Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission

INTRODUCTION

Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success.

METHOD

A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables.

RESULTS

Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission.

DISCUSSION/CONCLUSION

Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.

Challenges Experienced by Black Women with Breast Cancer During Active Treatment: Relationship to Treatment Adherence

BACKGROUND

Although rates of death from breast cancer have declined in the USA for both Black and White women since 1990, mortality rates for Black women remain strikingly higher - 40% higher compared to White women (American Cancer Society 1). The barriers and challenges that may be triggering unfavorable treatment-related outcomes and diminished treatment adherence among Black women are not well understood.

METHODS

We recruited 25 Black women with breast cancer who were to receive surgery and chemotherapy and/or radiation therapy. Through weekly electronic surveys, we assessed types and severity of challenges across various life domains. Because the participants rarely missed treatments or appointments, we examined the impact of severity of weekly challenges on thoughts of skipping treatment or appointment with their cancer care team using a mixed-effects location scale model.

RESULTS

Both a higher average severity of challenges and a higher deviation of severity reported across weeks were associated with increased thoughts on skipping treatment or appointment. The correlation between the random location and scale effects was positive; thus, those women that reported more thoughts on skipping a dose of medicine or appointment were also more unpredictable with respect to the severity of challenges reported.

CONCLUSIONS

Black women with breast cancer are impacted by familial, social, work-related, and medical care factors, and these may in turn affect adherence to treatment. Providers are encouraged to actively screen and communicate with patients regarding life challenges and to build networks of support within the medical care team and social community that can help patients successfully complete treatment as planned.

The mediating effect of self-efficacy on the relationship between social support and medication adherence in adults with type 2 diabetes

Objective

To evaluate the status of medication adherence in diabetic patients and its effective factors.

Methods

A cross-sectional descriptive study was conducted with 170 diabetic patients in Iran. Participants were assessed for medication adherence, self-efficacy, and social support. Descriptive statistics, bivariate analyses, and multiple stepwise regression were conducted to explore predictors for medication adherence.

Results

Regression analysis showed that 48% of medication adherence changes stemmed from the four variables including social support, self-efficacy, income, and education levels, (R2adj = 0.480, F = 39.943, p < 0.001). According to the model, the highest effects were related to income level (β = 0.332, t = 5.493, p ⩽ 0.001) and self-efficacy (β = 0.330, t = 4.789, p ⩽ 0.001), respectively. Based on the final model, only the social support variable showed no significant relationship with adherence (β = 0.002, t = 0.032, p = 0.947).

Conclusion

Social support and self-efficacy were related to medication adherence in diabetic patients, and social support can improve medication adherence in patients with diabetes by affecting self-efficacy. Healthcare workers who interact with individuals with diabetes should take into account the factors mentioned above when designing health promotion interventions to address the needs of these individuals.

Objectively measured adherence may affect side effects of mandibular advancement therapy in subjects with obstructive sleep apnea

PURPOSE

The purpose of this study was to determine if objectively measured adherence to oral appliance (OA) treatment may affect dental changes and temporomandibular disorders (TMD) in patients with obstructive sleep apnea (OSA).

METHODS

The original study group consisted of adults with OSA who were referred for OA therapy. Eight indicators of subjective side effects of using OA (temporomandibular joint (TMJ) and muscle pain, pain in teeth, jaw stiffness in the morning, clicking, dry mouth, hypersalivation, gingival irritation) were evaluated by a questionnaire. Three occlusal indicators (overjet, overbite, molar occlusion) and clinical TMD signs (TMJ pain, muscle pain, clicking, jaw deviation on opening) were evaluated at baseline and at the 3-, 6-, and 12-month follow-up. In addition, objective adherence monitoring for OA was registered. Statistical analyses included the chi-square test, Fisher's exact test, paired sample t-test, and linear regression analyses.

RESULTS

A total of 58 adults with OSA were referred for OA therapy. Mean (SD) age was 50.7 (11.7) and mean apnea-hypopnea index (AHI) was 19.5 (10.0). At 1-year follow-up, the study group consisted of 28 men and 12 women. Overjet but not overbite reduced significantly after 1-year OA therapy. The average nightly wear of OA was related to overjet and overbite reduction, and to TMD signs. Hypersalivation, dry mouth, and tooth discomfort were the most common subjective side effects of OA therapy.

CONCLUSION

There was a time-dependent relationship with the nightly wear of OA and reduction in overjet and overbite, and clinical TMD signs. With 60% of mandibular advancement, dental changes and TM-disorders were considered mild/minor in the 1-year study period.

ADA_ETA_BIO2021: real-world evaluation of adherence, persistence, and cost-effectiveness of originator and biosimilar biologic drugs in the treatment of rheumatoid arthritis: a multicenter study in Italy

OBJECTIVES

The objective was to assess the adherence, persistence, and costs of bDMARDs through a multicentre study of nine Italian hospital pharmacies.

METHODS

The drugs analysed were Abatacept, Adalimumab, Certolizumab, Etanercept, Golimumab and Tocilizumab.Adult subjects with Rheumatoid Arthritis were considered in the analysis.In this study, we calculated the following metrics: Adherence to treatment was evaluated as dose-intensity, which is the ratio between the amount of medication received and probably taken by the patient at home (Received Daily Dose, RDD) and the amount prescribed by the clinician (Prescribed Daily Dose, PDD). Persistence was calculated as the number of days between the first and last dispensing of the same drug. Lastly, costs were assessed based on persistence to treatment and normalized for adherence.

RESULTS

Adherence to treatment was found to be above 0.8 for all drugs studied. The median persistence for a 5-year treatment period was 1.4 years for Abatacept, 1.7 years for Adalimumab, 1.8 years for Certolizumab, 1.4 years for Etanercept, 1.3 years for Golimumab, and 1.6 years for Tocilizumab.

CONCLUSIONS

This multicentre retrospective observational study of bDMARDs used in the treatment of RA showed that, for all the drugs studied, there was no problem with adherence to treatment but rather a difficulty in maintaining treatment with the same drug over time.

Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication - a longitudinal cohort study

BACKGROUND

Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication.

AIM

to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication.

METHODS

A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life.

RESULTS

In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy..

CONCLUSION

Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.

The problems and information needs of patients with bipolar disorder during the treatment process: A qualitative study in Turkey

The objective of the present study was to determine the problems and information needs of patients with bipolar disorder during the treatment process. The present research is in the type of descriptive and qualitative study. In-depth individual interviews were conducted with 11 volunteer patients with bipolar disorder. The data collected from the interviews were evaluated using the descriptive analysis method. In the study, four categories (disease onset/diagnosis stage, adherence to treatment, interpersonal relationships, information needs) and nine main themes (symptoms, family support, factors that positively affect treatment adherence, factors that negatively affect treatment adherence, positive effects of treatment, negative effects of treatment, stigmatization, treatment, disease) were determined. Patients with bipolar disorder can be helped to cope with the problems they experience by providing information about the disease, adherence to treatment, the treatment process, and the effects of drugs.

Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic

OBJECTIVES

Adherence problems have a great impact on auto-immune Rheumatic Diseases (AIRD). The COVID-19 pandemic may have worsened treatment adherence. The aims of this study were to measure treatment adherence to identify an earlier risk of poor adherence and measure families' satisfaction with the health service during the pandemic.

METHODS

Prospective observational study with 50 parents/children and adolescents with recent AIRD diagnosis. Initially, they answered questions (demographic data, disease) and completed the Pediatric Rheumatology Adherence Questionnaire (PRAQ), after 6 months they completed the Morisky-Green Test (MGT), Brief Medication Questionnaire (BMQ), Compliance Questionnaire for Rheumatology (CQR-19) and Pediatric Quality of Life Inventory Questionnaire 3.0 (PedsQl^TM-SSS). The patient's medical records from the previous 12 weeks were reviewed for global and medication adherence data.

RESULTS

The mean global adherence score was 94.3 ± 10.0, for medication adherence 97.3 ± 9.3, and for PRAQ questionnaire 5.2 ± 1.5. The authors observed agreement between MGT, BMQ, CQR-19, PedsQL^TM-SSS scores and medication adherence rate, but not with global adherence rate. There were no associations between demographic characteristics, disease diagnosis, and adherence. No associations between PRAQ scores and values and global/medication adherence rates were observed. No variables were shown to be predictors of good adherence. The mean PedsQL^TM-SSS rate was 92.1 ± 6.8.

CONCLUSION

The high values of MGT, BMQ, CQR-19 questionnaire scores were in agreement with the medication adherence rate. Despite the pandemic, the global and medication adherence rates were good. It was not possible to demonstrate the PRAQ's predictive power. The authors weren't able to establish an association between families' satisfaction and treatment adherence rates.

Relation between diabetes related distress and glycemic control: The mediating effect of adherence to treatment

AIMS

Diabetes related distress (DRD) is a negative emotional reaction to stresses associated with diabetes mellitus (DM) and its management. This study estimated the burden of DRD and self-reported adherence to treatment (SRAT) among patients with DM and investigated their relationship with glycemic control.

METHODS

A cross sectional study of consented 157 diabetics was conducted using the17-item Diabetes Distress Scale (DDS). It measures distress at four subscales: Emotional Burden (EB), Physician-related (PD), Regimen-related (RD) and Interpersonal Distress (ID). SRAT was assessed using Morisky's scale. Glycemic control was assessed using the most recent HbA1c results. Multivariable linear regression analysis was used for adjustment of confounders and bootstrap Confidence Interval was used to test for the occurrence of mediating effect.

RESULTS

Average age was 44.5 ± 16.0 years, 65% were females, 79% had type 2 DM and nearly 55% has had DM for more than 7 years and the average HbA1c was 8.9 ± 2.2%. Clinically significant DRD was reported by 37% of the participants, EB and RD in 40.8%, PD in 46.5%, and ID among 32.5%. Younger patients showed higher level of stress compared to older participants and patients with type 1 DM showed higher level of stress in all DRD domains. Only 46% of patients were defined as having satisfactory SRAT and improvement of SRAT significantly enhanced the glycemic control (r = -0.32, p < 0.01). DRD and low SRAT negatively correlated with HbA1c; increasing the DRD by one point may increase the HbA1c on average by 0.41 (C.I. 0.02-0.80) and will indirectly raise the HbA1c by 0.24 (C.I. 0.04-0.47) through the mediating effect of low SRAT.

CONCLUSION

DRD and low SRAT are commonly reported among DM patients and both are indirectly correlated. The mediating effect of low SRAT highlights the clinical role of DRD and clarifies the process by which distress affect the outcome of DM management.

Sex differences in the effectiveness and affecting factors to adherence of continuous positive airway pressure therapy

Although sex differences in clinical backgrounds of patients with obstructive sleep apnea (OSA) are well known, studies of sex differences about the influencing factors on adherence to continuous positive airway pressure (CPAP) are very sparse. Our aim was to investigate the effects of CPAP use affecting therapeutic adherence in sex differences. We retrospectively assessed demographic data, clinical characteristics, OSA-related symptoms, and effects and adherence of CPAP use in 348 patients (264 males, median age 58 years) who continued CPAP for at least 1 year. Poor adherence was defined as CPAP dropout within 1 year after starting CPAP or the average cumulative CPAP use less than four hours/night. We also studied the predictors or influencing factors of CPAP adherence by multivariate logistic regression analyses. Age was higher and the severity of OSA was lower in female patients. Although the adherence level itself was not significantly different between both sexes, influencing factors were different. OSA severity, such as apnea-hypopnea index and sleepiness, and many effects from CPAP use (respiratory difficulty, difficult adaptation to CPAP use, improved awakening, reduced nocturia, and easy adaptation to CPAP) influenced adherence only in men. Common factors of poor adherence in both sexes were lower age, insomnia by CPAP use, and improved daytime sleepiness. No other specific factors predicted poor adherence in women. We found that there were sex differences in influencing factors on CPAP adherence not only in clinical characteristics of OSA, but also in effectiveness and side effects of CPAP use.

Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study

Background

Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease.

Methods

We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI).

Results

We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence.

Conclusions

Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04483-8.

The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature

INTRODUCTION

Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it.

PURPOSE OF REVIEW

The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients?

METHODS

A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship.

RESULTS

As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet).

CONCLUSION

The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.

The Predictive Value of Degree of Preference for Extended-Release Naltrexone for Treatment Adherence, Opioid Use, and Relapse

BACKGROUND

Extended-release naltrexone (XR-NTX) is effective for illicit opioid abstinence as an opioid maintenance treatment. To improve treatment outcomes, patient's preference for the modality of treatment is an important factor.

OBJECTIVES

We aimed to test the relationship between baseline preference for XR-NTX and adherence to treatment, use of illicit opioids, and risk of relapse.

METHODS

In an open-label, Norwegian clinical trial participants with opioid use disorder were randomized to either monthly injections with XR-NTX or daily sublingual buprenorphine-naloxone (BP-NLX) for 12 weeks. Subsequently, participants could continue with their preferred medication in a 36-week follow-up and in a prolonged period of 104 weeks.

RESULTS

Of 153 participants who completed detoxification, 72% were men, with a mean age of 36 years. Preference levels were similar across the randomized groups, with no significant associations between preference and adherence to treatment, opioid use, or relapse. The BP-NLX group had a significantly higher risk of first relapse to opioids than the XR-NTX group for all levels of preference (p < 0.001) and a significantly higher number of days of illicit opioid use. In the follow-up period, the adherence rate was twice as high among participants with the highest preference compared to participants with the lowest preference, both among those who switched to XR-NTX and those who continued (hazard ratio 2.2; 1.2-4.0, p = 0.013). Opioid use was significantly higher among participants who switched to XR-NTX with the lowest preference than the medium (p = 0.003) or the highest (p = 0.001) preference. The risk of relapse to opioids, however, was significantly higher among XR-NTX continuing participants with the lowest (p = 0.002) or the medium (p = 0.043) preference than those with the highest preference.

CONCLUSIONS

Individuals who matched with their preferred treatment used less illicit opioids than those who did not during short-term treatment. However, baseline preference for XR-NTX treatment primarily influenced longer term opioid use and treatment adherence.

Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use

AIM

To assess the adherence to treatment, sustained virologic response (SVR) rate, and reinfection rate in hepatitis C patients with and without intravenous drug use.

METHODS

This retrospective study included hepatitis C patients, evaluated and treated in our hepatology outpatient clinic between January 2014 and October 2019. The following information was extracted from the patient's file: the presence of positive viral load for hepatitis C virus (HCV), active and recent (in the last 6 months) use of i.v. drugs, HCV genotype, treatment regimen, SVR, HCV reinfection rate, coinfection with human immunodeficiency virus (HIV) and ongoing opioid substitution therapy (OST).

RESULTS

We included 431 hepatitis C patients, 234 people who inject drugs (PWID) and 197 non-PWID. Most patients were treated with direct-acting antivirals (DAA) only. The rate of documented SVR by treated patients was significantly higher in the non-PWID cohort (91.5% vs. 61.5%, p < 0.0001), while noncompliance (did not show up to start treatment) rate or refusal of treatment was significantly higher in the PWID cohort (19.4% vs. 8.9%, p = 0.004). In the PWID cohort, younger age and recent (in the last 6 months) or ongoing i.v. drug use was associated with noncompliance: 31.1 ± 8.4 years vs. 35.8 ± 10.6 years (p = 0.02) and 33.3% vs. 12.8% (p = 0.0008), respectively. Ongoing OST was associated with better compliance: 61.1% vs. 46.1% (p = 0.04).

CONCLUSION

To achieve elimination of hepatitis C better treatment strategies are needed, especially in PWIDs.

The association of the level of self-care on adherence to treatment in patients diagnosed with type 2 diabetes

AIMS

The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural.

METHODS

The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS).

RESULTS

The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453).

CONCLUSIONS

Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.

Understanding health-seeking and adherence to treatment by patients with esophageal cancer at the Uganda cancer Institute: a qualitative study

BACKGROUND

In the low- and middle-income countries, most patients with esophageal cancer present with advanced stage disease and experience poor survival. There is inadequate understanding of the factors that influence decisions to and actual health-seeking, and adherence to treatment regimens among esophageal cancer patients in Uganda, yet this knowledge is critical in informing interventions to promote prompt health-seeking, diagnosis at early stage and access to appropriate cancer therapy to improve survival. We explored health-seeking experiences and adherence to treatment among esophageal cancer patients attending the Uganda Cancer Institute.

METHODS

We conducted an interview based qualitative study at the Uganda Cancer Institute (UCI). Participants included patients with established histology diagnosis of esophageal cancer and healthcare professionals involved in the care of these patients. We used purposive sampling approach to select study participants. In-depth and key informant interviews were used in data collection. Data collection was conducted till point of data saturation was reached. Thematic content analysis approach was used in data analyses and interpretations. Themes and subthemes were identified deductively.

RESULTS

Sixteen patients and 17 healthcare professionals were included in the study. Delayed health-seeking and poor adherence to treatment were related to (i) emotional and psychosocial factors including stress of cancer diagnosis, stigma related to esophageal cancer symptoms, and fear of loss of jobs and livelihood, (ii) limited knowledge and recognition of esophageal cancer symptoms by both patients and primary healthcare professionals, and (iii) limited access to specialized cancer care, mainly because of long distance to the facility and associated high transport cost. Patients were generally enthused with patient - provider relationships at the UCI. While inadequate communication and some degree of incivility were reported, majority of patients thought the healthcare professionals were empathetic and supportive.

CONCLUSION

Health system and individual patient factors influence health-seeking for symptoms of esophageal cancer and adherence to treatment schedule for the disease. Interventions to improve access to and acceptability of esophageal cancer services, as well as increase public awareness of esophageal cancer risk factors and symptoms could lead to earlier diagnosis and potentially better survival from the disease in Uganda.

Effects of novel diabetic therapeutic footwear on preventing ulcer recurrence in patients with a history of diabetic foot ulceration: study protocol for an open-label, randomized, controlled trial

BACKGROUND

Recurrence after the healing of a foot ulcer is very common among patients with diabetes mellitus. Novel diabetic therapeutic footwear consisted of merino wool, vibration chip, and orthopedic insoles is designed to influence multifaceted mechanisms of foot ulcer occurrence. The aim of this study is to examine the effect of the optimally designed therapeutic footwear on preventing ulcer recurrence in patients with a history of diabetic foot ulcers (DFU).

METHODS/DESIGN

The trial is designed as a two arms, parallel-group, open-label randomized controlled intervention study. The Log-rank Test was used for calculating sample size based on the latest national multicenter survey data of DFU in China. Three hundred and twenty participants will be recruited from the Diabetic Foot Care Center, West China Hospital, Sichuan University. Adults with diabetic peripheral neuropathy, healed foot ulceration in the 3 months prior to randomization, and aged ≥18 years, will be recruited. Participants will be randomized to receive novel diabetic therapeutic footwear (n = 160) or their own footwear (n = 160). The primary outcome will be the incidence of ulcer recurrence. The secondary outcome will be measurements of barefoot dynamic plantar pressures, the influence of footwear adherence on ulcer recurrence, and the incidence of cardiovascular events. Assessment visits and data collection will be obtained at baseline, 1, 3, 6, 9, and 12 months. The intention-to-treat principle will be applied. A cox regression model will be used to calculate the hazard ratio for the incidence of ulcer recurrence. The change of barefoot dynamic plantar pressures will be assessed using repeated measures ANOVA. The study protocol has been approved by the Ethics Committee of The Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Reference No. 2019(96)).

DISCUSSION

This clinical trial will give information on the ability of novel diabetic footwear on preventing ulcer recurrence in patients with a history of diabetic foot ulceration. If the optimally designed therapeutic footwear does work well, the findings will contribute to the development of innovative treatment devices for preventing foot ulcer recurrence in high-risk patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900025538 . Registered on 31 August 2019.

Safety, efficacy, and acceptability of ADV7103 during 24 months of treatment: an open-label study in pediatric and adult patients with distal renal tubular acidosis

BACKGROUND

A new prolonged-release formulation of potassium citrate and potassium bicarbonate, ADV7103, has been shown to improve metabolic control, palatability, and gastrointestinal safety in patients with distal renal tubular acidosis (dRTA) when compared to standard of care (SoC) treatments. The present work evaluates safety and efficacy of ADV7103 during 24 months.

METHODS

Thirty pediatric and adult patients were included in an open-label extension study after a phase II/III trial. Safety and tolerability were assessed. Plasma bicarbonate and potassium levels, as well as urine parameters, were evaluated over time. Acceptability, adherence, and quality of life were also assessed. The evolution of clinical consequences of dRTA in the cohort was explored.

RESULTS

There were 104 adverse events (AEs) reported, but only 9 gastrointestinal events observed in five patients (17%) were considered to be related to ADV7103 treatment. There were no AEs leading to treatment discontinuation. Plasma bicarbonate and potassium levels were in the normal ranges at the different visits, respectively, in 69-86% and 83-93% of patients. Overall adherence rates were ≥ 75% throughout the whole study in 79% patients. An average improvement of quality of life of 89% was reported at 24 months of study.

CONCLUSIONS

Common AEs concerned metabolism and gastrointestinal disorders; the former being related to the disease. Less than half of the gastrointestinal AEs were related to ADV7103 treatment and they were mostly mild in severity. Metabolic parameters were maintained in the normal ranges in most patients. Patient satisfaction was high and adherence to treatment was good and remained stable.

TRIAL REGISTRATION NUMBER

Registered as EudraCT 2013-003828-36 on the 3rd of September 2013.

[Comparing group educational intervention to individual and self-learning in COPD]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is considered a public health issue which affects 10.2% of Spanish population between 40 and 80 years of age. Many patients do not perform well the inhalation technique. Error rates vary between 50-80% depending on the device under study. These values haven been proven to decrease with educational interventions.

OBJECTIVE

To ascertain whether a group educational intervention is superior to an individual intervention or to a conventional approach in these patients as regards quality of life measured by means of the total score of the COPD Assessment Test (CAT),of adherence to treatment, exacerbations and hospitalizations.

MATERIAL AND METHODS

A multicenter, multidisciplinary cluster-randomized controlled clinical trial with three branches (conventional intervention, individual intervention and group intervention) in a cohort of COPD-patients. Sociodemographic data and risk factors were collected and several questionnaires were completed (CAT, BODEx, Barthel, Lawton y Brody). A descriptive analysis of qualitative and quantitative variables and a multiple linear regression were conducted.

OUTCOMES

149 patients of average age 69.08 (SD 1.26). Significant differences were observed in CAT in the different intervention groups according to the level of severity on BODEx. The rate of patients performing well the inhalation technique was significantly lower at the beginning of the study and the number of exacerbations was lower after the intervention. Last year's exacerbations were linearly related to post-intervention suffering.

CONCLUSIONS

Better results are obtained using the traditional and individual interventions. There is a decrease in number of exacerbations, hospitalizations, CAT score and post-intervention inhalation technique.

Effects of a Comprehensive Care Program on the Readmission Rate and Adherence to Treatment in Elderly Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

The low treatment adherence of patients with chronic obstructive pulmonary disease (COPD) leads to the exacerbation of their symptoms and readmission. Comprehensive care programs are among interventions that can improve the patients' adherence to treatment and prevent readmission. The present study aimed to evaluate the effects of a comprehensive care program on the adherence to treatment and readmission of COPD patients.

MATERIALS AND METHODS

This randomized clinical trial was performed in a hospital in Rafsanjan, Iran, in 2017. Sixty elderly patients with COPD were randomly enrolled in this study by pair-matching. The intervention group participated in a comprehensive care program, whereas the control group received routine care. The readmission rate and adherence to treatment were measured at one-, three-, and six-month intervals. To evaluate the patients' adherence to treatment, an adherence-to-treatment questionnaire for chronic diseases was used. Data were analyzed using Chi-square test, independent t-test, and repeated measures ANOVA at a significance level of 0.05.

RESULTS

A significant difference was observed between the two groups in terms of readmission at the end of the study (P=0.03). In the intervention group, the mean level of adherence to treatment and its subscales improved as compared to the control group, and there was a significant difference between the two groups.

CONCLUSION

Although most of the patients in this study were old, with a rather low educational level and socioeconomic status, the care program could improve their treatment adherence and reduce the readmission rate.

Feasibility and efficacy of a supervised home-based physical exercise program for metastatic cancer patients receiving oral targeted therapy: study protocol for the phase II/III - UNICANCER SdS 01 QUALIOR trial

BACKGROUND

Currently, oral targeted therapies are known to be effective and are frequently used to treat metastatic cancer patients, but fatigue is a frequently reported early side effect of these treatments. This fatigue may impact the patient's treatment adherence and result in a negative impact on quality of life. Physical exercise significantly improved the general well-being and quality of life of advanced cancer patients. However, there is no specific physical activity program adapted for patients with advanced disease.

METHODS

QUALIOR is a two-part, randomized, open-label, and multicenter with two arms phase II/III trial. Patients (phase II: n = 120; phase III: n = 312) with metastatic cancer (breast cancer, kidney cancer, lung cancer, and other cancers [including but not limited to colon cancer, melanoma, sarcoma, or hepatocarcinoma]) treated with a first- or second-line oral targeted therapy without chemotherapy will be included. Patients will be randomized (2:1) to a 3-month supervised home-based standardized physical activity program or to a recommended adapted physical activity (via a booklet). The primary objective of the phase II is to evaluate the feasibility of the supervised program. The primary objective of the phase III is the evaluation of the benefit of the supervised home-based program compare to the recommended program in terms of fatigue and quality of life at 3 months. The secondary objectives aim to evaluate the impact of the supervised program on fatigue over time, pain, physical capacities, psychosocial and cognitive functions, general quality of life, frequency of dose reduction and patients' adherence to the targeted therapy, overall survival, and progression-free survival. This study will also evaluate the medico-economic impact of supervised program compared to the recommended adapted physical activity program.

DISCUSSION

The aim of this study is to evaluate home-based physical exercise program for metastatic cancer patients treated with oral targeted therapies to help patients to cope with fatigue and improve quality of life.

TRIAL REGISTRATION

This trial was registered in ClinicalTrials.gov since May 2017 ( NCT03169075 ).

Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade

OBJECTIVE

Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre.

METHODOLOGY

This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%).

RESULTS

A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA_1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.

The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial

PURPOSE

Comprehensive Geriatric Assessment (CGA) can identify health problems in older persons. In addition, CGA includes intervention towards the identified problems. With follow up, more problems may be identified and the interventions can be adjusted. We wanted to compare CGA with or without tailored follow-up in a randomised design.

PATIENTS AND METHODS

Patients 70+ years referred for oncology treatment with four primary tumour sites. Participants were randomised 1:1 to either control group with no follow-up or intervention group with a tailored follow-up by a multidisciplinary team. Primary outcome was adherence to cancer treatment. Secondary outcomes were daily life activities, physical performance and hospitalisation.

RESULTS

In total, 363 participants were randomised. After randomisation only 301 were planned to receive specific cancer treatment. Median age was 75 years. Among the 301 participants, 52% of control group vs. 61% of intervention group completed treatment. Risk Rate (RR): 1.16 (95% Confidence Interval (CI): 0.95-1.42), p = .14. The impact varied between the included tumour-sites, p < .01. We found no difference in 90 days physical performance or daily life activities between groups. During the study period, 55% of controls vs. 47% in the intervention group were admitted to hospital, RR: 0.86 (95%CI: 0.69-1.07), p = .19.

CONCLUSION

In frail and vulnerable patients with cancer, a tailored follow-up on CGA showed no differences in ability to complete initially planned cancer treatment. The impact varied between the included tumour sites. We did not find any impact of tailored follow-up on daily life activities, physical performance or hospitalisation.

Discriminative learning and associative memory under the differential outcomes procedure is modulated by cognitive load

Working memory (WM) has been thought to be the cause of associative memory deficits in older adults. Previous research has demonstrated the benefits of a discriminative learning procedure, the differential outcomes procedure (DOP), to ameliorate such associative-memory maintenance deficits in situations that simulate adherence to medical prescriptions in both healthy and pathological ageing. Specifically, the DOP involves rewarding each correct response to each stimulus-stimulus association with a distinct and unique outcome (reinforcer). The aim of the present study was to explore the limits of this procedure by testing the amount of cognitive load at which the DOP improves discriminative learning and associative memory in a task that simulates adherence to medical treatment in undergraduate students. During the training phase, participants were asked to learn three pill/name (low-load condition) or four pill/name associations (high-load conditions) under the DOP in comparison with a control condition (the non-differential outcomes condition, NOP). Long-term retention of such learned associations was tested 1h and 1week after completion of the training phase. Participants showed a better accuracy and long-term retention of the learned associations when the DOP was used, but just in the high-load condition. These results suggest that when WM is overtaxed, the DOP plays a fundamental role in the long-term maintenance of the learned stimulus-stimulus associations, rendering such learning procedure as a useful technique to enhance people's discriminative learning and associative memory.

Medication Compliance in COPD Patients

Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor control of the disease is low patient compliance with treatment plan. The aim of the study was to investigate sociodemographic and health status factors that may have an influence on adherence to treatment. There were 106 inpatients (F/M, 42/64; mean age 70 ± 6 years) with COPD enrolled into this retrospective study. Patients completed the Adherence to Refills and Medications Scale (ARMS) to assess adherence to therapy. We found that the mean ARMS score was 23.1 ± 6.8. About 86% of patients had low adherence, and 14% had good adherence (mean score 3.2 ± 2.4). The low-adherence patients were more likely to be older (p = 0.020), female (p = 0.011), single (p = 0.019), not professionally active (p = 0.049), hospitalized more often (p = 0.005) and for a longer time (p = 0.046), feel worse (p = 0.023), experience a greater impact of the disease on sleep quality (p = 0.008) and daily activities (p = 0.001), and had a higher GOLD stage of COPD when compared to patients with good adherence patients (p = 0.012). Multiple factor analysis demonstrates that independent adverse predictors of the ARMS score included the following: being single (OR = 3.18), having had more than eight hospitalizations (OR = 1.18), and experiencing dysfunction in daily activities (OR = 1.79). Male gender (OR = 0.77) and longer than 21-day hospitalizations (OR = 0.93) were independent positive predictors of adherence. In conclusion, COPD patients demonstrate a low level of adherence to pharmacotherapy. Adherence is adversely affected by sociodemographic (older age, female gender, being single, and professionally inactive) and clinical factors (more frequent hospitalizations, perception of poor well-being, disordered sleep and daily functioning, and a higher GOLD stage).

Understanding side effects of therapy for myasthenia gravis and their impact on daily life

Background

Myasthenia gravis is a chronic, autoimmune, neuromuscular junction disorder characterized by skeletal muscle weakness. Current therapies for myasthenia gravis are associated with significant side effects. The objective of this study was to characterize the side effects, and associated health-related quality of life and treatment impacts, of traditional myasthenia gravis treatments.

Methods

This study had two phases; a Phase 1 interview and a 2-part web-based survey in Phase 2 that included brainstorming (Step 1) and rating (Step 2) exercises using group concept mapping. In Phase 1, all 14 participants reported experiencing side effects from myasthenia gravis treatments which had significant impacts on daily life. In Phase 2, 246 participants contributed to Step 1; 158 returned for Step 2.

Results

The brainstorming exercise produced 874 statements about side effects and their impact, which were reduced to 35 side effects and 23 impact-on-daily life statements. When rating these statements on severity, frequency, and tolerability, blood clots, infections/decreased immunity, weight gain, and diarrhea were the least tolerable and most severely rated. The most frequent and severe impacts were sleep interference and reduced physical and social activities.

Conclusions

Based on these findings, there appears to be a need for better and more tolerable treatments for myasthenia gravis patients.

[Electronic prescription: limitations and possible improvements to ensure greater adherence to treatments]

OBJECTIVE

The electronic prescription has meant an evolution in the quality of health care, but it has a series of deficiencies that compromise the adherence to treatments. The objective of this work was to collect and group these limitations and propose the changes that could solve them.

METHODS

During 2017 and 2018, through dispensing and pharmacotherapeutic monitoring activities, incidents related to the electronic prescription were collected in a pharmacy in Santander and their causes were identified. A survey was conducted and sent to the Information Centers of the Medicines of the rest of the regions to know if the same problems were shared and the resulting data were treated by frequency distribution.

RESULTS

We detected 1,500 incidents related to the way of access to the treatment and its activation period, with the availability of the medication when the patient requested it and those in which the assessment of the problem by the doctor was essential. The survey data showed that in 100% of the CCAA the patient must return to the doctor when there is an incidence, because there is no protocol to solve it from the pharmacy.

CONCLUSIONS

These incidents compromise the adherence to treatments and the health of patients. To avoid them, we propose the elimination of the password that is necessary to access the treatment, the establishment of a minimum period of 30 days for its activation, the creation of protocols so that the pharmacist can solve problems and perform dispensations in special circumstances, and finally, the optimization of the communication between pharmacist and doctor.

Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

Background

Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State.

Method

We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study.

Result

We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence.

Conclusion

Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

Familial hypercholesterolemia and young patients' thoughts on own condition and treatment

OBJECTIVES

Familial hypercholesterolemia (FH) is a hereditary and usually asymptomatic condition characterized by elevated blood cholesterol and increased risk of premature cardiovascular disease. It is treated with dietary modifications and lipid lowering drugs. The objective was to learn about young FH patients' perceptions and choices regarding treatment.

METHODS

Data were collected through in-depth interviews with 24 patients (ages 16-35), and analysed according to Grounded Theory.

RESULTS

The findings are presented as theoretical concepts describing the participants' way of handling their condition. The core category was identified as "Thoughts of consequences vs. Postponing thoughts of consequences", which could be described through the following subcategories: 1. Normalising the condition, 2. Belittling of treatment vs. Committed to treatment and 3. Trust in advice vs. Avoid unnecessary interference. The participants' position regarding these categories was described to affect motivation and challenges with treatment.

CONCLUSIONS

Participants who postpone the thoughts of consequences, belittle the treatment and avoid unnecessary interference represent a challenge to health care practitioners.

PRACTICAL IMPLICATIONS

Practitioners should explore aspects such as thoughts of consequences, view of treatment and the feeling of interference to be able to better understand illness behaviour, adjust their communication and hopefully improve adherence.

HIV-related care for transgender people: A systematic review of studies from around the world

RATIONALE

Transgender people face unique challenges, such as structural, interpersonal, and individual vulnerabilities to chronic diseases. Stigma and prejudice may hamper their access to health care and prevent their inclusion in the labor market, as well as cause exposition to violence. Labor market exclusion contributes to engagement in survival sex work, which increases HIV infection vulnerability. HIV continuum of care combines HIV prevention (including antiretroviral pre-exposure prophylaxis (PrEP), antiretroviral post-exposure prophylaxis (PEP) and HIV testing) with linkage to care (that is, initiating, maintaining and monitoring antiretroviral therapy). Currently, many studies evaluate the access barriers and facilitators to HIV care for transgender people.

OBJECTIVE

The present systematic review aimed to provide a clear summary of the current literature on HIV-related care for transgender men, transgender women and gender diverse people.

METHOD

Inclusion criteria were peer-reviewed quantitative studies, published through April 04, 2018, concerning transgender women, transgender men and gender diverse people and HIV-related care, which was any intervention aiming to prevent, treat or alleviate the impact of HIV on these populations.

RESULTS

From 6,585 references, 62 articles were included: Three articles had results on PEP, 18 on PrEP, 29 on HIV-testing, 17 on access to health care, and 13 on adherence to treatment.

CONCLUSIONS

The present study is the first systematic review evaluating HIV-related care for transgender people. Data collection is still scarce regarding transgender men and gender diverse people. Worldwide, testing for HIV infection does not necessarily enable access to the HIV continuum of care for transgender populations or even guarantee awareness of HIV seropositivity.

Why patients want to take or refuse to take antibiotics: an inventory of motives

BACKGROUND

Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics.

METHODS

Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics.

RESULTS

A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics.

CONCLUSION

Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.

The evaluation of phenylalanine levels in Estonian phenylketonuria patients during eight years by electronic laboratory records

Blood phenylalanine (Phe) values from the dried blood spots of all Estonian phenylketonuria (PKU) patients have been deposited into a unified electronic laboratory database for eight years, providing an opportunity to assess the adherence of the patients to dietary recommendations over time and to observe patient practices both individually and collectively. Our results demonstrate generally good adherence to clinical and dietary recommendations during the first six years of life, as the percentage of patients with median Phe values fitting under the national recommendation levels were 95%, 84% and 70% in age groups 0-1, 1-2 and 2-6 years, respectively. Conversely, significant deviations occur in the group of 6 to 12 year-olds, mildly decreasing in adolescence and increasing in adulthood (43%, 53% and 57%, respectively). Wide individual differences occurred in all groups, especially in patients with a classical PKU phenotype caused by PAH variants that fully abolish phenylalanine hydroxylase activity. Surprisingly, some of the best dietary adherence was seen in the late-diagnosed PKU patients with poor cognitive functioning. As a rule, the median of Phe values crosses the recommended thresholds in approximately one third to one half of the patients of each age group after the first two years of life.

Adherence, insight and disability in paranoid schizophrenia

Insight has long been linked to both prognosis and functioning in patients with schizophrenia; likewise, it is key to treatment adherence. This study seeks to assess the association between insight, adherence to pharmacological treatment, and disability in schizophrenia, and to study the potential mediating role of adherence between insight and disability. Insight (SUMD), adherence (CRS), and disability (WHO-DAS) were measured in 80 clinically stable patients with DSM-IV TR paranoid schizophrenia. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In a first step, predictors of disability were identified using linear regression to identify variables related to disability and further a mediation analysis was carried out. Negative symptoms, insight, and adherence account for 54.2% of the variance in disability. Negative symptoms act directly on disability, while the effect of insight on disability is partially mediated by adherence. Insight is key in disability in schizophrenia and should be leveraged in treatment programs.

[Adherence to the treatment of pre surgical nasoalveolar molding in cleft lip and palate]

OBJECTIVES

The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection.

MATERIALS AND METHODS

Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher's exact correction.

RESULTS

46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences.

CONCLUSIONS

Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater.

Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/Formoterol 100/6 μg b.I.D.: a 12-month comparison of outcomes in mild-to-moderate asthma

Background

Bronchial asthma is an inflammatory disease of the airways. Beclomethasone dipropionate/Formoterol (BDP/F) and Fluticasone furoate/Vilanterol (FF/V) are two of the most effective LABA/ICS combinations for managing persistent bronchial asthma. Aim of the study was to compare the outcomes achieved in mild-to-moderate asthma patients assuming BDP/F 100/6 μg b.i.d. (Group A) or FF/V 92/22 μg once-daily (Group B) for 12-months. No head-to-head long-term comparison is available at present.

Methods

Data were automatically and anonymously obtained from the institutional database: FEV₁% predicted values; the exacerbation and hospitalization rates; days of hospitalization; GP and/or specialist visits; days of inactivity; courses of systemic steroids and/or antibiotics were recorded at baseline and after 3, 6 and 12 months of both treatments. The overall adherence to treatments was also calculated. The propensity score method was used for matching and comparing the two cohorts of patients; Anova and Wilcoxon tests were used for checking the trends and time-to-time comparisons over the period; statistical significance was accepted for p < 0.05.

Results

The PS-matching process returned a cohort of 40 group A patients matched with 40 patients of group B, fully comparable for demographics, clinical characteristics, and comorbidities. The improvement in lung function was significant in both groups (p < 0.001), even if it was significantly higher and time-dependent in group B. The mean (±SE) exacerbation rate/patient changed from 0.63 (±0.13) at baseline to 0.53 (±0.12) after three; to 0.58 (±0.13) after six, and to 0.60 (±0.18) after twelve months in group A (p = ns), while from of 1.05 (±0.16) at baseline, to 0.28 (±0.07) after three; to 0.33 (±0.08) after six, and to 0.18 (±0.08) after twelve months in group B (p < 0.001), respectively. The mean hospitalization rate/patient changed from 0.25 ± 0.07 at baseline to 0.15 (±0.06) after three; to 0.08 (±0.04) after six, and to 0.13 (±0.05) after twelve months in group A (p = ns), while from 0.30 (±0.07) at baseline to 0.08 (±0.04) after three; to 0.10 (±0.05) after six, and to 0.03 (±0.03) after twelve months in group B (p < 0.001), respectively. Also mean duration of hospitalization and days of inactivity were in favour of FF/V treatment over time (in both cases p < 0.001). GP’s visits were reduced by both treatments (p < 0.007 in group A and p < 0.001 in group B, respectively, while Specialist’s visits only dropped during FF/V (p < 0.001). Steroid and antibiotic courses were significantly reduced by both treatments, even if more systematically in group B (p < 0.001 vs p < 0.007, and p < 0.001 vs p < 0.044, respectively). Moreover, changes in all outcomes considered proved time-dependent during the FF/V treatment only, particularly over the second semester. Finally, the overtime adherence to treatment was higher by 22 days during FF/V .

Conclusions

Both the ICS/LABA combinations proved effective, even if characterized by different patterns of effectiveness either in terms of lung function and of long-term clinical outcomes. Only the once-daily inhalation of combined FF/V 92/22 μg once-daily optimized systematically the exacerbation and hospitalization rates in mild-to-moderate asthma, together with all other outcomes over time. The effectiveness of FF/V 92/22 once-daily μg proved progressive and time-dependent over the twelve-month period of the study, and associated to a higher adherence to treatment.

Long-term prediction of adherence to continuous positive air pressure therapy for the treatment of moderate/severe obstructive sleep apnea syndrome

BACKGROUND

Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for obstructive sleep apnea syndrome (OSAS). However, poor adherence is a limiting factor, and a significant proportion of patients are unable to tolerate CPAP. The aim of this study was to determine predictors of long-term non-compliance with CPAP.

METHODS

CPAP treatment was prescribed to all consecutive patients with moderate or severe OSAS (AHI ≥15 events/h) (n = 295) who underwent a full-night CPAP titration study at home between February 1, 2002 and December 1, 2016. Adherence was defined as CPAP use for at least 4 h per night and five days per week. Subjects had periodical follow-up visits including clinical and biochemical evaluation and assessment of adherence to CPAP.

RESULTS

Median follow-up observation was 74.8 (24.2/110.9) months. The percentage of OSAS patients adhering to CPAP was 41.4% (42.3% in males and 37.0% in females), and prevalence was significantly higher in severe OSAS than in moderate (51.8% vs. 22.1%; p < 0.001; respectively). At multivariate analysis, lower severity of OSAS (HR = 0.66; CI 95 0.46-0.94) p < 0.023), cigarette smoking (HR = 1.72; CI 95 1.13-2.61); p = 0.011), and previous cardiovascular events (HR = 1.95; CI 95 1.03-3.70; p = 0.04) were the only independent predictors of long-term non-adherence to CPAP after controlling for age, gender, and metabolic syndrome.

CONCLUSIONS

In our cohort of patients with moderate/severe OSAS who were prescribed CPAP therapy, long-term compliance to treatment was present in less than half of the patients. Adherence was positively associated with OSAS severity and negatively associated with cigarette smoking and previous cardiovascular events at baseline.

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil

Background

In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day.

Methods

This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day.

Results

At baseline, the forced expiratory volume in one second (FEV₁) and the FEV₁/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV₁% and in the FEV₁/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV₁, the FEV₁/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF_25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF_25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV₁% (p = 0.004).

Conclusions

The fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF_25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV₁%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

Rituximab in clinical practice: dosage, drug adherence, Ig levels, infections, and drug antibodies

The objective of this study is to explore the following: (1) the impact of two different initial doses and cumulative 2-year dose of rituximab (RTX) on drug adherence and predictors of adherence to treatment in rheumatoid arthritis (RA) patients in an observational clinical setting, (2) immunoglobulin levels (IgG/IgM/IgA) during repeated treatment and their relation to infections, and (3) development of anti-rituximab antibodies (ADA). All RA patients receiving RTX from January 2003 to April 2012 at the department were included. The initiating doses were 500 or 1000 mg intravenously days 1 and 15. Drug adherence was estimated using life-table. Baseline predictors of adherence to treatment were analyzed using Cox regression model. Levels of immunoglobulins were measured at treatment initiation and before retreatment. Serum levels of RTX and ADA were measured in 96 patients at 6 months using ELISA. One hundred fifty-three patients were included. Seventy-four (48%) started treatment with 500 and 79 (52%) with 1000 mg. No difference in drug adherence was seen between the different initial or cumulative RTX doses. Methotrexate (MTX) use and low DAS28 at baseline predicted better drug adherence. Ig levels decreased with repeated treatments but low levels were not associated with infections. 11/96 patients had developed ADA at 6 months. Long-term adherence to RTX in RA patient was not influenced by starting- or cumulative 2-year doses. MTX use and low DAS28 at baseline was positively associated with drug adherence. Decreasing Ig levels during treatment were not associated with risk of infections. Development of ADA may influence treatment efficacy and tolerability.

Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment

Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.

A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial

BACKGROUND

Enhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients' and clinicians' behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes.

METHODS

This article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake.

DISCUSSION

This study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment.

TRIAL REGISTRATION

Trial registration: Dutch Trial Register NTR5677 . Registered 17th January 2016.

Patients' beliefs about medicines and adherence to medication in ischemic heart disease

Introduction

The phenomenon of adherence to treatment is a motive of worry from the scientific community, since it is considered as a worldwide problem of high magnitude. The implications are of great relevance in morbidity, mortality, in the significant increase in the consumption of health care and in the costs to the health system, particularly in patients with ischemic heart disease. We intend to evaluate adherence to treatment and relate beliefs about medicines with adherence to treatment.

Material and methods

This study is descriptive-correlational and cross-sectional. It was performed on 254 patients with ischemic heart disease who were in follow-up consultation in the hospital at the time of the questionnaire application. Data collection was performed through a self-administered questionnaire, integrating the following scales: Measure Adherence to Treatment and Beliefs about Medicines Questionnaire.

Results

The patients had a mean age of 66.94 years (SD = 11.62), 74% were male, 73.2% were married, 69.3% had education up to the “4th grade”, 57.1% lived in the village, 70.1% were retired and 49.6% had an income below “one minimum wage”. We found that 50.4% of patients did not adhere to treatment. Women had a strong belief in the specific needs of the prescribed medication, while men expressed greater belief in relation to long-term side effects (P > .05). Patients who expressed a low belief about the harmful potential of medicines revealed predictors of adherence to medication.

Conclusion

The results are consistent with previous studies in which individuals with lower beliefs in specific concerns reported higher rates of adherence to medication.

Therapy discontinuation or substitution in patients with cardiovascular disease, switching among different products of the same off-patent active substance: a 'real-world' retrospective cohort study

OBJECTIVE

The present study investigated the effects of switching to different products of the same off-patent active substance (brand name or generic) on therapy discontinuation or substitution with another molecule of the same class, in patients with cardiovascular disease treated with statins and antihypertensives in a 'real-world' setting.

DESIGN

A retrospective cohort study in a 'real-world' setting.

SETTING

Analysis of data performed by integrating administrative databases that included approximately two million individuals who are assisted by the National Health System from three Local Health Units located in three different regions of Italy.

PARTICIPANTS

All patients aged ≥18 years with at least one prescription of simvastatin, ramipril or amlodipine in the period 1 January to 31 December 2010 were included and followed up for 2 years.

MAIN OUTCOME MEASURES

Prescription refills occurring during follow-up were evaluated. Frequency of discontinuation of therapy or substitution with another molecule of the same class (eg, from simvastatin to a different statin) during follow-up was identified.

RESULTS

During follow-up, therapy discontinuation or substitution was found to be more frequent in patients switching to a different product of the same active substance compared with non-switching patients (11.5% vs 10.8% and 22.2% vs 20.8% (p=0.002), respectively, in the simvastatin group; 4.0% vs 3.5% and 24.6% vs 22.7% (p<0.001), respectively, in the amlodipine group). In the ramipril group, 8% of patients undertook a therapy substitution to another molecule; no trend towards a lower percentage of substitution was observed in the non-switching group, while 18% of patients discontinued treatment, with a significant difference in favour of patients not switching. These findings were partially confirmed by multivariate analysis.

CONCLUSIONS

Switches among products of the same active substance are quite common in patients with cardiovascular disease. Our study suggests that switching may expose patients to a higher risk of therapy discontinuation or substitution.

Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30-60 years: study protocol for a randomized controlled trial

BACKGROUND

Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment.

METHODS/DESIGN

A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8th and 24th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information.

DISCUSSION

This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan.

TRIAL REGISTRATION

This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.

[Adherence to treatment after kidney transplantation as quality indicator of the information received: Longitudinal study of 2 years follow-up]

INTRODUCTION

Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment.

MATERIAL AND METHODS

The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data.

RESULTS

The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation "not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post- transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment.

CONCLUSIONS

Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up.

Self-reported stigma and symptoms of anxiety and depression in people with intellectual disabilities: Findings from a cross sectional study in England

BACKGROUND

No studies have investigated the relationship between self-reported stigma and multiple health outcomes in people with intellectual disabilities (ID). The association between self-reported stigma and symptoms of anxiety and depression (psychological distress), quality of life, service utilisation and adherence to treatment were examined.

METHOD

Cross sectional study of 229 participants with ID (without mental illness) recruited from 12 centres in England.

RESULTS

Self-reported stigma was positively associated with psychological distress, and number of contacts with services, particularly contact with community intellectual disability services and the police, and negatively associated with quality of life. It was not associated with adherence to treatment. Self-reported stigma was also associated with refusal of at least one service in the last six months. The relationship between stigma and quality of life and stigma and service use were mediated by psychological distress.

LIMITATIONS

The Cross-sectional design of this study prevents inferences being made about the direction of causality. IQ was not formally assessed but was based on clinical data.

CONCLUSION

This study provides evidence that stigma may contribute to poor psychological health in people with ID, may be a burden on services due to higher service utilisation but may also prevent people from accessing appropriate services. Services should consider screening people at risk of psychological distress due to stigmatising treatment and provide appropriate support. There is an urgent need to develop evidence-based interventions to reduce societal stigma against people with ID and to reduce the impact of stigma when it is experienced by individuals with ID.

Examining the influence of treatment preferences on attrition, adherence and outcomes: a protocol for a two-stage partially randomized trial

Background

Empirical evidence pertaining to the influence of treatment preferences on attrition, adherence and outcomes in intervention evaluation trials is inconsistent. The inconsistency can be explained by the method used for allocating treatment and measuring preferences. The current methodological study is designed to address these factors by implementing the two-stage partially randomized or preference trial design, and administering a validated measure to assess participants’ preferences for the treatments under evaluation. It aims to compare attrition, adherence and outcomes for participants allocated randomly or by preference to treatment. The study is in its final stages of data collection; its protocol is presented in this paper.

Methods/Design

A partially randomized clinical or preference trial is used. Eligible participants are randomized to two trial arms. First is the random arm involving random assignment to treatments, and second is the preference arm involving allocation to the chosen treatment. Participants with chronic insomnia are targeted. Two behavioral treatments are offered, stimulus control therapy and sleep restriction therapy, in the same format (small group) and dose (two sessions given over a 4-week period). A participant log is used to collect data on attrition. Adherence is evaluated in terms of exposure and enactment of treatment. Sleep-related outcomes (sleep parameters and perceived insomnia severity) are measured at pretest, posttest, 6 and 12 month follow-up. Treatment preferences, adherence and outcomes are assessed with reliable and valid measures.

Discussion

The advantages and limitations of the preference trial design are highlighted. The challenges in implementing the trial are discussed relative to the distribution of participants in the groups defined by treatment received and method of treatment allocation.

Trial registration

ClinicalTrials.gov Registry NCT02513017

The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients

PURPOSE

The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran.

METHOD

In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests.

RESULTS

At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05).

CONCLUSIONS

Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. Implications for Rehabilitation Adherence to treatment means that all patients' behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. Individual structured programs are most likely to be successful in encouraging adherence to treatment.

A randomized controlled trial to evaluate an educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure: Rationale, design and methodology

Background

Chronic heart failure (CHF) is an increasingly important health problem worldwide. Effective self-care can improve the outcomes and quality of life in patients with CHF. Acknowledging the important role of educational interventions for improving self-care, we sought to assess a new educational strategy involving community health volunteers (CHVs) that could reduce the cost and, hypothetically, increase the effectiveness of self-care education in patients with CHF.

Methods/Design

In this ongoing three-arm controlled trial, approved by two human research ethics committees in Australia and Iran, 231 patients with CHF registered at a referral cardiovascular hospital in Iran were randomly allocated into three groups -trained by community health volunteers at patients’ homes, rained by formal health professionals at hospital; and a control group with no formal educational exposure. Data obtained through interviewing participants and using the Persian self-care of CHF index (pSCHFI) before and two months after interventions will be analysed using SAS and SPSS.

Discussion

The results of this study may help health service systems, especially in countries with limited resources, make use of community volunteers to teach patients with CHF to develop self-care behaviors and skills, reducing the cost of care and improving CHF outcomes. Also, this home-based educational strategy using face-to-face training, if successful, may provide psychosocial supports for patients suffering from chronic illnesses.

Trial registration number

ACTRN12614000788673 (Australian New Zealand Clinical Trials Registry)

Treatment adherence in bipolar I and schizoaffective disorder, bipolar type

BACKGROUND

Poor adherence rates in Bipolar Disorder type I (BDI) and Schizoaffective Disorder, bipolar type (SAD) may be high This study was aimed at comparing the clinical correlates of adherence to treatment and the course of illness in BDI and SAD patients.

METHODS

75 SAD and 150 BDI DSM-IV outpatients were included. Adherence was assessed on the basis of patients' and care-givers' reports and serum levels, when available. Socio-demographic, clinical and treatment variables were collected and compared between diagnostic subsamples and then between goodly and poorly adherent patients. Multiple logistic regressions were performed, controlling for diagnostic subsample differences, to identify correlates of adherence in BDI and SAD groups.

RESULTS

Poor adherence was highly prevalent both in BDI (32%) and in SAD patients (44%), with no significant differences between diagnostic categories. Presence of psychotic symptoms (p=0.029), higher number of manic relapses (p<0.001), comorbidity with personality disorders (p=0.002), and lithium therapy (p=0.003) were associated with poor adherence to treatment. Diagnostic subgroup analyses showed different predictive models, with the BDI poorly adherent subsample being more likely to include comorbid personality and manic recurrences and the SAD poorly adherent subsample being less clinically predictable.

LIMITATIONS

The cross-sectional nature of the study limits de capacity to ascertain the direction of the relationship between certain variables.

CONCLUSIONS

Rates of poor adherence to oral treatments are similar in SAD and BDI. BDI patients with comorbid personality and substance use disorders are likely to be poorly adherent. Treatment adherence may be more difficult to predict in SAD patients.