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Graziano PA, Sibley MH, Coxe SJ, Bickman L, Martin P, Scheres A, Hernandez ML. Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes. Behav Ther 2024; 55:412-428. [PMID: 38418050 PMCID: PMC10902603 DOI: 10.1016/j.beth.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 03/01/2024]
Abstract
Previous research suggests that routine psychosocial care for adolescents with attention-deficit/hyperactivity disorder (ADHD) is an eclectic and individualized mix of diluted evidence-based practices (EBPs) and low-value approaches. This study evaluated the extent to which a community-delivered EBP and usual care (UC) for adolescents with ADHD produce differential changes in theorized behavioral, psychological, and cognitive mechanisms of ADHD. A randomized community-based trial was conducted with double randomization of adolescent and community therapists to EBP delivery supports (Supporting Teens' Autonomy Daily [STAND]) versus UC delivery. Participants were 278 culturally diverse adolescents (ages 11-17) with ADHD and caregivers. Mechanistic outcomes were measured at baseline, post-treatment, and follow-up using parent-rated, observational, and task-based measures. Results using linear mixed models indicated that UC demonstrated superior effects on parent-rated and task-based executive functioning relative to STAND. However, STAND demonstrated superior effects on adolescent motivation and reducing parental intrusiveness relative to UC when it was delivered by licensed therapists. Mechanisms of community-delivered STAND and UC appear to differ. UC potency may occur through improved executive functioning, whereas STAND potency may occur through improved teen motivation and reducing low-value parenting practices. However, when delivered by unlicensed, community-based therapists, STAND did not enact proposed mechanisms. Future adaptations of community-delivered EBPs for ADHD should increase supports for unlicensed therapists, who comprise the majority of the community mental health workforce.
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Affiliation(s)
| | - Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute, and Florida International University
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Macphee FL, Brewer SK, Sibley MH, Graziano P, Raiker JS, Coxe SJ, Martin P, Van Dreel SJ, Rodriguez MO, Lyon AR, Page TF. Study protocol of a randomized trial of STRIPES: a schoolyear, peer-delivered high school intervention for students with ADHD. BMC Psychol 2023; 11:268. [PMID: 37670368 PMCID: PMC10481510 DOI: 10.1186/s40359-023-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Youth with ADHD are at risk of academic impairments, dropping out of high school, and dysfunction in young adulthood. Interventions delivered early in high school could prevent these harmful outcomes, yet few high school students with ADHD receive treatment due to limited access to intervention providers. This study will test a peer-delivered intervention (STRIPES) for general education 9th grade students with impairing ADHD symptoms. METHODS A type 1 hybrid effectiveness-implementation design will be used to evaluate the effectiveness of STRIPES and explore the intervention's implementability. Analyses will test the impact of STRIPES vs. enhanced school services control on target mechanisms and determine whether differences in basic cognitive profiles moderate intervention response. The acceptability and feasibility of STRIPES and treatment moderators will also be examined. DISCUSSION This study will generate knowledge about the effectiveness and implementability of STRIPES, which will inform dissemination efforts in the future. A peer-delivered high school intervention for organization, time management, and planning skills can provide accessible and feasible treatment targeting declines in academic motivation, grades, and attendance during the ninth-grade year. TRIAL REGISTRATION This study is registered on OSF Registries (10.17605/OSF.IO/Q8V6S).
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Affiliation(s)
- Fiona L Macphee
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Stephanie K Brewer
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA, 98115, USA.
| | - Margaret H Sibley
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Joseph S Raiker
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Stefany J Coxe
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Pablo Martin
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Shauntal J Van Dreel
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Mercedes Ortiz Rodriguez
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA, 98115, USA
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship Nova Southeastern University, Florida, USA
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Adherence to Post-Stroke Pharmacotherapy: Scale Validation and Correlates among a Sample of Stroke Survivors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081109. [PMID: 36013576 PMCID: PMC9413934 DOI: 10.3390/medicina58081109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Adherence to post-stroke pharmacotherapy has been less studied compared with other cardiovascular diseases, and previous research in this context utilized generic tools without cross-validating for stroke specific factors and patient characteristics. This study aimed to validate the Lebanese Medication Adherence Scale (LMAS-14) among stroke survivors to assess adherence to post-stroke pharmacotherapy. It also aimed to determine the socioeconomic, clinical characteristics, and health related quality of life correlates of medication adherence among stroke survivors. Materials and Methods: This was a cross-sectional study that included stroke survivors from districts throughout Lebanon. A well-structured questionnaire consisting of three parts was developed and utilized to collect data. The first part included questions about the sociodemographic and socioeconomic characteristics. The second part included questions about medical history, current clinical characteristics of the patients, and use of medications. The third part included validated scales to assess stroke outcomes, daily performance and activities, and quality of life. Results: A total of 172 stroke survivors were included. The LMAS-14 structure was validated over a solution of three factors, with a Kaiser−Meyer−Olkin (KMO) measure of sampling adequacy = 0.836 and a significant Bartlett’s test of sphericity (p < 0.001). Severe difficulty in obtaining medications within the current Lebanese economic crisis was significantly associated with lower medication adherence (Beta = −8.473, p = 0.001). Lower medication adherence was also associated with poor stroke prognosis (Beta = −3.264, p = 0.027), higher number of used medications (Beta = −0.610, p = 0.034), and longer duration of stroke diagnosis (Beta = −4.292, p = 0.002). Conclusions: The LMAS−14 is a valid and reliable tool to assess medication adherence in stroke practice and research. Severe difficulty in obtaining medications due to unpredictable availability and shortage of supplies is associated with lower medication adherence, and thus places stroke survivors at higher risk of complications and morality. Additional measures and urgent action by stroke care providers and public health stakeholders are necessary to ensure adequate post-stroke management and outcomes.
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Sibley MH, Morley C, Rodriguez L, Coxe SJ, Evans SW, Morsink S, Torres F. A Peer-Delivered Intervention for High School Students With Impairing ADHD Symptoms. SCHOOL PSYCHOLOGY REVIEW 2020. [DOI: 10.1080/2372966x.2020.1720803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sibley MH, Comer JS, Gonzalez J. Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017; 39:467-485. [PMID: 28989230 PMCID: PMC5625835 DOI: 10.1007/s10862-017-9598-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, FL
| | - Jonathan S. Comer
- Department of Psychology, Florida International University, Miami, FL
| | - Jaife Gonzalez
- Center for Children and Families, Florida International University, Miami, FL
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Auyeung V, Patel JP, Abdou JK, Vadher B, Bonner L, Brown A, Roberts LN, Patel RK, Arya R. Anticoagulated patient's perception of their illness, their beliefs about the anticoagulant therapy prescribed and the relationship with adherence: impact of novel oral anticoagulant therapy - study protocol for The Switching Study: a prospective cohort study. BMC HEMATOLOGY 2016; 16:22. [PMID: 27559477 PMCID: PMC4995624 DOI: 10.1186/s12878-016-0061-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 08/01/2016] [Indexed: 12/21/2022]
Abstract
Background Anticoagulant therapy is prescribed for millions of patients worldwide for the prevention and treatment of both arterial and venous thrombosis. Historically, only vitamin K antagonists have been available for clinicians to prescribe. The anticoagulation landscape is changing. The recent availability of the novel oral anticoagulants overcome many of the disadvantages associated with vitamin K antagonists. However the lack of formal monitoring and clinic follow-up is a concern for clinicians, as medication adherence is being assumed, which is known to decline in patients prescribed medications for chronic conditions. The switching study is a programme of work investigating the association between medication adherence and patient’s beliefs about anticoagulation therapy (warfarin and subsequently novel oral anticoagulants), together with beliefs about their illness and anticoagulation related quality of life. Methods/design The anticoagulation database at King’s College Hospital will be interrogated and two groups of patients will be identified; those with a time in therapeutic range on warfarin of ≥75 % and those <50 %. These groups of patients will have their illness perceptions, anticoagulation specific quality of life and beliefs about medications compared. Those patients in the time in therapeutic range <50 % group, will be then be invited to switch to a novel oral anticoagulant, as per local guidance. Those patients, who do switch, will then be followed longitudinally and have their adherence, illness perceptions, anticoagulation specific quality of life and beliefs about medications, re-evaluated on the novel agent. The results from these sub-studies, will inform a clinical pathway to support patients on these novel agents, which will be evaluated in an independent group of patients. Discussion The results from the switching study will be used to develop a clinical pathway to support patient’s prescribed novel oral anticoagulant therapy long-term. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0061-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vivian Auyeung
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK
| | - Jignesh P Patel
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK ; Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK
| | - John K Abdou
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK ; Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King's College London, 5th Floor, Franklin-Wilkins Building, London, SE1 9NH UK
| | - Bipin Vadher
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Lynda Bonner
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Alison Brown
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Lara N Roberts
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Raj K Patel
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Roopen Arya
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
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Ruppar TM, Dobbels F, Lewek P, Matyjaszczyk M, Siebens K, De Geest SM. Systematic Review of Clinical Practice Guidelines for the Improvement of Medication Adherence. Int J Behav Med 2016; 22:699-708. [PMID: 25805550 DOI: 10.1007/s12529-015-9479-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear. PURPOSE This review evaluated clinical practice guidelines designed to help health care providers address patients' medication adherence. METHOD Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation. RESULTS We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10). CONCLUSION Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes.
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Affiliation(s)
| | | | | | | | | | - Sabina M De Geest
- University of Leuven (KU Leuven), Leuven, Belgium.,University of Basel, Basel, Switzerland
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Andretta I, Meyer E, Kuhn R, Rigon M. A Entrevista Motivacional no Brasil: Uma Revisão Sistemática. ACTA ACUST UNITED AC 2014. [DOI: 10.15603/2176-1019/mud.v22n2p15-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Electronic monitoring of medication adherence in a 1-year clinical study of 2 dosing regimens of mesalazine for adults in remission with ulcerative colitis. Inflamm Bowel Dis 2014; 20:82-91. [PMID: 24284414 DOI: 10.1097/01.mib.0000437500.60546.2a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adherence to medication is an issue of great importance for patients with ulcerative colitis. Once daily mesalazine seems to be no worse than divided doses in preventing relapse in remitting patients. Although this has been attributed to improved adherence, detailed measures of adherence have been lacking from previous studies. METHODS A 1-year substudy was conducted alongside a trial that compared 2 different dosing regimens (once daily versus three times daily) of mesalazine for patients in remission with ulcerative colitis. Participants in the substudy had their adherence monitored electronically using the medication event monitoring system, self-report, and tablet counts. We compared measures, determined factors associated with adherence and associations between adherence and relapse, modeled adherence over time, and explored behavioral aspects. RESULTS We included 58 participants. Adherence was high across all measures (89.3% self-report, 96.7% tablet counts, and 89.2% medication event monitoring system). Agreement between the measures was poor at times. Adherence according to the medication event monitoring system best distinguished between the participants who relapsed (71.4%) and those who remained in remission (93.4%), although this difference was not statistically discernible at the 5% level. Adherence deteriorated over the study period, with three times daily participants generally less adherent than once-daily participants (odds ratio, 0.03; 95% confidence interval, 0.01-0.08). Adherence was higher on weekdays (odds ratio, 1.47; 95% confidence interval, 1.31-1.65) and around clinic visit dates (odds ratio, 1.43; 95% confidence interval, 1.18-1.72). CONCLUSIONS Simple dosing regimens are preferable to multiple daily dosing regimens. Electronic monitoring of adherence should be used more often in clinical studies. Self-reported adherence and tablet counts may underestimate adherence. Adherence declined over time, and adherence was generally lower and more varied for those allocated to the three times daily regimen.
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Reach G. Non-observance dans le diabète de type 2. Presse Med 2013; 42:886-92. [DOI: 10.1016/j.lpm.2013.02.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
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Heaton E, Levender MM, Feldman SR. Review: timing of office visits can be a powerful tool to improve adherence in the treatment of dermatologic conditions. J DERMATOL TREAT 2013; 24:82-8. [DOI: 10.3109/09546634.2011.588194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hagele TJ, Levender MM, Davis SA, Williford PM, Feldman SR. Practice Trends in the Treatment of Actinic Keratosis in the United States: 0.5% Fluorouracil and Combination Cryotherapy plus Fluorouracil are Underused despite Evidence of Benefit. J Cutan Med Surg 2012; 16:107-14. [DOI: 10.2310/7150.2011.11002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Topical fluorouracil and cryotherapy are among the most commonly used treatments for actinic keratosis. Evidence shows that 0.5% fluorouracil has similar efficacy and is better tolerated than 5% fluorouracil. Evidence also shows that combination therapy with cryosurgery and fluorouracil is beneficial. Objective: To examine fluorouracil and cryotherapy use in the treatment of actinic keratosis. Methods: The National Ambulatory Medical Care Survey database was queried for visits for actinic keratosis. Visits were analyzed for patient demographics, provider specialty, and treatment regimens. Fluorouracil and cryotherapy use was analyzed over time. Results: Cryotherapy was the most commonly used treatment for actinic keratosis. Fluorouracil products were prescribed to 1.1 million patients (6.6%) between 2001 and 2008; of these, dermatologists prescribed 0.5% fluorouracil in 51.8% of cases and 5% fluorouracil in 38.9% of cases. Combination fluorouracil and cryotherapy was used for only 1.1% of actinic keratosis visits between 1993 and 2008 and was never used by nondermatologists. Conclusions: Despite evidence suggesting comparable efficacy, greater tolerability, and lower cost of 0.5% fluorouracil relative to 5% fluorouracil, 5% fluorouracil is used by dermatologists almost as often as 0.5% fluorouracil. Among nondermatologists, 5% fluorouracil is used exclusively. Combination therapy of fluorouracil and cryotherapy is underused despite evidence of its benefit.
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Affiliation(s)
- Thomas J. Hagele
- Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michelle M. Levender
- Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Scott A. Davis
- Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Phillip M. Williford
- Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Steven R. Feldman
- Departments of Dermatology, Pathology, and Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC
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van de Klundert J, Gorissen P, Zeemering S. Measuring clinical pathway adherence. J Biomed Inform 2010; 43:861-72. [DOI: 10.1016/j.jbi.2010.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 07/28/2010] [Accepted: 08/02/2010] [Indexed: 11/27/2022]
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Gupta G, Mallefet P, Kress D, Sergeant A. Adherence to topical dermatological therapy: lessons from oral drug treatment. Br J Dermatol 2009; 161:221-7. [DOI: 10.1111/j.1365-2133.2009.09253.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Ulcerative colitis (UC) is chronic inflammation of large intestine and often requires lifelong medication. Medical therapy aims to induce and maintain a clinical remission, reduce the risk of colorectal cancer and improve quality of life. Aminosalicylates are currently the first choice therapy both for the induction and the maintenance of remission in the patients with mild-to-moderate UC. For moderate-to-severe cases or those who do not respond to aminosalicylate therapy, additional treatment options including corticosteroids, immunomodulators, biological agents, cyclosporin, tacrolimus and surgery are available. Poor adherence to medication has been an important barrier to successful management of UC. Nonadherence has been associated with increased relapse rates, higher risk of colorectal cancer, poor quality of life and significantly increased healthcare costs. Therefore, improving adherence to medication is an important approach for a better care of the patients with UC. Definitive strategies are required to help the patients effectively self manage their disease and improve adherence. This review examines current medical therapy for UC, research progresses on medication adherence and the possible strategies for improving adherence in these patients.
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Biuso TJ, Butterworth S, Linden A. A Conceptual Framework for Targeting Prediabetes with Lifestyle, Clinical, And Behavioral Management Interventions. ACTA ACUST UNITED AC 2007; 10:6-15. [PMID: 17309360 DOI: 10.1089/dis.2006.628] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prediabetes is a condition that does not fall squarely into the primary or secondary prevention domain, and therefore tends to be inadequately addressed by interventions in either health promotion or disease management. Prediabetes is defined as having an impaired fasting glucose (fasting glucose of 100-125 mg/dL), impaired glucose tolerance (two-hour postprandial glucose of 140-199 mg/dL), or both. There is substantial evidence to suggest that even at these blood glucose levels, significant risk exists for both microand macrovascular complications. This paper introduces a conceptual framework of care for prediabetes that includes both screening and the provision of up-to-date clinical therapies in conjunction with an evidence-based health coaching intervention. In combination, these modalities represent the most effective means for delaying or even preventing the onset of diabetes in a prediabetes population. This paper concludes with a brief example in which these principles are applied to a hypothetical patient.
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Affiliation(s)
- Thomas J Biuso
- Regional Hospitalist Program Director, Apogee Medical, Tucson, Arizona, USA
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Butterworth SW, Linden A, McClay W. Health Coaching as an Intervention in Health Management Programs. ACTA ACUST UNITED AC 2007. [DOI: 10.2165/00115677-200715050-00004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Linden A, Butterworth SW, Roberts N. Disease Management Interventions II: What Else Is in the Black Box? ACTA ACUST UNITED AC 2006; 9:73-85. [PMID: 16620193 DOI: 10.1089/dis.2006.9.73] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The success of any disease management (DM) program ultimately depends upon the ability and willingness of participants to change and maintain desired health behaviors. To achieve those results, DM program administrators have several issues to consider, including the type of behavioral change desired, the scope of intervention that the organization is willing and capable of implementing, and whether the appropriate support structures are available to ensure successful achievement of program goals. An understanding of these issues will assist program designers in selecting the appropriate change models. This paper serves as an extension of our prior paper in which eight core psychosocial behavioral change models were described. Here, five more recently developed theory-based approaches are introduced, providing readers with up-to-date information in this area.
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Affiliation(s)
- Ariel Linden
- Linden Consulting Group, and School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
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Abstract
Ulcerative colitis is a chronic inflammatory and debilitating disease requiring lifelong treatment. First-line therapy for ulcerative colitis is 5-aminosalicylic acid, which suffers from poor patient adherence outside the clinical trial setting. Formulations to deliver 5-aminosalicylic acid to the disease activity site, both orally and topically, are often inconvenient and require multiple daily dosing. Such regimens can interfere with normal life and reduce the overall quality of life, negatively impacting on treatment adherence and leading to poorer long-term outcomes. These include increased morbidity with an elevated risk of symptomatic relapse, possible greater risk of colorectal cancer and higher overall costs of care. Ulcerative colitis patients cite treatment regimen complexity, tablet quantity and dose frequency as key negative influencers of adherence. Solutions to these issues include addressing patient concerns, simplifying daily regimens and utilizing new formulations such as micropellet and multimatrix oral formulations, rectal gel and once-daily suppository formulations. This review examines the prevalence and impact of non-adherence to 5-aminosalicylic acid therapy among patients with ulcerative colitis, as well as drug delivery strategies that may enhance dosing regimens to improve patient acceptability, adherence and long-term clinical outcomes. It is a combination of understanding patient behaviour, recognizing signs of non-adherent behaviour and utilizing management strategies to change behaviour that will improve patient outcomes.
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Affiliation(s)
- S V Kane
- Section of Gastroenterology, Department of Medicine, The University of Chicago, Chicago, IL, USA.
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