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 01/25/2023]
Abstract
Aims and objectives To identify that workarounds (defined as “informal temporary practices for handling exceptions to normal procedures or workflow”) by nurses using information technology potentially compromise medication safety. Therefore, we aimed to identify potential risk factors associated with workarounds performed by nurses in Barcode‐assisted Medication Administration in hospitals. Background Medication errors occur during the prescribing, distribution and administration of medication. Errors could harm patients and be a tragedy for both nurses and medical doctors involved. Interventions to prevent errors have been developed, including those based on information technology. To cope with shortcomings in information technology‐based interventions as Barcode‐assisted Medication Administration, nurses perform workarounds. Identification of workarounds in information technology is essential to implement better‐designed software and processes which fit the nurse workflow. Design We used the data from our previous prospective observational study, performed in four general hospitals in the Netherlands using Barcode techniques, to administer medication to inpatients. Methods Data were collected from 2014–2016. The disguised observation was used to gather information on potential risk factors and workarounds. The outcome was a medication administration with one or more workarounds. Logistic mixed models were used to determine the association between potential risk factors and workarounds. The STROBE checklist was used for reporting our data. Results We included 5,793 medication administrations among 1,230 patients given by 272 nurses. In 3,633 (62.7%) of the administrations, one or more workarounds were observed. In the multivariate analysis, factors significantly associated with workarounds were the medication round at 02 p.m.–06 p.m. (adjusted odds ratio [OR]: 1.60, 95% CI: 1.05–2.45) and 06 p.m.–10 p.m. (adjusted OR: 3.60, 95% CI: 2.11–6.14) versus the morning shift 06 a.m.–10 a.m., the workdays Monday (adjusted OR: 2.59, 95% CI: 1.51–4.44), Wednesday (adjusted OR: 1.92, 95% CI: 1.2–3.07) and Saturday (adjusted OR: 2.24, 95% CI: 1.31–3.84) versus Sunday, the route of medication, nonoral (adjusted OR: 1.28, 95% CI: 1.05–1.57) versus the oral route of drug administration, the Anatomic Therapeutic Chemical classification‐coded medication “other” (consisting of the irregularly used Anatomic Therapeutic Chemical classes [D, G, H, L, P, V, Y, Z]) (adjusted OR: 1.49, 95% CI: 1.05–2.11) versus Anatomic Therapeutic Chemical class A (alimentary tract and metabolism), and the patient–nurse ratio ≥6–1 (adjusted OR: 5.61, 95% CI: 2.9–10.83) versus ≤5–1. Conclusions We identified several potential risk factors associated with workarounds performed by nurses that could be used to target future improvement efforts in Barcode‐assisted Medication Administration. Relevance to clinical practice Nurses administering medication in hospitals using Barcode‐assisted Medication Administration frequently perform workarounds, which may compromise medication safety. In particular, nurse workload and the patient–nurse ratio could be the focus for improvement measures as these are the most clearly modifiable factors identified in this study.
Collapse
Affiliation(s)
- Willem van der Veen
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Department of IQ Healthcare, Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - David W Bates
- Harvard Medical School and Brigham and Woman's Hospital, Boston, MA, USA
| | - Patricia M L A van den Bemt
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
14
|
Wouters H, Foster JM, Ensink A, O'Donnell LK, Zuidema SU, Boersma F, Taxis K. Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study. Front Pharmacol 2019; 10:1026. [PMID: 31619991 PMCID: PMC6759938 DOI: 10.3389/fphar.2019.01026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/12/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews. Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the "method of constant comparison." Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: "realizing fidelity of the patient perspective (theme 1)," "level of comprehensiveness of medication reviews (theme 2)," "inclinations of healthcare providers (theme 3)," and "inter-professional collaboration and alliances (theme 4)." Theme 1 "realizing fidelity of the patient perspective" referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 "level of comprehensiveness of medication reviews" reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 "inclinations of healthcare providers" concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 "inter-professional collaboration and alliances" highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions. Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration.
Collapse
Affiliation(s)
- Hans Wouters
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Anne Ensink
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Froukje Boersma
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| |
Collapse
|
15
|
Wouters H, Foster JM, Ensink A, O'Donnell LK, Zuidema SU, Boersma F, Taxis K. Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study. Front Pharmacol 2019. [PMID: 31619991 DOI: 10.3389/fphar.2019.01026/full] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews. Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the "method of constant comparison." Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: "realizing fidelity of the patient perspective (theme 1)," "level of comprehensiveness of medication reviews (theme 2)," "inclinations of healthcare providers (theme 3)," and "inter-professional collaboration and alliances (theme 4)." Theme 1 "realizing fidelity of the patient perspective" referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 "level of comprehensiveness of medication reviews" reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 "inclinations of healthcare providers" concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 "inter-professional collaboration and alliances" highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions. Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration.
Collapse
Affiliation(s)
- Hans Wouters
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Anne Ensink
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Froukje Boersma
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| |
Collapse
|
16
|
Vlieland ND, van den Bemt BJF, Wouters H, Egberts ACG, Bouvy M, Gardarsdottir H. Associations between personality traits and adequate home storage of drugs in older patients. PSYCHOL HEALTH MED 2019; 24:1255-1266. [PMID: 31283357 DOI: 10.1080/13548506.2019.1634822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this study was to investigate the association between personality traits of older patients and adequate home storage of drugs. Forty-four participating Dutch community pharmacists randomly selected each up to four community-dwelling elderly patients (≥65 years) who were using at least one prescription drug. The Big Five Inventory was used to assess the personality traits - 'openness', 'conscientiousness', 'extraversion', 'agreeableness' and 'neuroticism' - of patients. An assessment of adequate home storage of drugs was made using a summed composite score for each patient ranging from zero (adequate storage) to three (inadequate storage) was based on storage criteria representing quality, information and level of storage organization. A 51.2% of the patients stored drugs adequately in accordance with all quality ("Q") and information ("I") criteria. A high level of drug storage organization was found in 70.8% of patients. Forty-three patients (31.4%) stored their drugs adequately based on all storage criteria (composite storage score 0). No associations between personality dimensions and adequate drug storage were found. Having a lower number of drugs was associated with adequate drug home storage (ORadjusted 0.86; 95% CI: 0.77-0.96). In conclusion, this study suggests that personality is not associated with adequate home storage of drugs in older patients.
Collapse
Affiliation(s)
- N D Vlieland
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht , Utrecht , The Netherlands
| | - B J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek , Nijmegen , The Netherlands.,Department of Pharmacy, Radboud Medical Center , Nijmegen , The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center , Maastricht , The Netherlands
| | - H Wouters
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - A C G Egberts
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht , Utrecht , The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University , Utrecht , The Netherlands
| | - Marcel Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University , Utrecht , The Netherlands
| | - H Gardarsdottir
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht , Utrecht , The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University , Utrecht , The Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland , Reykjavik , Iceland
| |
Collapse
|
17
|
van der Meer HG, Wouters H, Teichert M, Griens F, Pavlovic J, Pont LG, Taxis K. Feasibility, acceptability and potential effectiveness of an information technology-based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals. Ther Adv Drug Saf 2019; 10:2042098618805881. [PMID: 31019675 PMCID: PMC6463339 DOI: 10.1177/2042098618805881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Anticholinergic/sedative medications are frequently used by older people,
despite their negative impacts on cognitive and physical function. We
explore the feasibility, acceptability and potential effectiveness of an
innovative information technology (IT)-based intervention to prevent an
increase in anticholinergic/sedative load in older people. Methods: This was a prospective study in 51 Dutch community pharmacies. Pharmacists
used an IT-based tool to identify patients aged ⩾65 years,
with existing high anticholinergic/sedative loads (drug burden index
⩾2) and a newly initiated anticholinergic/sedative medication. We
determined the following. Feasibility: number of eligible patients
identified. Acceptability: pharmacists’ satisfaction with the
intervention, pharmacists’ time investment and patients’
willingness to reduce medication use. Potential effectiveness: number of
recommendations, rate of agreement of general practitioners (GPs) with
proposed recommendations and factors associated with agreement. To evaluate
the latter, pharmacists conducted medication reviews and proposed
recommendations to GPs for 5–10 patients selected by the IT-based
tool. Results: We included 305 patients from 47 pharmacies. Feasibility: a mean of 17.0
(standard deviation, 8.8) patients were identified per pharmacy.
Acceptability: 43 pharmacists (91.5%) were satisfied with the intervention.
The median time investment per patient was 33 min (range
6.5–210). Of 35 patients, 30 (85.7%) were willing to reduce
medication use. Potential effectiveness: pharmacists proposed 351
recommendations for 212 patients (69.5%). GPs agreed with recommendations
for 108 patients (35.4%). Agreement to stop a medication was reached in
19.8% of recommendations for newly initiated medications (37 of 187) and for
15.2% of recommendations for existing medications (25 of 164). Agreement was
more likely for recommendations on codeine [odds ratio (OR) 3.30; 95%
confidence interval (CI) 1.14–9.57] or medications initiated by a
specialist (OR 2.85; 95% CI 1.19–6.84) and less likely for
pharmacies with lower level of collaboration with GPs (OR 0.15; 95% CI
0.02–0.97). Conclusion: This innovative IT-based intervention was feasible, acceptable and
potentially effective. In one-third of patients an increase in
anticholinergic/sedative load was prevented within reasonable time
investment.
Collapse
Affiliation(s)
- Helene G van der Meer
- University of Groningen, Unit PharmacoTherapy, -Epidemiology & -Economy, HPC: XB45, Antonius Deusinglaan 1, 9711 AV Groningen, the Netherlands
| | - Hans Wouters
- University Medical Centre Groningen, Groningen, The Netherlands
| | - Martina Teichert
- Leiden University Medical Centre, Leiden, The NetherlandsRoyal Dutch Pharmacists Association, The Hague, The Netherlands
| | - Fabiënne Griens
- Foundation for Pharmaceutical Statistics, The Hague, The Netherlands
| | | | - Lisa G Pont
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Katja Taxis
- University of Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
van der Veen W, van den Bemt PMLA, Wouters H, Bates DW, Twisk JWR, de Gier JJ, Taxis K, Duyvendak M, Luttikhuis KO, Ros JJW, Vasbinder EC, Atrafi M, Brasse B, Mangelaars I. Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. J Am Med Inform Assoc 2019; 25:385-392. [PMID: 29025037 DOI: 10.1093/jamia/ocx077] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.
Collapse
Affiliation(s)
- Willem van der Veen
- Faculty of Science and Engineering, Department of PharmacoTherapy, PharmacoEpidemiology and PharmaEconomics, University of Groningen, Groningen, the Netherlands
| | | | - Hans Wouters
- Faculty of Science and Engineering, Department of PharmacoTherapy, PharmacoEpidemiology and PharmaEconomics, University of Groningen, Groningen, the Netherlands
| | - David W Bates
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics of the Vrije Universiteit Medical Centre, and the Institute of Health Science of the Vrije Universiteit, Amsterdam, the Netherlands
| | - Johan J de Gier
- Faculty of Science and Engineering, Department of PharmacoTherapy, PharmacoEpidemiology and PharmaEconomics, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- Faculty of Science and Engineering, Department of PharmacoTherapy, PharmacoEpidemiology and PharmaEconomics, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
van der Meer HG, Taxis K, Teichert M, Griens F, Pont LG, Wouters H. Anticholinergic and sedative medication use in older community-dwelling people: A national population study in the Netherlands. Pharmacoepidemiol Drug Saf 2019; 28:315-321. [PMID: 30747477 PMCID: PMC6593836 DOI: 10.1002/pds.4698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/18/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
Purpose To identify the proportion of older adults with a high anticholinergic/sedative load and to identify patient subgroups based on type of central nervous system (CNS)‐active medication used. Methods A cross‐sectional study of a nationwide sample of patients with anticholinergic/sedative medications dispensed by 1779 community pharmacies in the Netherlands (90% of all community pharmacies) in November 2016 was conducted. Patients aged older than 65 years with a high anticholinergic/sedative load defined as having a drug burden index (DBI) greater than 1 were included. Proportion of patients with a high anticholinergic/sedative load was calculated by dividing the number of individuals in our study population by the 2.4 million older patients using medications dispensed from study pharmacies. Patient subgroups based on type of CNS‐active medications used were identified with latent class analysis. Results Overall, 8.7% (209 472 individuals) of older adults using medications had a DBI greater than 1. Latent class analysis identified four patient subgroups (classes) based on the following types of CNS‐active medications used: “combined psycholeptic/psychoanaleptic medication” (class 1, 57.9%), “analgesics” (class 2, 17.9%), “antiepileptic medication” (class 3, 17.8%), and “anti‐Parkinson medication” (class 4, 6.3%). Conclusions A large proportion of older adults in the Netherlands had a high anticholinergic/sedative load. Four distinct subgroups using specific CNS‐active medication were identified. Interventions aiming at reducing the overall anticholinergic/sedative load should be tailored to these subgroups.
Collapse
Affiliation(s)
- Helene G van der Meer
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Fabiënne Griens
- Foundation for Pharmaceutical Statistics, The Hague, the Netherlands
| | - Lisa G Pont
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Hans Wouters
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
20
|
Holvast F, Oude Voshaar RC, Wouters H, Hek K, Schellevis F, Burger H, Verhaak PFM. Non-adherence to antidepressants among older patients with depression: a longitudinal cohort study in primary care. Fam Pract 2019; 36:12-20. [PMID: 30395196 DOI: 10.1093/fampra/cmy106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is common among older adults and is typically treated with antidepressants. OBJECTIVE To determine the non-adherence rates to antidepressants among older adults in primary care, based on non-initiation, suboptimal implementation or non-persistence. METHODS We selected all patients aged ≥60 years and diagnosed with depression in 2012, from the Netherlands Institute for Health Services Research (NIVEL) Primary Care Database. Non-initiation was defined as no dispensing within 14 days of the first prescription; suboptimal implementation, as fewer than 80% of the days covered by dispensed dosages; and non-persistence, as discontinuation within 294 days after first dispense. First, we determined the antidepressant non-initiation, suboptimal implementation and non-persistence rates. Second, we examined whether comorbidity and chronic drug use were associated with non-adherence by mixed-effects logistic regression (non-initiation or suboptimal implementation as dependent variables) and a clustered Cox regression (time to non-persistence). RESULTS Non-initiation, suboptimal implementation and non-persistence rates were 13.5%, 15.2% and 37.1%, respectively. As the number of chronically used drugs increased, the odds of suboptimal implementation (odds ratio, 0.89; 95% confidence interval, 0.83-0.95) and of non-persistence (hazard ratio, 0.87; 95% confidence interval, 0.82-0.92) reduced. CONCLUSIONS Non-adherence to antidepressants is high among older patients with depression in primary care settings. Adherence is better when patients are accustomed to taking larger numbers of prescribed drugs, but this only provides partial explanation of the variance. GPs should be aware of the high rates of non-adherence. Emphasizing the importance of adhering to the optimal length of antidepressant therapy might be prudent first steps to improving adherence.
Collapse
Affiliation(s)
- Floor Holvast
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen
| | - Richard C Oude Voshaar
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen
| | - Hans Wouters
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen
| | - Karin Hek
- NIVEL, Netherlands Institute for Health Services Research, Utrecht
| | - Francois Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht.,Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Huibert Burger
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen
| | - Peter F M Verhaak
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen.,NIVEL, Netherlands Institute for Health Services Research, Utrecht
| |
Collapse
|
21
|
Heringa M, Floor-Schreudering A, Wouters H, De Smet PAGM, Bouvy ML. Preferences of Patients and Pharmacists with Regard to the Management of Drug-Drug Interactions: A Choice-Based Conjoint Analysis. Drug Saf 2018; 41:179-189. [PMID: 28965265 PMCID: PMC5808046 DOI: 10.1007/s40264-017-0601-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction The management of drug–drug interactions (DDIs) is a complex process in which risk–benefit assessments should be combined with the patient’s perspective. Objective The aim of this study was to determine patients’ and pharmacists’ preferences regarding DDI management. Methods We conducted a choice-based conjoint survey about a fictitious DDI concerning the combination of a cardiovascular drug and an antibiotic for pneumonia. Patients and pharmacists had to choose 12 times between two management options. The options were described by five attributes, including risk, benefit and practical consequences. Each attribute could have two different levels, which were varied over the choice tasks. Latent class analysis was used to identify potential classes of respondents with distinct patterns of similar preferences. Results In total, 298 patients and 178 pharmacists completed the questionnaire. The latent class model for both patients and pharmacists resulted in three classes. For patients, in one class the most importance was attached to avoiding switch of medication (class probability 20%), in a second class to fewer adverse events (41%), and in a third class to blood sampling (39%). For pharmacists, again one class attached the highest importance to avoiding switch of medication (31%). The other classes gave priority to curing pneumonia (31%) and avoiding blood sampling (38%). Conclusion The results showed diverging preferences regarding DDI management among both patients and pharmacists. Different groups attached different value to risk and benefit versus practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients is a step towards shared decision making in DDI management. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0601-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands. .,Health Base Foundation, Houten, The Netherlands.
| | - Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Wouters
- Department of Pharmacotherapy, -Epidemiology and -Economics, Groningen University, Groningen, The Netherlands
| | - Peter A G M De Smet
- Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | - Marcel L Bouvy
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
22
|
Holvast F, Wouters H, Hek K, Schellevis F, Oude Voshaar R, van Dijk L, Burger H, Verhaak P. Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study. Int J Cardiol 2018; 274:366-371. [PMID: 30249352 DOI: 10.1016/j.ijcard.2018.08.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is common among patients with cardiovascular disease and has been associated with both drug non-adherence and increased mortality. Non-adherence can occur because of non-initiation, suboptimal implementation, or non-persistence. We aimed to determine if depression increased the risk of any of these components of non-adherence among older patients prescribed cardiovascular drugs in primary care. METHODS A longitudinal analysis of routine primary care data from the Nivel Primary Care Database was performed using data for 2011-2013. A total of 1512 patients aged ≥60 years diagnosed with depression in 2012 were compared with age- and sex-matched groups with either other psychological diagnoses (N = 1457) or mentally healthy controls (N = 1508), resulting in the inclusion of 4477 patients. Non-adherence was classified as non-initiation, suboptimal implementation, or non-persistence. Regression analyses were performed to determine the association between mental health status and non-initiation, suboptimal implementation, and non-persistence. RESULTS Mixed-effects logistic regression analyses showed increased odds for suboptimal implementation of beta-blockers among depressed patients (2.18; 95% CI 1.29-3.69). For non-persistence, a clustered Cox regression analysis demonstrated that, compared with controls, there was an increased hazard ratio for depressed patients to discontinue beta-blockers (2.31; 95% CI 1.58-3.37) and calcium antagonists (1.74; 95% CI 1.23-2.46). CONCLUSIONS It is likely that older patients in primary care diagnosed with depression are at increased risk of non-persistence with cardiovascular drug therapy. Because non-adherence is associated with increased cardiovascular mortality, it is important that physicians ensure that older depressed patients persevere with therapy.
Collapse
Affiliation(s)
- Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Hans Wouters
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Karin Hek
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - François Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of General Practice and Elderly care medicine/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Richard Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, the Netherlands
| | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Peter Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands; NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
23
|
van der Meer HG, Wouters H, Pont LG, Taxis K. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial. BMJ Open 2018; 8:e019042. [PMID: 30030308 PMCID: PMC6059312 DOI: 10.1136/bmjopen-2017-019042] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI). DESIGN Randomised controlled single blind trial. SETTING 15 community pharmacies in the Northern Netherlands. PARTICIPANTS 157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1. INTERVENTION A medication review by the community pharmacist in collaboration with the patient's general practitioner and patient. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes were the presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up. RESULTS Mean participant age was 75.7 (SD, 6.9) years in the intervention arm and 76.6 (SD, 6.7) years in the control arm, the majority were female (respectively 69.3% and 72.0%). Logistic regression analysis showed no difference in the proportion of patients with a≥0.5 decrease in DBI between intervention arm (17.3%) and control arm (15.9%), (OR 1.04, CI 0.47 to 2.64, p=0.927). Intervention patients scored higher on the Digit Symbol Substitution Test, measure of cognitive function (OR 2.02, CI 1.11 to 3.67, p=0.021) and reported fewer sedative side effects (OR 0.61, CI 0.40 to 0.94, p=0.024) at follow-up. No significant difference was found for other secondary outcomes. CONCLUSIONS Pharmacist-led medication review as currently performed in the Netherlands was not effective in reducing the anticholinergic/sedative load, measured with the DBI, within the time frame of 3 months. Preventive strategies, signalling a rising load and taking action before chronic use of anticholinergic/sedative medication is established may be more successful. TRIAL REGISTRATION NUMBER NCT02317666.
Collapse
Affiliation(s)
- Helene G van der Meer
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - Hans Wouters
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisa G Pont
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| |
Collapse
|
24
|
Taxis K, Kochen S, Wouters H, Boersma F, Jan Gerard M, Mulder H, Pavlovic J, Stevens G, McLachlan A, Pont LG. Cross-national comparison of medication use in Australian and Dutch nursing homes. Age Ageing 2018; 47:319. [PMID: 28087558 DOI: 10.1093/ageing/afx004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/13/2022] Open
|
25
|
Van Mierlo LD, Wouters H, Sikkes SAM, Van der Flier WM, Prins ND, Bremer JAE, Koene T, Van Hout HPJ. Screening for Mild Cognitive Impairment and Dementia with Automated, Anonymous Online and Telephone Cognitive Self-Tests. J Alzheimers Dis 2018; 56:249-259. [PMID: 27911296 PMCID: PMC5389042 DOI: 10.3233/jad-160566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Many older people worry about cognitive decline. Early cognitive screening in an anonymous and easily accessible manner may reassure older people who are unnecessarily worried about normal cognitive aging while it may also expedite help seeking in case of suspicious cognitive decline. Objective: To develop and validate online and telephone-based automated self-tests of cognitive function. Methods: We examined the feasibility and validity of the self-tests in a prospective study of 117 participants of whom 34 had subjective cognitive decline (SCD), 30 had mild cognitive impairment (MCI), and 53 had dementia. The ability of these self-tests to accurately distinguish MCI and dementia from SCD was examined with ROC curves. Convergent validity was examined by calculating rank correlations between the self-tests and neuropsychological tests. Results: Both the online and telephone cognitive self-tests were feasible, because the majority of participants (86% and 80%, respectively) were able to complete them. The online self-test had adequate diagnostic accuracy in the screening for MCI and dementia versus SCD with an Area under the Curve (AUC) of 0.86 (95% CI: 0.78–0.93). The AUC of the MMSE was 0.82 (95% CI: 0.74–0.89). By contrast, the telephone self-test had lower diagnostic accuracy (AUC = 0.75, 95% CI: 0.64–0.86). Both self-tests had good convergent validity as demonstrated by moderate to strong rank correlations with neuropsychological tests. Conclusion: We demonstrated good diagnostic accuracy and convergent validity for the online self-test of cognitive function. It is therefore a promising tool in the screening for MCI and dementia.
Collapse
Affiliation(s)
- Lisa D Van Mierlo
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans Wouters
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Sietske A M Sikkes
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
| | - Wiesje M Van der Flier
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
| | - Niels D Prins
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands
| | - Jonne A E Bremer
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Teddy Koene
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein P J Van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
26
|
Wouters H, Scheper J, Koning H, Brouwer C, Twisk JW, van der Meer H, Boersma F, Zuidema SU, Taxis K. Discontinuing Inappropriate Medication Use in Nursing Home Residents: A Cluster Randomized Controlled Trial. Ann Intern Med 2017; 167:609-617. [PMID: 29052691 DOI: 10.7326/m16-2729] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. OBJECTIVE To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home residents. DESIGN Pragmatic cluster randomized controlled trial, with clustering by elder care physicians and their wards. (ClinicalTrials.gov: NCT01876095). SETTING 59 Dutch nursing home wards for long-term care. PATIENTS Residents with a life expectancy greater than 4 weeks who consented to treatment with medication. INTERVENTION Multidisciplinary Multistep Medication Review (3MR) consisting of an assessment of the patient perspective, medical history, critical appraisal of medications, a meeting between the treating elder care physician and the pharmacist, and implementation of medication changes. MEASUREMENTS Successful discontinuation of use of at least 1 inappropriate drug (that is, without relapse or severe withdrawal symptoms) and clinical outcomes (neuropsychiatric symptoms, cognitive function, and quality of life) after 4 months of follow-up. RESULTS Nineteen elder care physicians (33 wards) performed the 3MR, and 16 elder care physicians (26 wards) followed standard procedures. A total of 426 nursing home residents (233 in the intervention group and 193 in the control group) were followed for an average of 144 days (SD, 21). In an analysis of all participants, use of at least 1 inappropriate medication was successfully discontinued for 91 (39.1%) residents in the intervention group versus 57 (29.5%) in the control group (adjusted relative risk, 1.37 [95% CI, 1.02 to 1.75]). Clinical outcomes did not deteriorate between baseline and follow-up. LIMITATIONS The 3MR was done only once. Some withdrawal symptoms or relapses may have been missed. CONCLUSION The 3MR is effective in discontinuing inappropriate medication use in frail nursing home residents without a decline in their well-being. PRIMARY FUNDING SOURCE Netherlands Organisation for Health Research and Development.
Collapse
Affiliation(s)
- Hans Wouters
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Jessica Scheper
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Hedi Koning
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Chris Brouwer
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Jos W Twisk
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Helene van der Meer
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Froukje Boersma
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Sytse U Zuidema
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| | - Katja Taxis
- From University of Groningen and University Medical Center Groningen, Groningen, and VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
27
|
Wouters H, Aalbers T, Maessen MFH, Verbeek ALM, Rikkert MGMO, Kessels RPC, Hopman MTE, Eijsvogels TMH. Physical Activity and Cognitive Function of Long-Distance Walkers: Studying Four Days Marches Participants. Rejuvenation Res 2017; 20:367-374. [PMID: 28602152 DOI: 10.1089/rej.2016.1876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies show physical activity to be beneficial for cognitive function. However, studies usually included individuals who were not particularly inclined to exercise. Following research among master athletes, we examined associations between physical activity and cognitive function in participants of the International Nijmegen Four Days Marches. These individuals are also inclined to exercise. On 4 consecutive days >40,000 participants walk a daily distance of 30-50 km (120-200 km or 75-125 miles in total). Four Days Marches participants and less active or inactive control participants from the Nijmegen Exercise Study were examined. Self-reported current and lifelong physical activities were quantified in Metabolic Equivalent of Task minutes/day, and training walking speed was estimated in km/h. Cognitive functioning in the domains of working memory, executive function, and visuospatial short-term memory was assessed using the validated Brain Aging Monitor. Data from 521 participants (mean age 54.7, standard deviation 12.9) showed neither positive associations between lifelong physical activity and working memory, executive function, and visuospatial short-term memory nor positive associations between current physical activity and cognitive functioning in these domains (p-values >0.05). However, a positive association between training walking speed and working memory was revealed (age adjusted β = 0.18, p-value <0.01). Walking speed as a surrogate marker of fitness, but not lifelong and current physical activity levels was associated with cognitive function. Therefore, walking speed deserves more attention in research aimed at unraveling associations between physical activity and cognitive function.
Collapse
Affiliation(s)
- Hans Wouters
- 1 Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen , Groningen, The Netherlands
| | - Teun Aalbers
- 2 Department of Geriatric Medicine, Radboud University Medical Centre , Nijmegen, The Netherlands .,3 Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Martijn F H Maessen
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - André L M Verbeek
- 5 Department of Health Evidence, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- 2 Department of Geriatric Medicine, Radboud University Medical Centre , Nijmegen, The Netherlands .,3 Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Roy P C Kessels
- 6 Donders Institute for Brain, Cognition and Behaviour, Radboud University , Nijmegen, The Netherlands .,7 Department of Medical Psychology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Maria T E Hopman
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands .,8 Research Institute for Sports and Exercise Sciences, Liverpool John Moores University , Liverpool, United Kingdom
| |
Collapse
|
28
|
Massoudi B, Blanker MH, van Valen E, Wouters H, Bockting CLH, Burger H. Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial. BMC Psychiatry 2017; 17:218. [PMID: 28610561 PMCID: PMC5470276 DOI: 10.1186/s12888-017-1376-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/06/2017] [Accepted: 06/01/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. METHODS This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. DISCUSSION This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice. TRIAL REGISTRATION Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).
Collapse
Affiliation(s)
- Btissame Massoudi
- Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands.
| | - Marco H. Blanker
- Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, the Netherlands
| | - Evelien van Valen
- 0000000120346234grid.5477.1Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands
| | - Hans Wouters
- Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, the Netherlands
| | - Claudi L. H. Bockting
- 0000000120346234grid.5477.1Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands ,0000 0004 0407 1981grid.4830.fDepartment of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Huibert Burger
- Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, the Netherlands
| |
Collapse
|
29
|
Taxis K, Kochen S, Wouters H, Boersma F, Jan Gerard M, Mulder H, Pavlovic J, Stevens G, McLachlan A, Pont LG. Cross-national comparison of medication use in Australian and Dutch nursing homes. Age Ageing 2017; 46:320-323. [PMID: 27974305 DOI: 10.1093/ageing/afw218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 11/06/2016] [Indexed: 01/20/2023] Open
Abstract
Background cross-national comparisons can be used to explore therapeutic areas and identify potential medication issues. Methods we used cross-sectional pharmacy supply data to explore medication use for nursing home residents in Australia (AU n = 26 homes, 1,560 residents) and the Netherlands (NL n = 6 homes, 2,037 residents). Binary logistic regression analysis was used to calculate the sex and aged adjusted odds ratios (OR) and associated 95% confidence intervals with a flexible Bonferroni-Holm procedure used to adjust for multiple hypothesis testing. Results total use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04, P = 0.16) and antibacterials (66.8% AU, 62.4% NL, OR 1.08 (0.93-1.24, P = 0.31) was similar, but choice of individual agents differed between the two countries. Differences were observed in the use of antithrombotics (46.7% AU, 64.7% NL, OR 0.48 (0.42-0.56, P > 0.01), ophthalmologicals (44.3% AU, 22.1% NL, OR 2.80 (2.42-3.24, P < 0.001), laxatives (77.1% AU, 65.8% NL, OR 1.65 (1.41-1.92, P < 0.001). Conclusion while the general prevalence of medication use in nursing home residents was similar across the two countries, distinct differences existed in the choice of agent among therapeutic groups. Comparing use between countries identified a number of potential medication related problem areas that need further exploration.
Collapse
Affiliation(s)
- Katja Taxis
- Department of Pharmacy, Rijksuniversiteit Groningen Ringgold Standard Institution, Division of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands
| | - Sjoerd Kochen
- Department of Pharmacy, Rijksuniversiteit Groningen Ringgold Standard Institution, Division of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands
| | - Hans Wouters
- Department of Pharmacy, Rijksuniversiteit Groningen Ringgold Standard Institution, Division of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands
| | - Froukje Boersma
- Department of General Practice, University Medical Center Groningen, Elderly Care Medicine, Groningen, The Netherlands
| | - Maring Jan Gerard
- Department of Pharmacy, Bethesda Ziekenhuis Ringgold Standard Institution, Hoogeveen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Ziekenhuis Assen WZA Ringgold Standard Institution, Assen, Drenthe, The Netherlands
| | - Jugoslav Pavlovic
- Department of Pharmacy, Rijksuniversiteit Groningen Ringgold Standard Institution, Division of Pharmacotherapy and Pharmaceutical Care, Groningen, The Netherlands
| | - Gerard Stevens
- Webstercare Ringgold Standard Institution, Five Dock, New South Wales, Australia
| | - Andrew McLachlan
- University of Sydney, Faculty of Pharmacy, Sydney, New South Wales, Australia
| | - Lisa G Pont
- Macquarie University Ringgold Standard Institution, Australian Institute for Health Innovation, North Ryde, New South Wales 2109, Australia
| |
Collapse
|
30
|
Wouters H, Van Campen JPCM, Appels BA, Beijnen JH, Zwinderman AH, Van Gool WA, Schmand B. Individualized evaluation of cholinesterase inhibitors effects in dementia with adaptive cognitive testing. Int J Methods Psychiatr Res 2016; 25:190-8. [PMID: 26299847 PMCID: PMC6877216 DOI: 10.1002/mpr.1484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/20/2015] [Accepted: 05/05/2015] [Indexed: 11/05/2022] Open
Abstract
Computerized Adaptive Testing (CAT) of cognitive function, selects for every individual patient, only items of appropriate difficulty to estimate his or her level of cognitive impairment. Therefore, CAT has the potential to combine brevity with precision. We retrospectively examined the evaluation of treatment effects of cholinesterase inhibitors by CAT using longitudinal data from 643 patients from a Dutch teaching hospital who were diagnosed with Alzheimer disease or Lewy Body disease. The Cambridge Cognitive Examination (CAMCOG) was administered before treatment initiation and after intervals of six months of treatment. A previously validated CAT was simulated using 47 CAMCOG items. Results demonstrated that the CAT required a median number of 17 items (inter-quartile range 16-20), or a corresponding 64% test reduction, to estimate patients' global cognitive impairment levels. At the same time, intraclass correlations between global cognitive impairment levels as estimated by CAT or based on all 47 CAMCOG items, ranged from 0.93 at baseline to 0.91-0.94 at follow-up measurements. Slightly more people had substantial decline on the original CAMCOG (N = 31/285, 11%) than on the CAT (N = 17/285, 6%). We conclude that CAT saves time, does not lose much precision, and therefore deserves a role in the evaluation of treatment effects in dementia. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Jos P C M Van Campen
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
| | - Bregje A Appels
- Department of Medical Psychology and Hospital Psychiatry, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Willem A Van Gool
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ben Schmand
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Abstract
BACKGROUND Chemotherapy has been shown to cause brain changes and to compromise cognitive function in cancer survivors. Knowledge about this matter is of vital importance for good clinical practice and insights into neurological aging. However, most studies have been conducted among breast cancer patients. Less is known about the effects of chemotherapy on the cognitive function of lymphoma patients. MATERIAL AND METHOD We studied patients with non-Hodgkin or Hodgkin lymphoma who had been treated with standard dose chemotherapy or with supplementary high dose chemotherapy when standard dose chemotherapy had been unsuccessful. Age- and sex-matched relatives and friends were invited to participate as control participants. All participants underwent a cognitive examination with a battery of validated neuropsychological tests. RESULTS Matching of patients with control participants was found to be successful. Regression analysis did not reveal worse cognitive functioning of patients (N = 106) compared to matched controls (N = 53) on the overall group level (All Bonferroni-Holm corrected p-values >0.05). However, a subgroup of 16% of patients had deviant performance according to a chance-corrected criterion based on Ingraham and Aiken's probability curves, i.e. 1.5 standard deviations below the norm on three of 14 tests. Exploratory analyses showed that this subgroup of patients was lower educated and had lower estimated premorbid intelligence. CONCLUSION Chemotherapy may compromise the function of the brain in a subgroup of lymphoma patients. We hypothesize protection of the brain by 'cognitive or brain reserve' as a possible explanation.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Joke W. Baars
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B. Schagen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Wouters H, Van Dijk L, Geers HCJ, Winters NA, Van Geffen ECG, Stiggelbout AM, Bouvy ML. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients. PLoS One 2016; 11:e0146272. [PMID: 26808151 PMCID: PMC4726652 DOI: 10.1371/journal.pone.0146272] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/15/2015] [Indexed: 12/25/2022] Open
Abstract
Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient alliance.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Liset Van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Harm C. J. Geers
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Nina A. Winters
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Erica C. G. Van Geffen
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel L. Bouvy
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
33
|
van der Meer HG, Wouters H, van Hulten R, Pras N, Taxis K. Decreasing the load? Is a Multidisciplinary Multistep Medication Review in older people an effective intervention to reduce a patient's Drug Burden Index? Protocol of a randomised controlled trial. BMJ Open 2015; 5:e009213. [PMID: 26700279 PMCID: PMC4691761 DOI: 10.1136/bmjopen-2015-009213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Older people often use medications with anticholinergic or sedative side effects which increase the risk of falling and worsen cognitive impairment. The Drug Burden Index (DBI) is a measure of the burden of anticholinergic and sedative medications. Medication reviews are typically done by a pharmacist in collaboration with a general practitioner to optimise the medication use and reduce these adverse drug events. We will evaluate whether a Multidisciplinary Multistep Medication Review (3MR) is an effective intervention to reduce a patient's DBI. METHODS A randomised controlled trial including 160 patients from 15 community pharmacies will be conducted. Per pharmacy, 1 pharmacist will perform a structured 3MR in close collaboration with the general practitioner, including the objective to reduce the DBI. ANALYSIS Primary outcome--the difference in proportion of patients having a decrease in DBI ≥ 0.5 in the intervention and control groups at follow-up. Secondary outcomes--anticholinergic and sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission, and mortality. ETHICS AND DISSEMINATION The burden of patients will be kept at a minimum. The 3MR can be considered as usual care by the pharmacist and general practitioner. Medical specialists will be consulted, if necessary. The intervention is specifically aimed at older community-dwelling patients in an attempt to optimise prescribing, in particular, to reduce medication with anticholinergic and sedative properties. Study results will be published in peer-reviewed journals and will be distributed through information channels targeting professionals. TRIAL REGISTRATION NUMBER NCT02317666; Pre-results.
Collapse
Affiliation(s)
- Helene G van der Meer
- Department of Pharmacy, Section of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Hans Wouters
- Department of Pharmacy, Section of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Rolf van Hulten
- Department of Pharmacy, Section of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Niesko Pras
- Department of Pharmacy, Section of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Department of Pharmacy, Section of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
34
|
Wouters H, Eijsvogels TMH, Hopman MTE. Walking speed and cognition in later life: findings from older participants of the Nijmegen 4 Days Marches. J Am Geriatr Soc 2015; 63:820-1. [PMID: 25900498 DOI: 10.1111/jgs.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hans Wouters
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands
| | | | | |
Collapse
|
35
|
Wouters H, Quik EH, Boersma F, Nygård P, Bosman J, Böttger WM, Mulder H, Maring JG, Wijma-Vos L, Beerden T, van Doormaal J, Postma MJ, Zuidema SU, Taxis K. Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial. BMJ Open 2014; 4:e006082. [PMID: 25296655 PMCID: PMC4194752 DOI: 10.1136/bmjopen-2014-006082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Nursing home residents often have a high number of comorbidities resulting in polypharmacy. Inappropriate prescribing is therefore likely to occur, which in turn is expected to worsen cognitive impairment, to increase the fall risk and to decrease residents' quality of life. The objective of the 'Discontinuing Inappropriate Medication in Nursing Home Residents' (DIM-NHR) study is to examine the efficacy and cost-effectiveness of the Multidisciplinary Multistep Medication Review (3MR) that is aimed at optimising prescribing and discontinuing inappropriate medication. METHODS A cluster randomised controlled trial will be conducted. Elderly care physicians and their wards (clusters) will be randomised. Data will be collected at baseline and 4 months after the 3MR has taken place. Six hundred nursing home residents will be recruited of whom more than half are expected to suffer from dementia. The 3MR will be based on consensus criteria and the relevant literature and will be performed by the patient's elderly care physician in collaboration with a pharmacist. ANALYSIS Primary outcomes-the difference in proportion of residents who successfully discontinued inappropriate medication between the intervention and control group at follow-up. Secondary outcomes-undertreatment, exposure to anticholinergic and sedative medicines, neuropsychiatric symptoms, cognitive function, falls, hospital admission, quality of life and cost-effectiveness. ETHICS AND DISSEMINATION Participant burden will be kept at a minimum. The elderly care physician will remain free to adjust medication when symptoms relapse or adverse events occur, rendering serious adverse events highly unlikely. Study findings will be published in peer-reviewed journals and a 3MR toolkit will be developed. TRIAL REGISTRATION NUMBER This study has been registered at http://www.ClinicalTrials.gov (trial registration number: NCT01876095).
Collapse
Affiliation(s)
- Hans Wouters
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Elise H Quik
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Froukje Boersma
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peder Nygård
- Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands
| | - Judith Bosman
- Hospital Pharmacy, Diaconessenhuis, Meppel, The Netherlands
| | | | - Hans Mulder
- Hospital Pharmacy, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands
| | | | - Linda Wijma-Vos
- Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands
| | - Tim Beerden
- Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands
| | - Jasperien van Doormaal
- Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacy, Unit of Pharmaco-epidemiology and Pharmaco-economics, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
36
|
de Jonghe J, Appels B, Goudsmit M, Wouters H. SS3.03: Cognitive screening for dementia: crossing four essential borders. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Abstract
BACKGROUND Antidepressants are frequently prescribed but results regarding their efficacy have been equivocal for different spectra of the severity continuum and their side-effects are often burdensome. Non-adherence is a likely consequence. The objective was therefore to examine patients' trade-offs between the efficacy, side-effects and other drawbacks of antidepressants and whether these trade-offs predicted non-adherence. METHOD Trade-offs from 225 antidepressant users, recruited through community pharmacies, were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated utilities, relative importance scores of treatment properties were calculated. Non-adherence was measured through self-report and pharmacy refill data. RESULTS Relapse prevention and symptom relief were on average equally important. Side-effects were as important and the side-effect stomach and intestine complaints was on average even slightly more important than relapse prevention and symptom relief. Additional treatment with psychotherapy was preferred by 61% of the patients. A benefit/drawback ratio revealed that 18% of the patients did not consider the efficacy to outweigh the drawbacks. A higher benefit/drawback ratio was associated with a decreased odds of intentional non-adherence [odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07-0.7, Wald = 6.7, p = 0.01). CONCLUSIONS For nearly one in five patients, the efficacy of antidepressants does not outweigh their drawbacks. Knowing patients' trade-offs is likely to aid both physicians and patients to identify important treatment preferences, to improve adherence and to make more deliberate decisions on whether or not to continue treatment.
Collapse
Affiliation(s)
- H Wouters
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands
| | - L Van Dijk
- NIVEL, Netherlands Institute for Health Services Research,Utrecht,The Netherlands
| | - E C G Van Geffen
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands
| | - H Gardarsdottir
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making,Leiden University Medical Centre,Leiden,The Netherlands
| | - M L Bouvy
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands
| |
Collapse
|
38
|
Wouters H, Stiggelbout AM, Bouvy ML, Maatman GA, Van Geffen ECG, Vree R, Nortier JW, Van Dijk L. Endocrine therapy for breast cancer: assessing an array of women's treatment experiences and perceptions, their perceived self-efficacy and nonadherence. Clin Breast Cancer 2014; 14:460-467.e2. [PMID: 24981234 DOI: 10.1016/j.clbc.2014.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/05/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although adjuvant endocrine therapy effectively prevents breast cancer recurrence, nonadherence rates are substantial. We therefore examined associations of women's experiences and perceptions regarding the efficacy, side effects, and practical problems of endocrine therapy with nonadherence. Furthermore, we examined whether women's perceived self-efficacy moderated these associations. PATIENTS AND METHODS Two hundred forty-one breast cancer patients participated. Using the electronic Tailored Medicine Inventory, which enables skipping of irrelevant items, experiences and perceptions were assessed in a comprehensive yet feasible manner. Adherence was assessed according to self-report and evaluated for agreement with adherence estimated from pharmacy refill data. RESULTS A substantial number of women doubted the efficacy of endocrine therapy, were worried about and/or had experienced hot flushes, loss of libido, joint ache, and/or practical problems with regard to information, intake, and packaging. Experience of practical problems (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0-5.8) and perceived self-efficacy with regard to medicine intake (OR, 0.5; 95% CI, 0.4-0.7) were associated with unintentional nonadherence. Number of side effects experienced (OR, 1.2; 95% CI, 1.05-1.4) and perceived self-efficacy with regard to learning about medication (OR, 0.6; 95% CI, 0.4-0.96) were associated with intentional nonadherence. Perceived self-efficacy did not moderate associations between women's treatment experiences and perceptions and nonadherence. CONCLUSION Endocrine therapy is challenging for many women. Targeting women's specific experiences and perceptions and improving their perceived self-efficacy is likely to decrease intentional and unintentional nonadherence.
Collapse
Affiliation(s)
- Hans Wouters
- Division of Pharmaco-Epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| | - Anne M Stiggelbout
- Department of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmaco-Epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Gemma A Maatman
- Division of Pharmaco-Epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Erica C G Van Geffen
- Division of Pharmaco-Epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Robbert Vree
- Department of Surgery, Diaconessenhuis Hospital, Leiden, The Netherlands
| | - Johan W Nortier
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liset Van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
39
|
Van Beneden K, Verschueren K, Willems W, Wouters H, D'Artois J, De Swert K, Arold G, De Bruyn S. FRI0329 Impact of Clinical Remission on Physical Function in Patients with Rheumatoid Arthritis Treated with Alx-0061: Post-Hoc Analysis of Phase I/Ii Data. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
40
|
Wouters H, Bouvy ML, Van Geffen ECG, Gardarsdottir H, Stiggelbout AM, Van Dijk L. Antidepressants in primary care: patients' experiences, perceptions, self-efficacy beliefs, and nonadherence. Patient Prefer Adherence 2014; 8:179-90. [PMID: 24550668 PMCID: PMC3926453 DOI: 10.2147/ppa.s53748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient adherence to antidepressants is poor. However, this is rather unsurprising, given the equivocal efficacy, side effects, and practical problems of antidepressants. The aim of this study was to examine a wide array of patient experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants, as well as their associations with nonadherence, and whether patients' perceived self-efficacy moderated these associations. PATIENTS AND METHODS Experiences and perceptions of 225 patients, recruited through community pharmacies, were efficiently assessed with the Tailored Medicine Inventory. Nonadherence was assessed through self-report and pharmacy refill data. RESULTS Many patients were not convinced of the efficacy, thought the efficacy to be limited or did not believe antidepressants to prevent relapse, were worried about or had experienced one or more side effects, and/or had experienced one or more practical problems regarding information, intake, and packaging. Being convinced of efficacy was associated with lower intentional nonadherence (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.8-0.96). A higher number of practical problems experienced was associated with increased unintentional nonadherence (OR 1.3, 95% CI 1.1-1.7). Higher perceived self-efficacy regarding taking antidepressants was associated with lower unintentional nonadherence (OR 0.7, 95% CI 0.5-0.9). Perceived self-efficacy did not moderate associations of patient experiences and perceptions with nonadherence. CONCLUSION Assessing a wide array of patients' experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants contributes to better understanding of nonadherence to antidepressants. Guiding physician-patient conversations by patients' experiences and perceptions may reduce both unintentional and intentional nonadherence. Also, it may give rise to considerations of prudent discontinuation, eg, when patients are not convinced of the efficacy.
Collapse
Affiliation(s)
- Hans Wouters
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Correspondence: Hans Wouters, Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, Utrecht 3508 TB, The Netherlands, Tel +31 6 1806 5473, Fax +31 30 253 9166, Email
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Erica CG Van Geffen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Liset Van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
41
|
Wouters H, van Geffen EC, Baas-Thijssen MC, Krol-Warmerdam EM, Stiggelbout AM, Belitser S, Bouvy ML, van Dijk L. Disentangling breast cancer patients' perceptions and experiences with regard to endocrine therapy: Nature and relevance for non-adherence. Breast 2013; 22:661-6. [DOI: 10.1016/j.breast.2013.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 04/15/2013] [Accepted: 05/09/2013] [Indexed: 11/25/2022] Open
|
42
|
Wouters H, Maatman G, Van Dijk L, Bouvy M, Vree R, Van Geffen E, Nortier J, Stiggelbout A. Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer. Ann Oncol 2013; 24:2324-9. [DOI: 10.1093/annonc/mdt195] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
43
|
Ceglia A, Meulebroeck W, Baert K, Wouters H, Nys K, Thienpont H, Terryn H. Cobalt absorption bands for the differentiation of historical Na and Ca/K rich glass. SURF INTERFACE ANAL 2011. [DOI: 10.1002/sia.3810] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Ceglia
- Faculty of Engineering, Brussels Photonics team B-PHOT, TONA-FirW; Vrije Universiteit Brussel; Pleinlaan 2 1050 Brussels Belgium
| | - W. Meulebroeck
- Faculty of Engineering, Brussels Photonics team B-PHOT, TONA-FirW; Vrije Universiteit Brussel; Pleinlaan 2 1050 Brussels Belgium
| | - K. Baert
- Faculty of Engineering, Research Group Electrochemical and Surface Engineering, Department of Materials and Chemistry, SURF-FirW; Vrije Universiteit Brussel; Pleinlaan 2 B-1050 Brussels Belgium
| | - H. Wouters
- Department of Art Sciences and Archaeology; Vrije Universiteit Brussel; Pleinlaan 2 1050 Brussels Belgium
| | - K. Nys
- Department of Art Sciences and Archaeology; Vrije Universiteit Brussel; Pleinlaan 2 1050 Brussels Belgium
| | - H. Thienpont
- Faculty of Engineering, Brussels Photonics team B-PHOT, TONA-FirW; Vrije Universiteit Brussel; Pleinlaan 2 1050 Brussels Belgium
| | - H. Terryn
- Faculty of Engineering, Research Group Electrochemical and Surface Engineering, Department of Materials and Chemistry, SURF-FirW; Vrije Universiteit Brussel; Pleinlaan 2 B-1050 Brussels Belgium
| |
Collapse
|
44
|
Wouters H, van Campen J, Appels B, Lindeboom R, Buiter M, de Haan RJ, Zwinderman AH, van Gool WA, Schmand B. Does Adaptive Cognitive Testing Combine Efficiency with Precision? Prospective Findings. ACTA ACUST UNITED AC 2011; 25:595-603. [DOI: 10.3233/jad-2011-101743] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hans Wouters
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Centre, Amsterdam, the Netherlands
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Jos van Campen
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, the Netherlands
| | - Bregje Appels
- Department of Medical Psychology Slotervaart Hospital, Amsterdam, the Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Centre, Amsterdam, the Netherlands
| | - Maarten Buiter
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Centre, Amsterdam, the Netherlands
| | - Rob J. de Haan
- Clinical Research Unit, Academic Medical Centre, Amsterdam, the Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Academic Medical Centre, Amsterdam, the Netherlands
| | - Willem A. van Gool
- Department of Neurology Academic Medical Centre, Amsterdam, the Netherlands
| | - Ben Schmand
- Department of Neurology Academic Medical Centre, Amsterdam, the Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
45
|
Wouters H, van Gool WA, Schmand B, Zwinderman AH, Lindeboom R. Three sides of the same coin: measuring global cognitive impairment with the MMSE, ADAS-cog and CAMCOG. Int J Geriatr Psychiatry 2010; 25:770-9. [PMID: 19946861 DOI: 10.1002/gps.2402] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The total scores of the ADAS-cog, MMSE and CAMCOG, comprising various cognitive tasks, are widely used to measure a dimension of global cognitive impairment. It is unknown, however, whether this dimension is common to these instruments. This hampers comparisons when either of these instruments is used. The extent to which these instruments share a common dimension of global cognitive impairment and how their scores relate was examined. METHODS Rasch analysis of CAMCOG and MMSE data of participants from a population based study and two memory clinics pooled with ADAS-cog and MMSE data of participants from three RCTs (overall N = 1566) to estimate a common dimension of global cognitive impairment and to examine the goodness of fit of the individual items to this dimension. RESULTS Using the estimated common dimension of global cognitive impairment, the total scores of the instruments could be related, e.g. a mean level of global cognitive impairment corresponded to a predicted score of 11.4 (ADAS-cog), 72.6 (CAMCOG) and 22.2 (MMSE). When revised according to The Rasch validity analyses, every individual item could be fitted to the dimension. CONCLUSIONS The MMSE, ADAS-cog and CAMCOG reflect a valid common dimension of global cognitive impairment, which enables comparisons of RCTs that use the ADAS-cog and observational studies that use the CAMCOG and MMSE.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
46
|
Podo F, Buydens LMC, Degani H, Hilhorst R, Klipp E, Gribbestad IS, Van Huffel S, van Laarhoven HWM, Luts J, Monleon D, Postma GJ, Schneiderhan-Marra N, Santoro F, Wouters H, Russnes HG, Sørlie T, Tagliabue E, Børresen-Dale AL. Triple-negative breast cancer: present challenges and new perspectives. Mol Oncol 2010; 4:209-29. [PMID: 20537966 PMCID: PMC5527939 DOI: 10.1016/j.molonc.2010.04.006] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 04/16/2010] [Indexed: 12/28/2022] Open
Abstract
Triple-negative breast cancers (TNBC), characterized by absence of estrogen receptor (ER), progesterone receptor (PR) and lack of overexpression of human epidermal growth factor receptor 2 (HER2), are typically associated with poor prognosis, due to aggressive tumor phenotype(s), only partial response to chemotherapy and present lack of clinically established targeted therapies. Advances in the design of individualized strategies for treatment of TNBC patients require further elucidation, by combined 'omics' approaches, of the molecular mechanisms underlying TNBC phenotypic heterogeneity, and the still poorly understood association of TNBC with BRCA1 mutations. An overview is here presented on TNBC profiling in terms of expression signatures, within the functional genomic breast tumor classification, and ongoing efforts toward identification of new therapy targets and bioimaging markers. Due to the complexity of aberrant molecular patterns involved in expression, pathological progression and biological/clinical heterogeneity, the search for novel TNBC biomarkers and therapy targets requires collection of multi-dimensional data sets, use of robust multivariate data analysis techniques and development of innovative systems biology approaches.
Collapse
Affiliation(s)
- Franca Podo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Wouters H, de Koning I, Zwinderman AH, van Gool WA, Schmand B, Buiter M, Lindeboom R. Adaptive cognitive testing in cerebrovascular disease and vascular dementia. Dement Geriatr Cogn Disord 2010; 28:486-92. [PMID: 19940481 DOI: 10.1159/000250593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To examine whether brevity can be combined with precision in measuring global cognitive ability in patients with cerebrovascular disease (CVD) or vascular dementia (VaD). Longer tests (e.g. the CAMCOG) are precise but inefficient, whereas brief tests (e.g. the MMSE) are efficient but imprecise. METHODS A simulated computerized adaptive testing (CAT) algorithm using existing CAMCOG data from 284 patients with CVD of whom 55 were diagnosed with VaD. CAT was used to estimate each individual patient's total score on a large precise test (the CAMCOG). CAT repeatedly selected only items of appropriate difficulty, depending on whether the previous item was (in)correctly responded to. CAT estimates were compared with total scores on the whole CAMCOG. RESULTS Even though there was an average test reduction of more than 40%, CAT estimates were in very high agreement with the whole test results (intraclass correlation >0.97) and had similar accuracy for the diagnosis of dementia (area under the curve = 0.94). CONCLUSION CAT combines efficiency with precision in the measurement of global cognitive ability in CVD patients.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, NL-1100 DD Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
48
|
Wouters H, Appels B, Van Campen J, Lindeboom R, Buiter M, Zwinderman AH, van Gool WA, Schmand B. Adaptive testing combines precision with brevity in the grading of cognitive impairment. Behav Neurol 2010; 23:181-3. [PMID: 21422549 PMCID: PMC5434403 DOI: 10.3233/ben-2010-0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hans Wouters
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAcademic Medical CenterAmsterdamThe Netherlands
| | - Bregje Appels
- Department of Medical PsychologySlotervaart HospitalAmsterdamThe Netherlands
| | - Jos Van Campen
- Department of Geriatric MedicineSlotervaart HospitalAmsterdamThe Netherlands
| | - Robert Lindeboom
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAcademic Medical CenterAmsterdamThe Netherlands
| | - Maarten Buiter
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAcademic Medical CenterAmsterdamThe Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAcademic Medical CenterAmsterdamThe Netherlands
| | | | - Ben Schmand
- Department of NeurologyAcademic Medical CenterAmsterdamThe Netherlands,Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
49
|
Fassaert T, De Wit MAS, Tuinebreijer WC, Wouters H, Verhoeff AP, Beekman ATF, Dekker J. Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents. Int J Methods Psychiatr Res 2009; 18:159-68. [PMID: 19701920 PMCID: PMC6878421 DOI: 10.1002/mpr.288] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Kessler Psychological Distress scale (K10) is an instrument that is widely used to screen for mental disorders, but information is lacking on its psychometric qualities in non-Western samples. This study used a population-based sample (N = 725) to assess the reliability and validity of the K10 across ethnic groups in an urban area. The results were generally supportive of the K10 as a reliable and valid instrument to screen for anxiety and depression in all three groups. Cronbach's alpha was high (0.93) and the results indicated the existence of a solid single factor structure. Item bias in relation to ethnic background was minor. In each group, there was good criterion validity with respect to one-month DSM-IV diagnosis for depressive and/or anxiety disorder. The results nevertheless highlight the importance of cross-cultural validation, as we found different cut-off values for ethnic subgroups to obtain optimal sensitivity and specificity for detecting depressive and/or anxiety disorders.
Collapse
Affiliation(s)
- T Fassaert
- Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The objective of this study was to investigate whether the Cambridge Cognitive Examination (CAMCOG), a widely used screening test for dementia, can be tailored to the individual patient with Computerized Adaptive Testing (CAT). CAT accomplishes this by only using items that are appropriate for the level of ability of the patient under investigation. Potential advantages of CAT for clinical practice and research are efficient cognitive testing and a reduction of the test burden in elderly patients and consequently less measurement error during testing. In a two step method with previously collected CAMCOG data (n = 797) (1) patient abilities and CAMCOG item difficulties were estimated with the One Parameter Logistic Model (OPLM), a Rasch type of model. CAT was then used (2) to re-estimate the patient abilities. Despite an average test reduction of 60%, CAT estimates were in excellent agreement (intra-class correlation > 0.98) with the results based on the entire CAMCOG and they also had similar accuracy for the diagnosis of dementia (area under the curve 0.91) as the original CAMCOG. These results were replicated in an independent sample (n = 170). We conclude that tailored testing with CAT enables much more efficient screening for dementia than testing with an extensive instrument.
Collapse
Affiliation(s)
- Hans Wouters
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|