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Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol 2018; 53:431-436. [PMID: 29457700 DOI: 10.1002/ppul.23950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Medication adherence among adolescents with cystic fibrosis (CF) is often suboptimal and this has significant impact on their health and quality of life. The purpose of the study was to evaluate the impact of frequent home pulmonary function (PFT) monitoring on medication adherence among adolescents with CF. HYPOTHESIS We hypothesized that weekly home PFT monitoring will improve adherence while not significantly adding to the treatment burden. METHODS Individuals aged 12-21 years with CF were provided a spirometer to measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT data were downloaded from the device during quarterly clinic visits. Adherence was calculated from prescription refill data and compared to the previous year. Perceptions of treatment burden were assessed using the CF questionnaire-revised (CFQ-R) quality of life measure. Health outcome measures including nutritional status and PFTs from clinic were collected for the study period and the year prior. RESULTS Thirty-nine subjects participated in the study. Mean age was 15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry monitoring was 59.47 ± 24.60%. Values generated on the device showed good correlation with those obtained in clinic. Mean medication possession ratio (MPR) was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion (P = 0.14). CONCLUSIONS Frequent home PFT monitoring is feasible in CF adolescents and could successfully improve medication adherence without significantly impacting treatment burden.
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Affiliation(s)
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lauren Kasmikha
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - Samya Z Nasr
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
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Colombo C, Catastini P, Brivio A, Acone B, Dang P, Quattrucci S. Delphi poll to assess consensus on issues influencing long-term adherence to treatments in cystic fibrosis among Italian health care professionals. Patient Prefer Adherence 2018; 12:2233-2241. [PMID: 30498335 PMCID: PMC6207380 DOI: 10.2147/ppa.s172222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to determine the level of consensus among Italian health care professionals (HCPs) regarding factors that influence adherence to cystic fibrosis (CF) treatments. METHODS A Delphi questionnaire with 94 statements of potential factors influencing adherence was developed based on a literature review and in consultation with a board of experts (n=4). This was distributed to a multidisciplinary expert panel of HCPs (n=110) from Italian CF centers. A Likert scale was used to indicate the level of agreement (1= no agreement to 9= maximum agreement) with each statement. Three rounds were distributed to establish a consensus (≥80% of participant ratings within one 3-point region) and, at the third round, assign a ranking to each statement with a high level of agreement (consensus in the 7-9 range) only. RESULTS Of 110 HCPs (from 31 Italian CF centers who were surveyed), responses were obtained from 85 (77%) in the first, 78 (71%) in the second, and 72 (65%) in the third round. The highest degree of agreement (95.8%) was reached with the statement that the HCP needs to build a relationship with the patient to influence adherence. A high level of agreement was not reached for statements that morbidity and mortality are influenced by the level of adherence to therapy, and no consensus was reached on the statement that age of the patient influences adherence to treatment. CONCLUSION We found that Italian HCPs endorsed a strong relationship with the patient as being a key driver in improving adherence. There were several areas, such as the influence of adherence on morbidity and mortality, where the consensus of Italian HCPs differed from the published literature. These areas require investigation to determine why these discrepancies exist.
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Affiliation(s)
- Carla Colombo
- Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,
| | - Paola Catastini
- Cystic Fibrosis Regional Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Anna Brivio
- Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,
- UOC DPS Department for Health Professional, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Serena Quattrucci
- Cystic Fibrosis Lazio Regional Center, Pediatrics Department, "Sapienza" University, Rome, Italy
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53
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Sawicki GS, McKone EF, Millar SJ, Pasta DJ, Konstan MW, Lubarsky B, Wagener JS. Patients with Cystic Fibrosis and a G551D or Homozygous F508del Mutation: Similar Lung Function Decline. Am J Respir Crit Care Med 2017; 195:1673-1676. [PMID: 28617084 DOI: 10.1164/rccm.201608-1678le] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gregory S Sawicki
- 1 Boston Children's Hospital Boston, Massachusetts.,2 Harvard Medical School Boston, Massachusetts
| | | | | | | | - Michael W Konstan
- 5 Case Western Reserve University School of Medicine Cleveland, Ohio.,6 Rainbow Babies and Children's Hospital Cleveland, Ohio
| | - Barry Lubarsky
- 7 Vertex Pharmaceuticals Incorporated Boston, Massachusetts and
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Chrysochoou EA, Hatziagorou E, Kirvassilis F, Tsanakas J. Telephone monitoring and home visits significantly improved the quality of life, treatment adherence and lung function in children with cystic fibrosis. Acta Paediatr 2017; 106:1882. [PMID: 28727186 DOI: 10.1111/apa.13996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elisavet-Anna Chrysochoou
- Paediatric Pulmonology and Cystic Fibrosis Unit; Hippokration Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Elpis Hatziagorou
- Paediatric Pulmonology and Cystic Fibrosis Unit; Hippokration Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Fotis Kirvassilis
- Paediatric Pulmonology and Cystic Fibrosis Unit; Hippokration Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - John Tsanakas
- Paediatric Pulmonology and Cystic Fibrosis Unit; Hippokration Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
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55
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Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 2017; 17:140. [PMID: 28899342 PMCID: PMC5596495 DOI: 10.1186/s12874-017-0411-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.
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Affiliation(s)
- Adem Sav
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia. .,, PO Box 456, Virginia, 4014, Australia.
| | - Asiyeh Salehi
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
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56
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Zobell JT, Schwab E, Collingridge DS, Ball C, Nohavec R, Asfour F. Impact of pharmacy services on cystic fibrosis medication adherence. Pediatr Pulmonol 2017; 52:1006-1012. [PMID: 28608652 DOI: 10.1002/ppul.23743] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/07/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study is to characterize the impact of pharmacy services on medication adherence and hospitalizations for pediatric cystic fibrosis (CF) patients. METHODS A retrospective health insurance claims analysis and patient medical charts review from January 1, 2014 to December 31, 2016 of patients from the Pediatric Intermountain CF Center was performed. Adherence to dornase alfa and hospital admissions for pulmonary exacerbations pre and post the implementation of an integrated pharmacy team were reviewed. Dornase alfa adherence was measured by the medication possession ratio (MPR) both monthly and yearly. RESULTS Fifty-four patients met inclusion criteria. The mean dornase alfa yearly MPR improved from 0.75 (2014) to 0.92 (2016). Patients were 2.8 times more likely to be adherent to dornase alfa when followed by integrated pharmacy team model (P < 0.001), and 2.4 times more likely to be adherent when followed by a dedicated CF clinic pharmacist only (P = 0.001). CONCLUSION The study demonstrated that pharmacy services improved adherence to dornase alfa.
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Affiliation(s)
- Jeffery T Zobell
- Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.,Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah
| | | | | | | | | | - Fadi Asfour
- Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.,Pediatric Pulmonology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Hoo ZH, Boote J, Wildman MJ, Campbell MJ, Gardner B. Determinants of objective adherence to nebulised medications among adults with cystic fibrosis: an exploratory mixed methods study comparing low and high adherers. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2017.1338958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Z. H. Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - J. Boote
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Research into Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - M. J. Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - M. J. Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - B. Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
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58
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Lee JL, Frey M, Frey P, Hollin IL, Wu AW. Seeing is Engaging: Vlogs as a Tool for Patient Engagement. THE PATIENT 2017; 10:267-270. [PMID: 28101817 PMCID: PMC5763490 DOI: 10.1007/s40271-017-0215-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Video blogs (‘vlogs’ – pronounced as one syllable) are a popular platform for conveying know-how online and can be used as a tool for patient engagement. It can be challenging to engage patients in their own care, and the unique attributes of vlogs overcome some of the barriers to engagement such as high treatment burden and a lack of the sense of community. While some clinicians may distrust social media and question its place in patient care, we present The Frey Life, one example of a patient vlog, to show how the platform models and fosters engagement, and provides the patient perspective. We discuss potential concerns regarding health vlogs, and suggest implications for physicians, researchers, and medical institutions regarding how to use patient vlogs as a resource.
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Affiliation(s)
- Joy L Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., 1101 West Tenth Street, Room 225, Indianapolis, IN, 46203, USA.
| | | | | | - Ilene L Hollin
- National Pharmaceutical Council, Washington DC, USA
- University of Southern California Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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59
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Faint NR, Staton JM, Stick SM, Foster JM, Schultz A. Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis. J Paediatr Child Health 2017; 53:488-493. [PMID: 28186386 DOI: 10.1111/jpc.13458] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/05/2016] [Accepted: 10/28/2016] [Indexed: 12/27/2022]
Abstract
AIM Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. METHODS Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. RESULTS Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2 = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). CONCLUSION Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes.
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Affiliation(s)
- Nicholas R Faint
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Janelle M Staton
- The University of Notre Dame, Perth, Western Australia, Australia
| | - Stephen M Stick
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Paediatric and Child Health, University of Western Australia, Perth, Western Australia, Australia
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60
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Oddleifson DA, Sawicki GS. Adherence and Recursive Perception Among Young Adults with Cystic Fibrosis. Anthropol Med 2017; 24:65-80. [PMID: 28292207 DOI: 10.1080/13648470.2017.1278865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adherence to prescribed treatment is a pressing issue for adolescents and young adults with cystic fibrosis (CF). This paper presents two narratives from the thematic analysis of unstructured interviews with 14 adolescents, young adults, and older adults living with CF. Through a new identity-based framework termed recursive perception that draws focus on how an individual perceives how others view them, it explores the social context of adherence and self-care among young adults with CF. It demonstrates that an individual's understanding of self and desire to maintain a certain image for peers can be deeply embedded in adherence and self-care patterns, leading individuals to feel they need to choose between tending to their health needs and living their lives. This suggests that current biomedical innovation in CF care must be complemented with renewed efforts to find effective means to empower young adults with CF to successfully navigate the social challenges of their illness and avoid the pitfalls of nonadherence that can lead to a permanent worsening of their health condition.
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Affiliation(s)
| | - Gregory S Sawicki
- b Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA , USA
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61
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Shakkottai A, Nasr SZ. The Use of Home Spirometry in Pediatric Cystic Fibrosis Patients: Results of a Feasibility Study. Glob Pediatr Health 2017; 4:2333794X17690315. [PMID: 28229102 PMCID: PMC5308520 DOI: 10.1177/2333794x17690315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022] Open
Abstract
Medication adherence is poor among pediatric cystic fibrosis (CF) patients, with adolescents having one of the lowest adherence rates. We wanted to identify an adherence intervention that would be acceptable to CF adolescents and assess its feasibility. We surveyed 40 adolescents with CF and asked about barriers to and motivators for their own adherence and to generate ideas for potential adherence interventions. Since most of the respondents chose frequent spirometry at home and medication reminders for interventions, we selected 5 subjects, 10 to 14 years of age, with CF to test the feasibility of home spirometry and medication reminders in pediatric CF patients. This article summarizes the results of both the survey and the feasibility pilot study.
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Affiliation(s)
| | - Samya Z. Nasr
- University of Michigan Health System, Ann Arbor, MI, USA
- Samya Z. Nasr, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 1500 E Medical Center Drive, SPC 5212, Ann Arbor, MI 48109-5212, USA.
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62
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Sawicki GS, Konstan MW. Reply: Combining Clinical Trial and Patient Registry Data in Cystic Fibrosis: Who Should Be Compared? Am J Respir Crit Care Med 2017; 195:405-406. [DOI: 10.1164/rccm.201609-1762le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gregory S. Sawicki
- Boston Children’s HospitalBoston, Massachusetts
- Harvard Medical SchoolBoston, Massachusettsand
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63
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Narayanan S, Mainz JG, Gala S, Tabori H, Grossoehme D. Adherence to therapies in cystic fibrosis: a targeted literature review. Expert Rev Respir Med 2017; 11:129-145. [DOI: 10.1080/17476348.2017.1280399] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Jochen G. Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Smeet Gala
- Market Access Solutions LLC. (MKTXS), Raritan, NJ, USA
| | - Harold Tabori
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Daniel Grossoehme
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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64
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Knudsen KB, Pressler T, Mortensen LH, Jarden M, Boisen KA, Skov M, Quittner AL, Katzenstein TL. Coach to cope: feasibility of a life coaching program for young adults with cystic fibrosis. Patient Prefer Adherence 2017; 11:1613-1623. [PMID: 29033550 PMCID: PMC5614776 DOI: 10.2147/ppa.s141267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Over the last two decades, lifespan has increased significantly for people living with cystic fibrosis (CF). However, several studies have demonstrated that many young adults with CF report mental health problems and poor adherence to their prescribed treatments, challenging their long-term physical health. Treatment guidelines recommend interventions to improve adherence and self-management. The aim of this study was to test the feasibility of a life coaching intervention for young adults with CF. METHODS A randomized, controlled feasibility study was conducted at the CF Center at Copenhagen University Hospital, Rigshospitalet. Participants were young adults with CF, aged 18-30 years without severe intellectual impairments. Participants were randomized to either life coaching or standard care. The intervention consisted of up to 10 individual, face-to-face or telephone coaching sessions over a period of 1 year. Primary outcomes were recruitment success, acceptability, adherence to the intervention, and retention rates. Secondary outcome measures included health-related quality of life, adherence to treatment, self-efficacy, pulmonary function, body mass index, and blood glucose values. RESULTS Among the 85 eligible patients approached, 40 (47%) were enrolled and randomized to the intervention or control group; two patients subsequently withdrew consent. Retention rates after 5 and 10 coaching sessions were 67% and 50%, respectively. Reasons for stopping the intervention included lack of time, poor health, perceiving coaching as not helpful, lack of motivation, and no need for further coaching. Coaching was primarily face-to-face (68%). No significant differences were found between the groups on any of the secondary outcomes. CONCLUSION Both telephone and face-to-face coaching were convenient for participants, with 50% receiving the maximum offered coaching sessions. However, the dropout rate early in the intervention was a concern. In future studies, eligible participants should be screened for their interest and perceived need for support and life coaching before enrollment.
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Affiliation(s)
- Karin Bæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Correspondence: Karin Bæk Knudsen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark, Tel +45 3545 3456, Fax +45 3545 2975, Email
| | - Tacjana Pressler
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Mary Jarden
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- University Hospital Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Skov
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Terese Lea Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Social Sciences, University of Copenhagen, Copenhagen, Denmark
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65
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Lewis KL, John B, Condren M, Carter SM. Evaluation of Medication-related Self-care Skills in Patients With Cystic Fibrosis. J Pediatr Pharmacol Ther 2016; 21:502-511. [PMID: 28018152 DOI: 10.5863/1551-6776-21.6.502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: As the life expectancy of patients with cystic fibrosis (CF) increases, the focus on ensuring success with medication therapies is increasingly important. The ability of patients to autonomously manage medications and related therapies is poorly described in the literature. OBJECTIVE: The goal of this project was to assess the level of medication-related knowledge and self-care skills in patients with CF. METHODS: This project took place in a Cystic Fibrosis Foundation accredited affiliate center. Eighty-nine patients between the ages of 6 and 60 were eligible to participate based on inclusion and exclusion criteria. Pharmacists administered a 16-item questionnaire and detailed medication history during clinic visits from January through May 2014. RESULTS: Forty-five patients 6 to 41 years old participated in the study. The skills most often performed independently were preparing nebulizer treatments (85%) and telling someone if they feel their medicines are causing a problem (89%). Skills least often performed were carrying a medication list (82%) and bringing a medication list to appointments (76%). In respondents 21 years of age and older, less than 75% of respondents were involved with obtaining financial resources, maintaining equipment, carrying a medication list, or rinsing their mouth after using inhaled medicines. Participants were able to provide drug name, dose, and frequency of use for pancreatic enzymes and azithromycin 37% and 24% of the time, respectively. CONCLUSIONS: In the population surveyed, many medication-related skills had not been acquired by early adulthood. Assessing and providing education for medication-related self-care skills at all ages are needed.
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Affiliation(s)
- Kelsey Lackey Lewis
- Department of Pharmacy, Washington Regional Medical Center, Fayetteville, Arkansas
| | - Barnabas John
- Department of Pharmacy, The Children's Hospital at Saint Francis, Tulsa, Oklahoma
| | - Michelle Condren
- Professor and Department Chair, Department of Pharmacy: Clinical and Administrative Sciences-Tulsa, University of Oklahoma College of Pharmacy; Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Sandra M Carter
- University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma
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66
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Bishay LC, Sawicki GS. Strategies to optimize treatment adherence in adolescent patients with cystic fibrosis. Adolesc Health Med Ther 2016; 7:117-124. [PMID: 27799838 PMCID: PMC5085292 DOI: 10.2147/ahmt.s95637] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While development of new treatments for cystic fibrosis (CF) has led to a significant improvement in survival age, routine daily treatment for CF is complex, burdensome, and time intensive. Adolescence is a period of decline in pulmonary function in CF, and is also a time when adherence to prescribed treatment plans for CF tends to decrease. Challenges to adherence in adolescents with CF include decreased parental involvement, time management and significant treatment burden, and adolescent perceptions of the necessity and value of the treatments prescribed. Studies of interventions to improve adherence are limited and focus on education, without significant evidence of success. Smaller studies on behavioral techniques do not focus on adolescents. Other challenges for improving adherence in adolescents with CF include infection control practices limiting in-person interactions. This review focuses on the existing evidence base on adherence intervention in adolescents with CF. Future directions for efforts to optimize treatment adherence in adolescents with CF include reducing treatment burden, developing patient-driven technology to improve tracking, communication, and online support, and rethinking the CF health services model to include assessment of individualized adherence barriers.
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Affiliation(s)
- Lara C Bishay
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA
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Travlos V, Bulsara C, Patman S, Downs J. A fine balance and a shared learning journey: Exploring healthcare engagement through the experiences of youth with Neuromuscular Disorders. NeuroRehabilitation 2016; 39:519-534. [DOI: 10.3233/nre-161383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Vivienne Travlos
- School of Physiotherapy, The University of Notre Dame Australia, Perth, WA, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Perth, WA, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Perth, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, Perth, WA, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Abstract
PURPOSE OF REVIEW Cystic fibrosis (CF) is the most common genetic, life-shortening illness among white populations. Management of the disease requires a complex, time-consuming treatment regimen. The purpose of this review is to highlight current research examining the psychological burden of CF, including psychological distress, social challenges, treatment burden, and adherence to daily treatments. RECENT FINDINGS Individuals with CF and their parent caregivers report elevated symptoms of depression and anxiety. Recent international guidelines (Cystic Fibrosis Foundation and European Cystic Fibrosis Society) recommend annual screening of these symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Symptoms of depression have been associated with decreased adherence, lower quality of life, and higher healthcare costs. Adherence to pulmonary medications has been found to be 50% or less and decreases with age. Poor adherence has been associated with higher healthcare costs, more frequent hospitalizations, and worse quality of life. SUMMARY Individuals with CF face unique challenges that can lead to psychological burden. Screening for these symptoms and developing effective interventions to improve adherence are the key targets for the next 5 years of research.
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Gonçalves ACV, Jácome CIO, Demain SH, Hunt KJ, Marques ASPDD. Burden of treatment in the light of the international classification of functioning, disability and health: a "best fit" framework synthesis. Disabil Rehabil 2016; 39:1253-1261. [PMID: 27374769 DOI: 10.1080/09638288.2016.1194898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This systematic literature review aimed to (1) summarize and explain the concept of Burden of Treatment (BoT) using the International Classification of Functioning, Disability and Health (ICF) terminology, and (2) inform the development of a future Comprehensive ICF Core Set for BoT. METHOD Searches on EMbase, Medline, CINAHL and PsycINFO were conducted. Only qualitative studies were considered for inclusion. The screening and data extraction stages were followed by a "Best-fit" framework synthesis and content analysis, using the established ICF linking rules. Screening, data extraction, quality appraisal and data analysis were performed by two independent researchers. RESULTS Seventeen studies were included in this review. The "Best-fit" framework synthesis generated 179 subthemes which identified that BoT impacts negatively on body functions and structures, restricts valued activities and participation and influences contextual factors through life roles, self-identify and relationships. The identified subthemes were linked to 77 ICF categories. CONCLUSIONS This study is part of the preparatory phase of a Comprehensive ICF Core Set for BoT and our findings will inform the further needed studies on this phase. The use of ICF terminology to describe BoT provides an accessible route for understanding this complex concept, which is pivotal for rethinking clinical practice. Implications for rehabilitation Health professionals applying the ICF should consider the negative impact of interventions on patient's life roles and self-identity, body functions and structures and on valued activities and participation. Health professionals who may be concerned about the treatment burden being experienced by their patients can now use the ICF terminology to discuss this with the multidisciplinary team. Poor adherence to rehabilitation programs may be explained by an increased BoT. This phenomenon can now be mapped to the ICF, and coded using a framework well known by multidisciplinary teams.
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Affiliation(s)
| | | | - Sara Holtum Demain
- a Faculty of Health Sciences , University of Southampton , Southampton , UK
| | - Katherine J Hunt
- a Faculty of Health Sciences , University of Southampton , Southampton , UK
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70
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Savant AP, McColley SA. Pediatric Pulmonology year in review 2015: Part 4. Pediatr Pulmonol 2016; 51:754-65. [PMID: 27171478 DOI: 10.1002/ppul.23470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
In this article, we highlight cystic fibrosis (CF) research published in Pediatric Pulmonology during 2015. Articles from other journals that reflect similar themes, and those of special importance, are also included. Pediatr Pulmonol. 2016;51:754-765. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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71
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Santoro SL, Martin LJ, Hopkin RJ. Screening for Hematological Disorders in Mosaic Down Syndrome: Parent Report of Experiences. Clin Pediatr (Phila) 2016; 55:421-7. [PMID: 26084538 DOI: 10.1177/0009922815589911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with Down syndrome (DS) have increased risk for multiple medical conditions with published health care guidelines. Current guidelines do not specify whether or not they apply to mosaic DS (mDS). We surveyed families of patients with mDS regarding screening, including monitoring practices as well as complications identified. Hematological complications were similar to those reported in nonmosaic DS. Of 91 parents of children with mDS surveyed, only 69% had ever had a screening lab; only 57% had ever had a screening complete blood count (CBC). Younger children were less likely to be screened (for CBC, 50% of 0- to 3-year-olds vs 90% of 4- to 12-year-olds; P = 0.0036). Screening practices are suboptimal, with the youngest children at greatest risk. Comparing reported screening practices with physician adherence, there was discrepancy between perceptions of adherence and perceptions of practice. Children with mDS should be monitored on the same schedule as other children with DS.
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Affiliation(s)
- Stephanie L Santoro
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Nationwide Children's Hospital Medical Center, Columbus, OH, USA
| | - Lisa J Martin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert J Hopkin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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72
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Cystic Fibrosis Transitions of Care: Lessons Learned and Future Directions for Cystic Fibrosis. Clin Chest Med 2015; 37:119-26. [PMID: 26857773 DOI: 10.1016/j.ccm.2015.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in cystic fibrosis (CF) care transformed the condition from one considered lethal by age 7 into a chronic illness (median lifespan, >40 years). With the growing numbers of adults with CF voicing their preference for care in age appropriate settings, the CF community met the challenge by developing an adult-focused care system modeled on the highly successful pediatric CF centers. Adult CF programs ensure lifelong CF specialty care. Preparation for transfer occurs in a process of "transition." This article reviews progress in transition-related care and provides recommendations for research and clinical practice to improve the transition process.
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73
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Elborn JS, Bell SC, Madge SL, Burgel PR, Castellani C, Conway S, De Rijcke K, Dembski B, Drevinek P, Heijerman HGM, Innes JA, Lindblad A, Marshall B, Olesen HV, Reimann AL, Solé A, Viviani L, Wagner TOF, Welte T, Blasi F. Report of the European Respiratory Society/European Cystic Fibrosis Society task force on the care of adults with cystic fibrosis. Eur Respir J 2015; 47:420-8. [PMID: 26453627 DOI: 10.1183/13993003.00592-2015] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/01/2015] [Indexed: 12/14/2022]
Abstract
The improved survival in people with cystic fibrosis has led to an increasing number of patients reaching adulthood. This trend is likely to be maintained over the next decades, suggesting a need to increase the number of centres with expertise in the management of adult patients with cystic fibrosis. These centres should be capable of delivering multidisciplinary care addressing the complexity of the disease, in addition to addressing the psychological burden on patients and their families. Further issues that require attention are organ transplantation and end of life management.Lung disease in adults with cystic fibrosis drives most of the clinical care requirements, and major life-threatening complications, such as respiratory infection, respiratory failure, pneumothorax and haemoptysis, and the management of lung transplantation require expertise from trained respiratory physicians. The taskforce therefore strongly reccommends that medical leadership in multidisciplinary adult teams should be attributed to a respiratory physician adequately trained in cystic fibrosis management.The task force suggests the implementation of a core curriculum for trainees in adult respiratory medicine and the selection and accreditation of training centres that deliver postgraduate training to the standards of the HERMES programme.
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Affiliation(s)
- J Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
| | - Scott C Bell
- Dept of Thoracic Medicine, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Susan L Madge
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Pierre-Regis Burgel
- Dept of Respiratory Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Carlo Castellani
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Steven Conway
- Paediatric and Adult CF Units, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | | | - Pavel Drevinek
- Dept of Medical Microbiology, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Harry G M Heijerman
- Haga Teaching Hospital, Dept of Pulmonology and Cystic Fibrosis, The Hague, The Netherlands
| | - J Alistair Innes
- Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, UK
| | - Anders Lindblad
- Dept of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | - Ampara Solé
- Lung Transplant and Adult Cystic Fibrosis, Dept of Pneumology, University Hospital la FE, Valencia, Spain
| | - Laura Viviani
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Thomas O F Wagner
- Christiane Herzog CF Centre, Dept of Respiratory Diseases, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Tobias Welte
- Dept of Respiratory Medicine, Hannover Medical School, Hanover, Germany
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
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74
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Sawicki GS, Goss CH. Tackling the increasing complexity of CF care. Pediatr Pulmonol 2015; 50 Suppl 40:S74-9. [PMID: 26335957 PMCID: PMC4562023 DOI: 10.1002/ppul.23244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 12/28/2022]
Abstract
Health outcomes for individuals with cystic fibrosis (CF) have dramatically improved in parallel with better organization of clinical care systems, evolution of novel therapeutics, and improvements in diagnosis and screening for CF and CF-related complications. In parallel with these advances has come an increasing complexity and burden of care, leading to challenges with adherence to treatment regimens. As novel therapeutics continue to be developed and introduced to the CF care regimen, there are clear opportunities to refine and personalize care. This can be done by adding comparative effectiveness research to the CF clinical research paradigm and integrating novel technologies in drug delivery and remote monitoring that can facilitate adherence but also reduce the burden of treatment while maintaining efficacy. This review highlights both the challenges of the increasingly complex treatment regimens in CF and the opportunities to advance care by addressing adherence, implementation science, comparative effectiveness, and integration of novel technologies in CF care.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher H Goss
- Division of Pulmonary Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
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75
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Goodfellow NA, Hawwa AF, Reid AJ, Horne R, Shields MD, McElnay JC. Adherence to treatment in children and adolescents with cystic fibrosis: a cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms. BMC Pulm Med 2015; 15:43. [PMID: 25927329 PMCID: PMC4417214 DOI: 10.1186/s12890-015-0038-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/15/2015] [Indexed: 11/12/2022] Open
Abstract
Background Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence. Methods A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence. Conclusions Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0038-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola A Goodfellow
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Ahmed F Hawwa
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK. .,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
| | - Alastair Jm Reid
- Northern Ireland Paediatric Cystic Fibrosis Centre, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK.
| | - Rob Horne
- UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK.
| | - Michael D Shields
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK. .,Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, UK.
| | - James C McElnay
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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76
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Sawicki GS, Chou W, Raimundo K, Trzaskoma B, Konstan MW. Randomized trial of efficacy and safety of dornase alfa delivered by eRapid nebulizer in cystic fibrosis patients. J Cyst Fibros 2015; 14:777-83. [PMID: 25921451 DOI: 10.1016/j.jcf.2015.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dornase alfa administered via jet nebulizer is indicated as a chronic respiratory medication for cystic fibrosis (CF) patients. Efficacy and safety of dornase alfa via an electronic nebulizer with vibrating membrane technology have not been formally assessed in randomized clinical trials. METHODS 87 CF patients (≥6 years) were randomized in a crossover study to receive dornase alfa 2.5 mg/d in 2-week periods with the Pari eRapid and Pari LC Plus jet nebulizers. The primary end point was comparison of forced expiratory volume in the first second. Safety, quality of life, and treatment satisfaction/preference were also compared between devices. RESULTS Lung function was equivalent between nebulizers. Most domain scores from the Cystic Fibrosis Questionnaire-Revised and Treatment Satisfaction Questionnaire for Medication instruments were similar but patients strongly preferred the eRapid. Mean patient-reported administration times were shorter with the eRapid vs the LC Plus (2.7 vs 10.2 min). Adverse events were similar between devices. CONCLUSIONS Administration of dornase alfa via the eRapid nebulizer resulted in comparable efficacy and safety, shorter nebulization times, and higher patient preference.
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Affiliation(s)
- Gregory S Sawicki
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Will Chou
- 1 DNA Way, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Karina Raimundo
- 1 DNA Way, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Ben Trzaskoma
- 1 DNA Way, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Michael W Konstan
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Jones S, Babiker N, Gardner E, Royle J, Curley R, Hoo ZH, Wildman MJ. Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence. Patient Prefer Adherence 2015; 9:1109-20. [PMID: 26346635 PMCID: PMC4529254 DOI: 10.2147/ppa.s82896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) health care professionals recognize the need to motivate people with CF to adhere to nebulizer treatments, yet little is known about how best to achieve this. We aimed to produce motivational posters to support nebulizer adherence by using social marketing involving people with CF in the development of those posters. METHODS The Sheffield CF multidisciplinary team produced preliminary ideas that were elaborated upon with semi-structured interviews among people with CF to explore barriers and facilitators to the use of nebulized therapy. Initial themes and poster designs were refined using an online focus group to finalize the poster designs. RESULTS People with CF preferred aspirational posters describing what could be achieved through adherence in contrast to posters that highlighted the adverse consequences of nonadherence. A total of 14 posters were produced through this process. CONCLUSION People with CF can be engaged to develop promotional material to support adherence, providing a unique perspective differing from that of the CF multidisciplinary team. Further research is needed to evaluate the effectiveness of these posters to support nebulizer adherence.
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Affiliation(s)
- Stephen Jones
- Psychology Department, University of Sheffield, Sheffield, UK
| | - Nathan Babiker
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Emma Gardner
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
| | - Jane Royle
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Rachael Curley
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zhe Hui Hoo
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Correspondence: Martin J Wildman, Adult CF and Respiratory Medicine, Adult Cystic Fibrosis Unit, CF Office, Brearley Outpatient, Northern General Hospital, Herries Road, Sheffield S5 7AU, United Kingdom, Tel +44 114 271 5212, Email
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Millington K, Miller V, Rubenstein RC, Kelly A. Patient and parent perceptions of the diagnosis and management of cystic fibrosis-related diabetes. J Clin Transl Endocrinol 2014; 1:100-107. [PMID: 29159090 PMCID: PMC5685035 DOI: 10.1016/j.jcte.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background Cystic Fibrosis Related Diabetes (CFRD) is an increasingly common complication in CF. CFRD introduces an additional complex chronic disease to individuals already attending to demanding treatment regimens. An improved understanding of the reaction to and coping mechanisms surrounding CFRD may facilitate management of CFRD. Methods Semi-structured interviews completed by 10 children with CFRD, 10 adults with CFRD and 10 parents of children with CFRD in a single large CF Care Center were analyzed utilizing phenomenological analysis. Results Patients and families reported having limited knowledge of CFRD prior to diagnosis. CFRD was considered an extension of their underlying CF and successful management depended upon integration into existing routines. Conclusions Health care professionals caring for patients with CFRD should be informed of the specific challenges that arise in CFRD. Education in advance of CFRD diagnosis may facilitate management.
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Affiliation(s)
- Kate Millington
- Perelman School of Medicine, University of Pennsylvania, 100 Stemmler Hall, Philadelphia, PA 19104, USA
| | - Victoria Miller
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ronald C Rubenstein
- Division of Pulmonary Medicine and Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA
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