1
|
Al Daccache M, Al-Shaar L, Sibai AM, Ismaeel H, Badr K, Nasreddine L. Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon. PLoS One 2023; 18:e0287844. [PMID: 37874832 PMCID: PMC10597531 DOI: 10.1371/journal.pone.0287844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 10/26/2023] Open
Abstract
Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.
Collapse
Affiliation(s)
- Melodie Al Daccache
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Laila Al-Shaar
- Faculty of Medicine, Department of Public Health Sciences, Pennsylvania State University, State College, Pennsylvania, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Abla Mehio Sibai
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Hussain Ismaeel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Medical Services, Aman Hospital, Doha, Qatar
| | - Kamal Badr
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Lara Nasreddine
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
2
|
Ishida R, Ishii A, Matsuo T, Minami T, Yoshikawa T. Association between eating behavior and the immediate neural activity caused by viewing food images presented in and out of awareness: A magnetoencephalography study. PLoS One 2022; 17:e0275959. [PMID: 36580472 PMCID: PMC9799321 DOI: 10.1371/journal.pone.0275959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
Obesity is a serious health problem in modern society. Considering the fact that the outcomes of treatments targeting appetitive behavior are suboptimal, one potential reason proposed for these poor outcomes is that appetitive behavior is driven more by unconscious decision-making processes than by the conscious ones targeted by traditional behavioral treatments. In this study, we aimed to investigate both the conscious and unconscious decision-making processes related to eating behavior, and to examine whether an interaction related to eating behavior exists between conscious and unconscious neural processes. The study was conducted on healthy male volunteers who viewed pictures of food and non-food items presented both above and below the awareness threshold. The oscillatory brain activity affected by viewing the pictures was assessed by magnetoencephalography. A visual backward masking procedure was used to present the pictures out of awareness. Neural activity corresponding to the interactions between sessions (i.e., food or non-food) and conditions (i.e., visible or invisible) was observed in left Brodmann's areas 45 and 47 in the high-gamma (60-200 Hz) frequency range. The interactions were associated with eating behavior indices such as emotional eating and cognitive restraint, suggesting that conscious and unconscious neural processes are differently involved in eating behavior. These findings provide valuable clues for devising methods to assess conscious and unconscious appetite regulation in individuals with normal or abnormal eating behavior.
Collapse
Affiliation(s)
- Rika Ishida
- Department of Sports Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akira Ishii
- Department of Sports Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Takashi Matsuo
- Department of Sports Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Minami
- Department of Sports Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Yoshikawa
- Department of Sports Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Werba JP, Giroli MG, Simonelli N, Vigo L, Gorini A, Bonomi A, Veglia F, Tremoli E. Uptake and effectiveness of a primary cardiovascular prevention program in an underserved multiethnic urban community. Nutr Metab Cardiovasc Dis 2022; 32:1110-1120. [PMID: 35260313 DOI: 10.1016/j.numecd.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic risk is increased among disadvantaged people and ethnic minorities. Paradoxically, their uptake of primary cardiovascular prevention is relatively low. New strategies are needed to tackle this public health problem. Aims of this study were to assess the uptake (as well as its determinants) and effectiveness of a primary cardiovascular prevention program for communities devised to facilitate access of disadvantaged and inclusion of ethnic minorities in addition to providing a state-of-the-art interdisciplinary personalized care. METHODS AND RESULTS Single center, hospital-based, open study. All the residents in an underserved multiethnic urban community aged 40-65 years (n = 1646, 43.6% immigrants) were proactively invited by post mail to participate in a cardiovascular prevention program and different approaches were adopted to promote accessibility and inclusiveness. Program uptake was 23% and individual features independently associated with program uptake were status of immigrant (OR [CI 95%]: 3.6 [2.6-5.1]), higher educational level (3.6 [2.8-4.7]), and female gender (1.6 [1.2-2.1]). Retention was 82% at 6 months and 69% at 12 months. A predefined outcome of global cardiovascular risk improvement at 12 months in subjects with glycaemia >126 mg/dl, LDL-C >115 mg/dl, systolic blood pressure ≥140 mmHg or BMI >28 at baseline was reached in 35%, 33%, 37% and 7% of the patients, respectively. 20% of smokers quitted and significant favorable changes were reported in diet quality, anxiety, depression and physical activity. CONCLUSION Access inequalities to effective prevention may be counteracted, but increasing global uptake requires further upstream sensitization and awareness actions. REGISTERED IN CLINICALTRIALS.GOV: NCT03129165.
Collapse
Affiliation(s)
- José P Werba
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.
| | - Monica G Giroli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Niccolò Simonelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Struttura Complessa Cardiologia, Azienda Ospedaliera Ss. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lorenzo Vigo
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/a, 20122 Milan, Italy; Istituti Clinici Scientifici Maugeri di Milano, IRCCS, 20138 Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy; Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola Ravenna, Italy
| |
Collapse
|
4
|
Ihm SH, Kim KI, Lee KJ, Won JW, Na JO, Rha SW, Kim HL, Kim SH, Shin J. Interventions for Adherence Improvement in the Primary Prevention of Cardiovascular Diseases: Expert Consensus Statement. Korean Circ J 2022; 52:1-33. [PMID: 34989192 PMCID: PMC8738714 DOI: 10.4070/kcj.2021.0226] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/05/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023] Open
Abstract
Over the last 2 decades, the management of chronic disease in Korea has been improved, but it has gradually stagnated. In order to improve care and reduce cardiovascular morbidity and mortality, it is crucial to improve primary prevention of cardiovascular diseases. In recent international guidelines for hypertension, diabetes, hyperlipidemia, obesity, and other conditions, adherence issues have become more frequently addressed. However, in terms of implementation in practice, separate approaches by dozens of related academic specialties need to be integrated into a systematic approach including clinician’s perspectives such as the science behind adherence, clinical skills, and interaction within team approach. In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patient-centered clinical communication skills, counseling using motivational strategies, decision-making by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.
Collapse
Affiliation(s)
- Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
| |
Collapse
|
5
|
Quigley A, Brouillette MJ, Fellows LK, Mayo N. Action for better brain health among people living with HIV: protocol for a randomized controlled trial. BMC Infect Dis 2021; 21:843. [PMID: 34416849 PMCID: PMC8377450 DOI: 10.1186/s12879-021-06540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle changes can protect or improve brain health in older adults. However, sustained lifestyle change is difficult for everyone and may be more difficult for those with executive dysfunction, including some people living with HIV. Thus, the key question is how we can improve adherence to the most promising interventions among people living with HIV experiencing cognitive difficulties. Goal management training is a cognitive rehabilitation program that targets executive dysfunction by teaching goal-directed behaviour and self-management. It is a promising means to improve adherence to lifestyle interventions. OBJECTIVE To estimate the extent to which goal management training before a healthy lifestyle program is associated with greater adherence to health recommendations, achievement of health-related goals, and better brain health and health outcomes compared to the healthy lifestyle program alone among people living with HIV. METHODS Brain Health Now cohort participants with cognitive difficulties or are not aging successfully are eligible. All participants will be given health resources, a health coach, a goal-setting digital application, and access to an online goal-setting workshop. The intervention group will participate in nine 2-h goal management training sessions and then will enter the healthy lifestyle program. Control participants will enter the healthy lifestyle program directly. A total sample of 100 participants will participate for 12 months. The main outcome is adherence to the healthy lifestyle program, defined as the number of weeks where physical activity adherence targets were met (150 min per week, measured with an activity monitor). Weekly social activities will be captured via self-report with confidential photo validation. We will send weekly health state reports to the participants. Downstream outcomes include cognitive ability, health-related quality of life, mobility, vascular risk profile, and social network size. We will analyze the data using a linear regression model. DISCUSSION This project is the first to test whether goal management training can augment adherence to health recommendations among individuals with cognitive difficulties. If successful, behavioural interventions such as goal management training could be implemented as an adjunct to lifestyle interventions in other clinical populations. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov (NCT04345484) on April 14, 2020, https://clinicaltrials.gov/ct2/show/NCT04345484?term=NCT04345484&draw=2&rank=1 .
Collapse
Affiliation(s)
- Adria Quigley
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
| | - Marie-Josée Brouillette
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Nancy Mayo
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada
| |
Collapse
|
6
|
Del Razo-Olvera FM, Martin-Vences AJ, Brito-Córdova GX, Elías-López D, Landa-Anell MV, Melgarejo-Hernández MA, Cruz-Bautista I, Manjarrez-Martínez I, Gómez-Velasco DV, Aguilar-Salinas CA. Primary Barriers of Adherence to a Structured Nutritional Intervention in Patients with Dyslipidemia. Nutrients 2021; 13:nu13061744. [PMID: 34063795 PMCID: PMC8223790 DOI: 10.3390/nu13061744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To describe the primary barriers to adequately adhering to a structured nutritional intervention. PATIENTS AND METHODS A total of 106 participants diagnosed with dyslipidemia and without a medical nutrition therapeutic plan were included in this two-year study conducted at the INCMNSZ dyslipidemia clinic in Mexico City. All patients were treated with the same structured strategies, including three face-to-face visits and two telephone follow-up visits. Diet plan adherence was evaluated at each site visit through a 3-day or 24-h food recall. RESULTS Barriers to adhere to the nutritional intervention were: lack of time to prepare their meals (23%), eating outside the home (19%), unwillingness to change dietary patterns (14%), and lack of information about a correct diet for dyslipidemias (14%). All barriers decreased significantly at the end of the intervention. Female gender, current smoking, and following a plan of more than 1500 kcal (R2 = 0.18 and p-value = 0.004) were associated with good diet adherence. Participants showed good levels of adherence to total caloric intake at visit 2 and 3, reporting 104.7% and 95.4%, respectively. Adherence to macronutrient intake varied from 65.1% to 126%, with difficulties in adhering to recommended carbohydrate and fat consumption being more notable. CONCLUSION The study findings confirm that a structured nutritional intervention is effective in reducing barriers and improving dietary adherence and metabolic control in patients with dyslipidemias. Health providers must identify barriers to adherence early on to design interventions that reduce these barriers and improve adherence.
Collapse
Affiliation(s)
- Fabiola Mabel Del Razo-Olvera
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | | | - Griselda X. Brito-Córdova
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Daniel Elías-López
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - María Victoria Landa-Anell
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico;
| | - Marco Antonio Melgarejo-Hernández
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico;
| | - Ivette Cruz-Bautista
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Iliana Manjarrez-Martínez
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Donají Verónica Gómez-Velasco
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
| | - Carlos Alberto Aguilar-Salinas
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
- Division of Nutrition, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán (INCMNSZ), Vasco de Quiroga #15, Tlalpan, Mexico City 14080, Mexico
- Correspondence: ; Tel.: +52-55-54-87-09-00 (ext. 1501); Fax: +52-55-55-13-45-07
| |
Collapse
|
7
|
Westland H, Schuurmans MJ, Bos-Touwen ID, de Bruin-van Leersum MA, Monninkhof EM, Schröder CD, de Vette DA, Trappenburg JC. Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial. Eur J Cardiovasc Nurs 2020; 19:721-731. [PMID: 32375491 PMCID: PMC7817988 DOI: 10.1177/1474515120919547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To understand better the success of self-management interventions and to
enable tailoring of such interventions at specific subgroups of patients,
the nurse-led Activate intervention is developed targeting one component of
self-management (physical activity) in a heterogeneous subgroup (patients at
risk of cardiovascular disease) in Dutch primary care. Aim The aim of this study was to evaluate the effectiveness of the Activate
intervention and identifying which patient-related characteristics modify
the effect. Methods A two-armed cluster-randomised controlled trial was conducted comparing the
intervention with care as usual. The intervention consisted of four
nurse-led behaviour change consultations within a 3-month period. Data were
collected at baseline, 3 months and 6 months. Primary outcome was the daily
amount of moderate to vigorous physical activity at 6 months. Secondary
outcomes included sedentary behaviour, self-efficacy for physical activity,
patient activation for self-management and health status. Prespecified
effect modifiers were age, body mass index, level of education, social
support, depression, patient provider relationship and baseline physical
activity. Results Thirty-one general practices (n = 195 patients) were
included (intervention group n = 93; control group
n = 102). No significant between-group difference was
found for physical activity (mean difference 2.49 minutes; 95% confidence
interval -2.1; 7.1; P = 0.28) and secondary outcomes.
Patients with low perceived social support (P = 0.01) and
patients with a low baseline activity level (P = 0.02)
benefitted more from the intervention. Conclusion The Activate intervention did not improve patients’ physical activity and
secondary outcomes in primary care patients at risk of cardiovascular
disease. To understand the results, the intervention fidelity and active
components for effective self-management require further investigation. Trial registration: ClinicalTrials.gov NCT02725203.
Collapse
Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | | | - Irene D Bos-Touwen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | | | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, The Netherlands
| | - Daphne A de Vette
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Jaap Ca Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
8
|
Mühlenbruch K, Zhuo X, Bardenheier B, Shao H, Laxy M, Icks A, Zhang P, Gregg EW, Schulze MB. Selecting the optimal risk threshold of diabetes risk scores to identify high-risk individuals for diabetes prevention: a cost-effectiveness analysis. Acta Diabetol 2020; 57:447-454. [PMID: 31745647 PMCID: PMC7093341 DOI: 10.1007/s00592-019-01451-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/31/2019] [Indexed: 01/21/2023]
Abstract
AIMS Although risk scores to predict type 2 diabetes exist, cost-effectiveness of risk thresholds to target prevention interventions are unknown. We applied cost-effectiveness analysis to identify optimal thresholds of predicted risk to target a low-cost community-based intervention in the USA. METHODS We used a validated Markov-based type 2 diabetes simulation model to evaluate the lifetime cost-effectiveness of alternative thresholds of diabetes risk. Population characteristics for the model were obtained from NHANES 2001-2004 and incidence rates and performance of two noninvasive diabetes risk scores (German diabetes risk score, GDRS, and ARIC 2009 score) were determined in the ARIC and Cardiovascular Health Study (CHS). Incremental cost-effectiveness ratios (ICERs) were calculated for increasing risk score thresholds. Two scenarios were assumed: 1-stage (risk score only) and 2-stage (risk score plus fasting plasma glucose (FPG) test (threshold 100 mg/dl) in the high-risk group). RESULTS In ARIC and CHS combined, the area under the receiver operating characteristic curve for the GDRS and the ARIC 2009 score were 0.691 (0.677-0.704) and 0.720 (0.707-0.732), respectively. The optimal threshold of predicted diabetes risk (ICER < $50,000/QALY gained in case of intervention in those above the threshold) was 7% for the GDRS and 9% for the ARIC 2009 score. In the 2-stage scenario, ICERs for all cutoffs ≥ 5% were below $50,000/QALY gained. CONCLUSIONS Intervening in those with ≥ 7% diabetes risk based on the GDRS or ≥ 9% on the ARIC 2009 score would be cost-effective. A risk score threshold ≥ 5% together with elevated FPG would also allow targeting interventions cost-effectively.
Collapse
Affiliation(s)
- Kristin Mühlenbruch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Xiaohui Zhuo
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Shao
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Laxy
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Centre, Leibniz-Centre for Diabetes Research, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ping Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
- Institute of Nutritional Sciences, University of Potsdam, Potsdam, Germany.
| |
Collapse
|
9
|
Harsha N, Kőrösi L, Pálinkás A, Bíró K, Boruzs K, Ádány R, Sándor J, Czifra Á. Determinants of Primary Nonadherence to Medications Prescribed by General Practitioners Among Adults in Hungary: Cross-Sectional Evaluation of Health Insurance Data. Front Pharmacol 2019; 10:1280. [PMID: 31736757 PMCID: PMC6836763 DOI: 10.3389/fphar.2019.01280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/07/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Primary nonadherence to prescribed medications occurs when patients do not fill or dispense prescriptions written by healthcare providers. Although it has become an important public health issue in recent years, little is known about its frequency, causes, and consequences. Moreover, the pattern of risk factors shows remarkable variability across countries according to the published results. Our study aimed to assess primary nonadherence to medications prescribed by general practitioners (GPs) and its associated factors among adults in Hungary for the period of 2012–2015. Methods: Data on all general medical practices (GMPs) of the country were obtained from the National Health Insurance Fund and the Central Statistical Office. The ratio of the number of dispensed medications to the number of prescriptions written by a GP for adults was used to determine the medication adherence, which was aggregated for GMPs. The effect of GMP characteristics (list size, GP vacancy, patients’ education provided by a GMP, settlement type [urban or rural], and geographical location [by county] of the center) on adherence, standardized for patients’ age, sex, and eligibility for an exemption certificate, were investigated through generalized linear regression modeling. Results: A total of 281,315,386 prescriptions were dispensed out of 438,614,000 written by a GP. Overall, 64.1% of prescriptions were filled. According to the generalized linear regression coefficients, there was a negative association between standardized adherence and urban settlement type (b = -0.099, 95%CI = -0.103 to -0.094), higher level of education (b = -0.440, 95%CI = -0.468 to -0.413), and vacancy of the general practices (b = -0.193, 95%CI = -0.204 to -0.182). The larger GMP size proved to be a risk factor, and there was a significant geographical inequality for counties as well. Conclusions: More than one-third of the written prescriptions of GPs for adults in Hungary were not dispensed. This high level of nonadherence had great variability across GMPs, and can be explained by structural characteristics of GMPs, the socioeconomic status of patients provided, and the quality of cooperation between patients and GPs. Moreover, our findings suggest that the use of the dispensed-to-prescribed medication ratio in routine monitoring of primary health care could effectively support the necessary interventions.
Collapse
Affiliation(s)
- Nouh Harsha
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Budapest, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Árpád Czifra
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
10
|
Harsha N, Papp M, Kőrösi L, Czifra Á, Ádány R, Sándor J. Enhancing Primary Adherence to Prescribed Medications through an Organized Health Status Assessment-Based Extension of Primary Healthcare Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203797. [PMID: 31600998 PMCID: PMC6843248 DOI: 10.3390/ijerph16203797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
This study was part of monitoring an intervention aimed at developing a general practitioner cluster (GPC) model of primary healthcare (PHC) and testing its effectiveness in delivering preventive services integrated into the PHC system. The aim was to demonstrate whether GPC operation could increase the percentage of drugs actually dispensed. Using national reference data of the National Health Insurance Fund for each anatomical-therapeutic chemical classification ATC group of drugs, dispensed-to-prescribed ratios standardized (sDPR) for age, sex, and exemption certificate were calculated during the first quarter of 2012 (before-intervention) and the third quarter of 2015 (post-intervention). The after-to-before ratios of the sDPR as the relative dispensing ratio (RDR) were calculated to describe the impact of the intervention program. The general medication adherence increased significantly in the intervention area (RDR = 1.064; 95% confidence interval (CI): 1.054-1.073). The most significant changes were observed for cardiovascular system drugs (RDR = 1.062; 95% CI: 1.048-1.077) and for alimentary tract and metabolism-specific drugs (RDR = 1.072; 95% CI: 1.049-1.097). The integration of preventive services into a PHC without any specific medication adherence-increasing activities is beneficial for medication adherence, especially among patients with cardiovascular, alimentary tract, and metabolic disorders. Monitoring the percentage of drugs actually dispensed is a useful element of PHC-oriented intervention evaluation frames.
Collapse
Affiliation(s)
- Nouh Harsha
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, Debrecen 4012, Hungary;
| | - Magor Papp
- Doctoral School of Health Sciences, University of Debrecen, Debrecen 4012, Hungary;
- Semmelweis Center for Health Promotion, Medical Faculty, Semmelweis University, Budapest 1094, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Budapest 1139, Hungary;
| | - Árpád Czifra
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4012, Hungary; (N.H.); (R.Á.)
- Correspondence: ; Tel.: +36-52-512-769
| |
Collapse
|
11
|
Beishuizen CR, Akenine U, Barbera M, Rosenberg A, Fallah Pour M, Richard E, Soininen H, Mangialasche F, Kivipelto M, Pols AJ, Moll van Charante E. Integrating nurses' experiences with supporting behaviour change for cardiovascular prevention into a self-management internet platform in Finland and the Netherlands: a qualitative study. BMJ Open 2019; 9:e023480. [PMID: 31175194 PMCID: PMC6577411 DOI: 10.1136/bmjopen-2018-023480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 03/13/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Global ageing is linked to an increased burden of cardiovascular disease and dementia, which calls for better prevention strategies. Self-management and eHealth applications are regarded as promising strategies to support prevention. The aim of this study was to explore nurses' best practices concerning behaviour change guidance for cardiovascular (CV) prevention in order to learn how to optimally integrate them into a coach-supported internet platform for CV self-management. DESIGN Qualitative focus group study in Finland and the Netherlands. Discussions were audiotaped and transcribed. Data were thematically analysed following principles of grounded theory. SETTING Dutch and Finnish primary care settings. PARTICIPANTS Six Finnish and seven Dutch primary care nurses with experience in CV prevention. RESULTS Similar best practices were found in both countries and comprised of (1) establishing a relationship of trust, (2) managing awareness and expectations and (3) appropriate timing and monitoring of the process of behaviour change. However, the Finnish and Dutch nurses used different approaches for accomplishment of these practices, which was reflected in their recommendations for online support. Both groups emphasised that online support should be combined with human support and integrated into regular care. Finnish nurses had more confidence in patient self-management and remote communication than Dutch nurses, who emphasised the importance of face-to-face contact and preferred to keep control of medical aspects of prevention. CONCLUSIONS Differences in Dutch and Finnish's nurses' practices for supporting CV prevention appear to reflect their local healthcare practices, which should be taken into account when designing internet platforms for health self-management. Including cognitive health as a goal of CV prevention might stimulate motivation for health behaviour change. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
Collapse
Affiliation(s)
- Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Ulrika Akenine
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Anna Rosenberg
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Mandana Fallah Pour
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | | | - Miia Kivipelto
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
- Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - A Jeannette Pols
- Department of General Practice, Section of Medical Ethics, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Westland H, Sluiter J, te Dorsthorst S, Schröder CD, Trappenburg JCA, Vervoort SCJM, Schuurmans MJ. Patients' experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study. PLoS One 2019; 14:e0212169. [PMID: 30753213 PMCID: PMC6372184 DOI: 10.1371/journal.pone.0212169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/29/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity. Methods A convergent mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi-structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success. Results The questionnaire and interview data corresponded, and no substantial differences among responders and non-responders emerged. Participating in the intervention increased patients’ awareness of their physical activity and their physical activity level. Key components of the intervention were the subsequent support of nurses with whom patients’ have a trustful relationship and the use of self-monitoring tools. Patients highly valued jointly setting goals, planning actions, receiving feedback and review on their goal attainment and jointly solving problems. Nurses’ support, the use of self-monitoring tools, and involving others incentivised patients to increase their physical activity. Internal circumstances and external circumstances challenged patients’ engagement in increasing and maintaining their physical activity. Conclusion Patients experienced the Activate intervention as valuable to increase and maintain their physical activity, irrespective of their objective change in physical activity. The findings enable the understanding of the effectiveness of the intervention and implementation in primary care. Trial registration ClinicalTrials.gov NCT02725203.
Collapse
Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Jill Sluiter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sophie te Dorsthorst
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carin D. Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht University Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jaap C. A. Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marieke J. Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
13
|
Making Sense of the Unfavourable Systematic Review of Exercise-Based Cardiac Rehabilitation in the Modern Era: How Should We Proceed? Heart Lung Circ 2018; 28:204-206. [PMID: 30170917 DOI: 10.1016/j.hlc.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 02/06/2023]
|
14
|
Duscha BD, Piner LW, Patel MP, Craig KP, Brady M, McGarrah RW, Chen C, Kraus WE. Effects of a 12-week mHealth program on peak VO 2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial. Am Heart J 2018; 199:105-114. [PMID: 29754647 DOI: 10.1016/j.ahj.2018.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Site-based cardiac rehabilitation (CR) provides supervised exercise, education and motivation for patients. Graduates of CR have improved exercise tolerance. However, when participation in CR ceases, adherence to regular physical activity often declines, consequently leading to worsening risk factors and clinical events. Therefore, the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR. METHODS AND RESULTS A 12-week mHealth program was implemented using physical activity trackers and health coaching. Twenty-five patients were randomized into mHealth or usual care after completing CR. The combination of a 4.7±13.8% increase in the mHealth and a 8.5±11.5% decrease in the usual care group resulted in a difference between groups (P≤.05) for absolute peak VO2. Usual care decreased the amount of moderate-low physical activity minutes per week (117±78 vs 50±53; P<.05) as well as moderate-high (111±87 vs 65±64; P<.05). mHealth increased moderate-high physical activity (138±113 vs 159±156; NS). The divergent changes between mHealth and usual care in moderate-high physical activity minutes/week resulted in a difference between groups (21±103 vs - 46±36; P<.05). CONCLUSIONS A 12-week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site-based CR.
Collapse
Affiliation(s)
- Brian D Duscha
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute.
| | - Lucy W Piner
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Mahesh P Patel
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Karen P Craig
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - Robert W McGarrah
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - William E Kraus
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| |
Collapse
|
15
|
Kwon SC, Patel S, Choy C, Zanowiak J, Rideout C, Yi S, Wyatt L, Taher MD, Garcia-Dia MJ, Kim SS, Denholm TK, Kavathe R, Islam NS. Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey. Transl Behav Med 2018; 7:444-466. [PMID: 28547738 DOI: 10.1007/s13142-017-0506-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Faith-based organizations (FBOs) (e.g., churches, mosques, and gurdwaras) can play a vital role in health promotion. The Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) Project is implementing a multi-level and evidence-based health promotion and hypertension (HTN) control program in faith-based organizations serving Asian American (AA) communities (Bangladeshi, Filipino, Korean, Asian Indian) across multiple denominations (Christian, Muslim, and Sikh) in New York/New Jersey (NY/NJ). This paper presents baseline results and describes the cultural adaptation and implementation process of the REACH FAR program across diverse FBOs and religious denominations serving AA subgroups. Working with 12 FBOs, informed by implementation research and guided by a cultural adaptation framework and community-engaged approaches, REACH FAR strategies included (1) implementing healthy food policies for communal meals and (2) delivering a culturally-linguistically adapted HTN management coaching program. Using the Ecological Validity Model (EVM), the program was culturally adapted across congregation and faith settings. Baseline measures include (i) Congregant surveys assessing social norms and diet (n = 946), (ii) HTN participant program surveys (n = 725), (iii) FBO environmental strategy checklists (n = 13), and (iv) community partner in-depth interviews assessing project feasibility (n = 5). We describe the adaptation process and baseline assessments of FBOs. In year 1, we reached 3790 (nutritional strategies) and 725 (HTN program) via AA FBO sites. Most AA FBOs lack nutrition policies and present prime opportunities for evidence-based multi-level interventions. REACH FAR presents a promising health promotion implementation program that may result in significant community reach.
Collapse
Affiliation(s)
- S C Kwon
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - S Patel
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA.
| | - C Choy
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - J Zanowiak
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - C Rideout
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - S Yi
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - L Wyatt
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - M D Taher
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | | | - S S Kim
- Korean Community Services of Metropolitan NY, Inc., New York, NY, USA
| | - T K Denholm
- Korean Community Services of Metropolitan NY, Inc., New York, NY, USA
| | | | - N S Islam
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| |
Collapse
|
16
|
Huang YM, Shiyanbola OO, Smith PD. Association of health literacy and medication self-efficacy with medication adherence and diabetes control. Patient Prefer Adherence 2018; 12:793-802. [PMID: 29785094 PMCID: PMC5953319 DOI: 10.2147/ppa.s153312] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The exact pathway linking health literacy, self-efficacy, medication adherence, and glycemic control for type 2 diabetes remains unclear. Understanding the relationship between patient factors, medication adherence, and lower glycated hemoglobin (HbA1c) may help patients better manage their disease. This study examined the association of health literacy and medication self-efficacy with self-reported diabetes medication adherence, and the association of health literacy, medication self-efficacy, and self-reported diabetes medication adherence with HbA1c of patients with type 2 diabetes. METHODS This cross-sectional study utilized a face-to-face questionnaire at two family medicine clinics in a Midwestern state among 174 patients; subjects enrolled were at least 20 years old with diagnosed type 2 diabetes, prescribed at least one oral diabetes medicine, and understood English. Questionnaires were administered to assess the participants': health literacy, using the Newest Vital Sign six-item questionnaire (NVS); self-efficacy for medication use, using the 13-item Self-Efficacy for Appropriate Medication Use Scale; and self-report medication adherence, using the eight-item Morisky Medication Adherence Scale. HbA1c values were obtained from participants' electronic medical records. Multiple linear regressions were used to explore the association of health literacy and medication self-efficacy with both medication adherence and HbA1c level after controlling for all other covariates. RESULTS Self-reported health status (β = 0.17, p = 0.015) and medication self-efficacy (β = 0.53, p < 0.001) were positively associated with diabetes medication adherence. Health literacy was neither associated with diabetes medication adherence (β = -0.04, p = 0.586) nor HbA1c (β = -0.06, p = 0.542). Lower diabetes medication adherence (β = -0.26, p = 0.008) and higher number of prescribed medications (β = 0.28, p = 0.009) were correlated with higher HbA1c. CONCLUSION Health literacy, as measured by the NVS, does not correlate with medication adherence or glycemic control among patients with type 2 diabetes. Interventions to improve patients' self-efficacy of medication use may improve diabetes medication adherence.
Collapse
Affiliation(s)
- Yen-Ming Huang
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
- Correspondence: Yen-Ming Huang, Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI 53705, USA, Email
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
17
|
Abell B, Glasziou P, Hoffmann T. The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression. SPORTS MEDICINE - OPEN 2017; 3:19. [PMID: 28477308 PMCID: PMC5419959 DOI: 10.1186/s40798-017-0086-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND While the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease. METHODS In this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, The Cochrane Library, SPORTDiscus) from citation tracking and hand-searching. Studies were included if they were randomised trials of a structured exercise intervention (versus usual care) for participants with coronary heart disease and reported at least one of cardiovascular mortality, total mortality, myocardial infarction or revascularisation outcomes. Each included trial was assessed using the Cochrane Risk of Bias Tool. Authors were also contacted for missing intervention details or data. Random effects meta-analysis was performed to calculate a summary risk ratio (RR) with 95% confidence interval (CI) for the effect of exercise on outcomes. Random effects meta-regression and subgroup analyses were conducted to examine the association between pre-specified co-variates (exercise components or trial characteristics) and each clinical outcome. RESULTS Sixty-nine trials were included, evaluating 72 interventions which differed markedly in terms of exercise components. Exercise-based cardiac rehabilitation was effective in reducing cardiovascular mortality (RR 0.74, 95% CI 0.65 to 0.86), total mortality (RR 0.90, 95% CI 0.83 to 0.99) and myocardial infarction (RR 0.80, 95% CI 0.70 to 0.92). This effect generally demonstrated no significant differences across subgroups of patients who received various types of usual care, more or less than 150 min of exercise per week and of differing cardiac aetiologies. There was however some heterogeneity observed in the efficacy of cardiac rehabilitation in reducing total mortality based on the presence of lipid lowering therapy (I 2 = 48%, p = 0.15 for subgroup treatment interaction effect). No single exercise component was identified through meta-regression as a significant predictor of mortality outcomes, although reductions in both total (RR 0.81, p = 0.042) and cardiovascular mortality (RR 0.72, p = 0.045) were observed in trials which reported high levels of participant exercise adherence, versus those which reported lower levels. A dose-response relationship was found between an increasing exercise session time and increasing risk of myocardial infarction (RR 1.01, p = 0.011) and the highest intensity of exercise prescribed and an increasing risk of percutaneous coronary intervention (RR 1.05, p = 0.047). CONCLUSIONS Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease. While our analysis was constrained by the quality of included trials and missing information about intervention components, there appears to be little differential effect of variations in exercise intervention, particularly on mortality outcomes. Given the observed effect between higher adherence and improved outcomes, it may be more important to provide exercise-based cardiac rehabilitation programs which focus on achieving increased adherence to the exercise intervention.
Collapse
Affiliation(s)
- Bridget Abell
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia.
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, 4229, Australia
| |
Collapse
|
18
|
Westland H, Bos-Touwen ID, Trappenburg JCA, Schröder CD, de Wit NJ, Schuurmans MJ. Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial. Trials 2017; 18:79. [PMID: 28228151 PMCID: PMC5322635 DOI: 10.1186/s13063-017-1823-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. Methods/design A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction. Discussion To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice. Trial registration ClinicalTrials.gov identifier: NCT02725203. Registered on 25 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1823-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands.
| | - Irene D Bos-Touwen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Carin D Schröder
- Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| |
Collapse
|
19
|
Pietrabissa G, Manzoni GM, Rossi A, Castelnuovo G. The MOTIV-HEART Study: A Prospective, Randomized, Single-Blind Pilot Study of Brief Strategic Therapy and Motivational Interviewing among Cardiac Rehabilitation Patients. Front Psychol 2017; 8:83. [PMID: 28223950 PMCID: PMC5293749 DOI: 10.3389/fpsyg.2017.00083] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023] Open
Abstract
Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health's challenge is to motivate patients to utilize self-care. Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program. Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through phone interviews. Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants' self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups. Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients. Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.
Collapse
Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Alessandro Rossi
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCS Verbania, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCSS Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy
| |
Collapse
|
20
|
Larsen P, Pedersen PU. The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi-experimental study. Int J Nurs Pract 2017; 22:15-21. [PMID: 26916059 DOI: 10.1111/ijn.12343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with heart failure (HF) live with a serious disease, and need long-term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self-care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi-experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form-36. One hundred sixty-two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.
Collapse
Affiliation(s)
- Palle Larsen
- Center of Clinical Guidelines, Institute of Medicine and Health Technology, Aalborg University
| | - Preben U Pedersen
- Center of Clinical Guidelines, Institute of Medicine and Health Technology, Aalborg University
| |
Collapse
|
21
|
Sattar T, Athar M. Hydrothermal Synthesis and Characterization of Copper Glycinate (Bio-MOF-29) and Its <i>in Vitro</i> Drugs Adsorption Studies. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojic.2017.72002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Burke LE, Kim Y, Senuzun F, Choo J, Sereika S, Music E, Dunbar-Jacob J. Evaluation of the Shortened Cholesterol-Lowering Diet Self-Efficacy Scale. Eur J Cardiovasc Nurs 2016; 5:264-74. [PMID: 16690358 DOI: 10.1016/j.ejcnurse.2006.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Revised: 03/21/2006] [Accepted: 03/23/2006] [Indexed: 11/26/2022]
Abstract
Specificity in the self-efficacy construct requires that instruments assess domain-specific behaviors. The objectives of the study were to (1) reexamine and shorten the original 57-item Cholesterol-Lowering Diet Self-Efficacy Scale (CLDSES), (2) estimate reliability and validity of the short form CLDSES (CLDSES-SF), (3) examine the dimensionality of the CLDSES-SF, (4) examine discriminant validity of the scale by its ability to differentiate between adherence and nonadherence to saturated fat intake guidelines, and (5) examine the CLDSES-SF's sensitivity and specificity. A sample of 238 patients being treated for hypercholesterolemia completed three instruments: the CLDSES, the Connor Diet Habit Survey (DHS) and a Three-Day Food Record. Internal consistency for the CLDSES-SF was .95. The inter-correlation coefficients among the seven sub-scales ranged from .28 to .62, and for the total to sub-scales .58 - .87, significant at p < .001. Evidence for criterion validity was shown in the correlations between the CLDSES-SF and the Connor DHS scores and between the CLDSES-SF and the Three-Day Food Record. Factor analysis showed a one-factor model that fits the data with a sufficient amount of total variance explained among the seven subscale items in each subscale, providing evidence of the uni-dimensionality of each subscale. Sensitivity (76%) and specificity (63%) for the CLDSES-SF were good with 88% positive predictive value for adherence. The shortened CLDSES retained its good psychometric properties and remains comprehensive in its assessment of self-efficacy for adherence to a cholesterol-lowering diet.
Collapse
Affiliation(s)
- Lora E Burke
- University of Pittsburgh, Health and Community Systems, Pittsburgh, PA, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Degli Esposti L, Sangiorgi D, Buda S, Degli Esposti E, Scaglione F. Therapy discontinuation or substitution in patients with cardiovascular disease, switching among different products of the same off-patent active substance: a 'real-world' retrospective cohort study. BMJ Open 2016; 6:e012003. [PMID: 27807083 PMCID: PMC5129038 DOI: 10.1136/bmjopen-2016-012003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The present study investigated the effects of switching to different products of the same off-patent active substance (brand name or generic) on therapy discontinuation or substitution with another molecule of the same class, in patients with cardiovascular disease treated with statins and antihypertensives in a 'real-world' setting. DESIGN A retrospective cohort study in a 'real-world' setting. SETTING Analysis of data performed by integrating administrative databases that included approximately two million individuals who are assisted by the National Health System from three Local Health Units located in three different regions of Italy. PARTICIPANTS All patients aged ≥18 years with at least one prescription of simvastatin, ramipril or amlodipine in the period 1 January to 31 December 2010 were included and followed up for 2 years. MAIN OUTCOME MEASURES Prescription refills occurring during follow-up were evaluated. Frequency of discontinuation of therapy or substitution with another molecule of the same class (eg, from simvastatin to a different statin) during follow-up was identified. RESULTS During follow-up, therapy discontinuation or substitution was found to be more frequent in patients switching to a different product of the same active substance compared with non-switching patients (11.5% vs 10.8% and 22.2% vs 20.8% (p=0.002), respectively, in the simvastatin group; 4.0% vs 3.5% and 24.6% vs 22.7% (p<0.001), respectively, in the amlodipine group). In the ramipril group, 8% of patients undertook a therapy substitution to another molecule; no trend towards a lower percentage of substitution was observed in the non-switching group, while 18% of patients discontinued treatment, with a significant difference in favour of patients not switching. These findings were partially confirmed by multivariate analysis. CONCLUSIONS Switches among products of the same active substance are quite common in patients with cardiovascular disease. Our study suggests that switching may expose patients to a higher risk of therapy discontinuation or substitution.
Collapse
Affiliation(s)
| | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | | | - Francesco Scaglione
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| |
Collapse
|
24
|
Hall J, Bond C, Kinnear M, McKinstry B. Views of patients and professionals about electronic multicompartment medication devices: a qualitative study. BMJ Open 2016; 6:e012915. [PMID: 27798025 PMCID: PMC5073531 DOI: 10.1136/bmjopen-2016-012915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. DESIGN Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. PARTICIPANTS AND SETTING Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services. Patients (n=15) who were current conventional or electronic multicompartment medication device users or had medication adherence problems were recruited from community pharmacies. 3 informal carers participated. RESULTS Electronic multicompartment medication devices which prompt the patient to take medication may be beneficial for selected individuals, particularly those with cognitive impairment, but who are not seriously impaired, provided they have a good level of dexterity. They may also assist individuals where it is important that medication is taken at fixed time intervals. These are likely to be people who are being supported to live alone. No single device suited everybody; smaller/lighter devices were preferred but their usefulness was limited by the small number/size of storage compartments. Removing medications was often challenging. Transportability was an important factor for patients and carers. A carer's alert if medication is not taken was problematic with multiple barriers to implementation and no consensus as to who should receive the alert. There was a lack of enthusiasm among professionals, particularly among pharmacists, due to concerns about responsibility and funding for devices as well as ensuring devices met regulatory standards for storage and labelling. CONCLUSIONS This study provides indicators of which patients might benefit from an electronic multicompartment medication device as well as the kinds of features to consider when matching a patient with a device. It also highlights other considerations for successful implementation including issues of responsibility, regulation and funding.
Collapse
Affiliation(s)
- Jill Hall
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
25
|
Dew MA, Switzer GE, DiMartini AF, Matukaitis J, Fitzgerald MG, Kormos RL. Psychosocial Assessments and Outcomes in Organ Transplantation. Prog Transplant 2016; 10:239-59; quiz 260-1. [PMID: 11232552 DOI: 10.1177/152692480001000408] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.
Collapse
Affiliation(s)
- M A Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pa., USA
| | | | | | | | | | | |
Collapse
|
26
|
Pumilia CV. Psychological Impact of the Physician-Patient Relationship on Compliance: A Case Study and Clinical Strategies. Prog Transplant 2016; 12:10-6. [PMID: 11993064 DOI: 10.1177/152692480201200103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents a case of a heart transplant recipient's noncompliance. A patient's probable medical compliance is among the primary psychosocial criteria in determining his or her eligibility for a heart transplant. The ability to predict and facilitate patient compliance remains a challenge to physicians in all areas of medicine and surgery. The accuracy of the compliance prediction is often contingent upon information generated by patient interviews, other medical personnel, and the patient's family members. All too often, this vital information is based on subjective data, creating difficulty for physicians in appraising patient compliance behavior. Such an amorphous data gathering process may leave physicians at a loss to explain the nature and extent of their patients' behaviors. Research has yet to provide consistent objective measures for compliance prediction. Patient compliance affects all corridors of medical practice and is responsible for an innumerable loss of human life, and financial resources each year.
Collapse
|
27
|
Mildestvedt T, Meland E, Eide GE. No difference in lifestyle changes by adding individual counselling to group-based rehabilitation RCT among coronary heart disease patients. Scand J Public Health 2016; 35:591-8. [PMID: 17852978 DOI: 10.1080/14034940701349241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aims: First, to examine whether autonomy-supportive and self-efficacy-enhancing individual lifestyle counselling was associated with improved maintenance of heart-protective diets and smoking cessation compared with group-based counselling. Second, to investigate to what extent reported motivation was associated with maintenance of dietary changes. Methods: A randomized controlled trial and longitudinal study of predictor variables in a four-week heart rehabilitation setting with two years follow-up. A total of 176 (38 female) patients were included, mainly with coronary heart disease. The main outcome measures were dietary changes and smoking cessation. Motivational factors were tested for predictive power in the three dietary outcomes: daily intake of fruit and vegetables, a low saturated fat diet, and weekly intake of fish dinners. Results: No clinically significant difference in improvement of dietary maintenance was found between the two groups. The between-group difference in smoking status change was statistically insignificant (p=0.12). Both groups showed an improvement in their dietary measures. Self-efficacy predicted an increased frequency of eating fish dinners (p=0.001) and more daily units of fruit and vegetables (p<0.001). Autonomous motivation had a marginal association with increased intake of fruits and vegetables (p=0.08) and was significantly associated with a lower saturated fat diet (p=0.001). Conclusions: Among this highly motivated group of rehabilitation patients, no effect was found of adding autonomy-supportive, individual counselling to group-based interventions. Based on longitudinal documentation, this cardiac rehabilitation programme improves long-term maintenance of dietary changes, and this maintenance is related to autonomous motivation and self-efficacy.
Collapse
Affiliation(s)
- Thomas Mildestvedt
- Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Bergen, Norway.
| | | | | |
Collapse
|
28
|
Tucker JS, Mueller JS. Spouses’ Social Control of Health Behaviors: Use and Effectiveness of Specific Strategies. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016. [DOI: 10.1177/01461672002611008] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Forty-four couples described the strategies they used in attempting to prompt their partner to engage in particular health behaviors, strategies used by their partner that were effective and ineffective in prompting their own engagement in health behaviors, and their own psychological reactions to the partner’s use of social control. Strategies that were more frequently mentioned as effective rather than ineffective included the partner also engaging in the desired health behavior, modeling the health behavior, discussing health issues, and providing emotional support. Spouses reported feeling lower self-esteem, less positive affect, and more negative affect in response to their partner’s use of ineffective rather than effective strategies. In addition, both spouses rated their partners’ use of ineffective (compared to effective) strategies as less motivated by a concern for the participant’s welfare and more motivated by their partner’s own desire to exert control within the relationship.
Collapse
|
29
|
Response by Bennett, Lane, Welch, Perkins, Brater, and Murray. West J Nurs Res 2016. [DOI: 10.1177/0193945905280312] [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]
|
30
|
Burke LE, Dunbar-Jacob J, Sereika S, Ewart CK. Development and Testing of the Cholesterol-Lowering Diet Self-Efficacy Scale. Eur J Cardiovasc Nurs 2016; 2:265-73. [PMID: 14667482 DOI: 10.1016/s1474-5151(03)00093-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A cornerstone of treatment for hypercholesterolemia is dietary therapy. However, maintaining adherence to the therapeutic diet has been difficult for patients. There is evidence that self-efficacy is a predictor of positive behavior change like that involved in or necessary for initiating or maintaining recommended diet therapy for cholesterol reduction. This paper reports on two studies guided by Bandura's self-efficacy theory. The first study focuses on development and initial psychometric evaluation of an instrument measuring self-efficacy for adhering to a cholesterol-lowering diet in a sample of 44 cardiac rehabilitation patients; the second establishes psychometric properties of the instrument in a sample of 228 subjects treated for hypercholesterolemia. In both studies, subgroups completed the instrument a second time to provide data on the instrument's temporal stability. The Cholesterol-Lowering Diet Self-Efficacy Scale consists of 33 statements, some with branches for a total of 56 items. The scale measures several components of the eating habits domain related to adhering to a cholesterol-lowering eating plan, and shows good reliability and validity. Reported self-efficacy is related to prior persistence and past success in modifying and maintaining dietary changes, and also to concurrent measures of dietary adherence behaviors. The scale is psychometrically sound thus far and seems adequate in identifying success in achieving and maintaining a cholesterol-lowering eating plan.
Collapse
Affiliation(s)
- Lora E Burke
- University of Pittsburgh, School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261, USA.
| | | | | | | |
Collapse
|
31
|
Paterson M, Kinnear M, Bond C, McKinstry B. A systematic review of electronic multi-compartment medication devices with reminder systems for improving adherence to self-administered medications. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:185-194. [PMID: 26833669 DOI: 10.1111/ijpp.12242] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 10/25/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Many patients experience difficulties adhering to medication regimes. For people who forget or get confused about medication, there are products to help them such as multi-compartment medication devices (MMDs). Some of these, known as electronic MMDs (eMMDs), use audible and/or visual signals to prompt the patient when to take medication, dispense medications, give instructions to the patient, and contact a caregiver (mobile Internet or text to a carer) as needed. AIM To systematically review the literature on the use of eMMDs, to determine what evidence for their effectiveness is available. METHODS A comprehensive literature search of 10 databases, plus an Internet search and hand searching was conducted, using the MeSH terms reminder systems/patient compliance/medication adherence. There were no date restrictions. Inclusion criteria were patients in any community setting, in any country and with no restrictions of age, gender, ethnicity or medical condition, using an eMMD. Peer-reviewed quantitative or qualitative studies of any design were included. RESULTS Of 805 abstracts identified and 99 full text papers retrieved, six met the inclusion criteria. Five of the studies reported adherence to medication regimes; one reported design factors to improve adherence. Adherence varied by the context of the reminders, the target group and usability of the devices. The studies were small scale and only one was a well conducted randomised controlled trial. CONCLUSION Overall methodological quality of the studies was poor. Although positive effects on adherence were reported further, rigorously conducted, studies are needed to inform the use of eMMDs.
Collapse
Affiliation(s)
- Mary Paterson
- e-Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Moira Kinnear
- NHS Lothian Pharmacy Service, Western General Hospital, Edinburgh, UK
| | - Christine Bond
- Centre for Academic Primary Care, Polwarth Building West Block, Aberdeen, UK
| | - Brian McKinstry
- e-Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.,Edinburgh Health Services Research Unit, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
32
|
Kimmick G, Edmond SN, Bosworth HB, Peppercorn J, Marcom PK, Blackwell K, Keefe FJ, Shelby RA. Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy. Breast 2015; 24:630-6. [PMID: 26189978 DOI: 10.1016/j.breast.2015.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors. METHODS Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one's doses or stopping medication, and unintentional, such as forgetting to take one's medication, non-adherent behaviors. RESULTS Participants were 112 women: mean age 64 (SD = 9) years; 81% white; mean time from surgery 40 (SD = 28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD = 29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p = 0.002) and intentional (p = 0.004) non-adherent behaviors. The presence of symptoms (p = 0.03) and lower self-efficacy for physician communication (p = 0.009) were associated with higher levels of intentional non-adherent behaviors. CONCLUSIONS These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.
Collapse
Affiliation(s)
- Gretchen Kimmick
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA.
| | - Sara N Edmond
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Hayden B Bosworth
- Department of Medicine, Psychiatry, and School of Nursing, Duke University Medical Center; Center for Health Services Research, Durham VAMC, USA
| | - Jeffrey Peppercorn
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Paul K Marcom
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Kimberly Blackwell
- Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham, NC 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, USA
| |
Collapse
|
33
|
Cate H, Bhattacharya D, Clark A, Holland R, Broadway DC. A comparison of measures used to describe adherence to glaucoma medication in a randomised controlled trial. Clin Trials 2015; 12:608-17. [DOI: 10.1177/1740774515592636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Understanding the magnitude of non-adherence in pre-marketing clinical trials and clinical practice is essential. However, accurately measuring non-adherence to medication is problematic, and the variety of adherence measures and/or calculation methods has led to highly variable results. Purpose: To compare commonly used methods for measuring adherence to eye drop therapy in order to assess which methods achieve the most complete datasets over an 8-month monitoring period, to quantify the magnitude of variance in adherence estimations and to review the different methods used to calculate or interpret adherence data. Methods: Adherence was measured electronically for 8 months by participants administering eye drops using a Travalert® dosing aid. The mean number of Travalert dosing aid recorded doses administered over the monitoring period was used to calculate a percentage adherence score. In addition, the value of graphically presenting Travalert dosing aid data to classify patterns of adherence behaviour was explored. The validated Morisky Measure of Adherence Scale and questions requesting participants to report the Frequency of Missed Doses were two measures of self-reported adherence calculated for each participant. Finally, medication possession ratio was calculated from expected repeat prescription orders compared with actual repeat prescription orders. Results: For the 208 recruited participants, self-reported adherence was the most reliable method of collecting complete datasets over the 8-month period; 16% of self-reported adherence data were missing compared with 45% of Travalert dosing aid data missing at 8 months. The mean adherence measured over the monitoring period by the Travalert dosing aid was 77%. When adherence measures were dichotomised into adherent and non-adherent groups, the Travalert dosing aid found 54% of participants were adherent, compared to 60% Morisky Measure of Adherence Scale and 57% Frequency of Missed Dose self-report measures. However, there was poor agreement between the Travalert dosing aid measured adherence and self-report measures. Medication possession ratio was not a reliable measure of persistence with medication. Graphical Travalert dosing aid data presentation provided additional information about participant behaviour by indicating that most non-adherence was due to participants taking drug holidays rather than missing occasional doses. Conclusion: The analysis provided evidence about the inconsistencies between different monitoring strategies and adherence measures. Furthermore, the analysis highlighted the difficulties in collecting complete data for studies investigating chronic, slowly progressive conditions that require long-term follow-up. Future adherence studies could use multiple methods for quantifying and classifying adherence in parallel, both to maximise precision of adherence estimates and to facilitate comparison between studies. However, the authors are cautious of the effect of using multiple adherence measures on participant behaviour and their potential reactivity effects is an area for future research.
Collapse
Affiliation(s)
- Heidi Cate
- Glaucoma Research Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David C Broadway
- Glaucoma Research Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- School of Pharmacy, University of East Anglia, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
34
|
Castelnuovo G, Zoppis I, Santoro E, Ceccarini M, Pietrabissa G, Manzoni GM, Corti S, Borrello M, Giusti EM, Cattivelli R, Melesi A, Mauri G, Molinari E, Sicurello F. Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine. Front Psychol 2015; 6:407. [PMID: 25926801 PMCID: PMC4396192 DOI: 10.3389/fpsyg.2015.00407] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/23/2015] [Indexed: 12/12/2022] Open
Abstract
Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the "chronic care management" challenge in both traditional and mHealth settings.
Collapse
Affiliation(s)
- Gianluca Castelnuovo
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Italo Zoppis
- Department of Informatics, Systems and Communication, Università degli Studi di Milano-BicoccaMilano, Italy
| | - Eugenio Santoro
- Laboratory of Medical Informatics, Department of Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico – Istituto di Ricerche Farmacologiche Mario NegriMilano, Italy
| | - Martina Ceccarini
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, University of BergamoBergamo, Italy
| | - Giada Pietrabissa
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gian Mauro Manzoni
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Stefania Corti
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, University of BergamoBergamo, Italy
| | - Maria Borrello
- Department of Psychology, University of BergamoBergamo, Italy
| | | | - Roberto Cattivelli
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
| | - Anna Melesi
- Department of Electronics, Information and Bioengineering, Politecnico di MilanoMilano, Italy
| | - Giancarlo Mauri
- Department of Informatics, Systems and Communication, Università degli Studi di Milano-BicoccaMilano, Italy
| | - Enrico Molinari
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San GiuseppeVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Francesco Sicurello
- Department of Informatics, Systems and Communication, Università degli Studi di Milano-BicoccaMilano, Italy
| |
Collapse
|
35
|
Pietrabissa G, Ceccarini M, Borrello M, Manzoni GM, Titon A, Nibbio F, Montano M, Bertone G, Gondoni L, Castelnuovo G. Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit. Front Psychol 2015; 6:298. [PMID: 25852614 PMCID: PMC4364083 DOI: 10.3389/fpsyg.2015.00298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so. OBJECTIVE The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy. CONCLUSION By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors. CLINICAL IMPLICATIONS MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
Collapse
Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Maria Borrello
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Annamaria Titon
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Ferruccio Nibbio
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Mariella Montano
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianandrea Bertone
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Luca Gondoni
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| |
Collapse
|
36
|
Wang D, Li XY, Zhang LN, Zhou L, Zhang KJ. WITHDRAWN: Effects of motivational interviewing on lifestyle modification and diabetes prevention in adults with pre-diabetes. Diabetes Res Clin Pract 2015:S0168-8227(15)00082-0. [PMID: 25748829 DOI: 10.1016/j.diabres.2015.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Dan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiu-Yun Li
- West Mofan Road Community Health Service Center, Nanjing, China
| | - Li-Na Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Kai-Jin Zhang
- School of Public Health, Southeast University, Nanjing, China.
| |
Collapse
|
37
|
Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, McDougald Scott AM, Wallston KA. Medication Nonadherence Before Hospitalization for Acute Cardiac Events. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:34-42. [PMID: 26513029 PMCID: PMC4705844 DOI: 10.1080/10810730.2015.1080331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
Collapse
Affiliation(s)
- Sunil Kripalani
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kathryn Goggins
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Sam Nwosu
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jonathan Schildcrout
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda S Mixon
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA
| | - Candace McNaughton
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda M McDougald Scott
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kenneth A Wallston
- h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| |
Collapse
|
38
|
|
39
|
Marklund M, Magnusdottir OK, Rosqvist F, Cloetens L, Landberg R, Kolehmainen M, Brader L, Hermansen K, Poutanen KS, Herzig KH, Hukkanen J, Savolainen MJ, Dragsted LO, Schwab U, Paananen J, Uusitupa M, Åkesson B, Thorsdottir I, Risérus U. A dietary biomarker approach captures compliance and cardiometabolic effects of a healthy Nordic diet in individuals with metabolic syndrome. J Nutr 2014; 144:1642-9. [PMID: 25080537 DOI: 10.3945/jn.114.193771] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Assessment of compliance with dietary interventions is necessary to understand the observed magnitude of the health effects of the diet per se. To avoid reporting bias, different dietary biomarkers (DBs) could be used instead of self-reported data. However, few studies investigated a combination of DBs to assess compliance and its influence on cardiometabolic risk factors. The objectives of this study were to use a combination of DBs to assess compliance and to investigate how a healthy Nordic diet (ND) influences cardiometabolic risk factors in participants with high apparent compliance compared with the whole study population. From a recently conducted isocaloric randomized trial, SYSDIET (Systems Biology in Controlled Dietary Interventions and Cohort Studies), in 166 individuals with metabolic syndrome, several DBs were assessed to reflect different key components of the ND: canola oil (serum phospholipid α-linolenic acid), fatty fish [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)], vegetables (plasma β-carotene), and whole grains (plasma alkylresorcinols). High-fat dairy intake (expectedly low in the ND) was reflected by serum pentadecanoic acid. All participants with biomarker data (n = 154) were included in the analyses. Biomarkers were combined by using a biomarker rank score (DB score) and principal component analysis (PCA). The DB score was then used to assess compliance. During the intervention, median concentrations of alkylresorcinols, α-linolenic acid, EPA, and DHA were >25% higher in the ND individuals than in the controls (P < 0.05), whereas median concentrations of pentadecanoic acid were 14% higher in controls (P < 0.05). Median DB score was 57% higher in the ND than in controls (P < 0.001) during the intervention, and participants were ranked similarly by DB score and PCA score. Overall, estimates of group difference in cardiometabolic effects generally appeared to be greater among compliant participants than in the whole study population (e.g., estimates of treatment effects on blood pressure and lipoproteins were ∼1.5- to 2-fold greater in the most compliant participants), suggesting that poor compliance attenuated the dietary effects. With adequate consideration of their limitations, DB combinations (e.g., DB score) could be useful for assessing compliance in intervention studies investigating cardiometabolic effects of healthy dietary patterns. The study was registered at clinicaltrials.gov as NCT00992641.
Collapse
Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ola K Magnusdottir
- Unit for Nutrition Research, Landspitali, The National University of Iceland, Reykjavík, Iceland Faculty of Food Science and Nutrition and School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Fredrik Rosqvist
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Lieselotte Cloetens
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, Lund, Sweden
| | - Rikard Landberg
- Department of Food Science, BioCenter, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland VTT Technical Research Centre of Finland, Espoo, Finland
| | - Lea Brader
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kaisa S Poutanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland VTT Technical Research Centre of Finland, Espoo, Finland
| | - Karl-Heinz Herzig
- Institute of Biomedicine, Department of Physiology and Medical Research Center Oulu and
| | - Janne Hukkanen
- Institute of Clinical Medicine, Department of Internal Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Markku J Savolainen
- Institute of Clinical Medicine, Department of Internal Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Lars O Dragsted
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Institute of Clinical Medicine, Internal Medicine and
| | - Jussi Paananen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Björn Åkesson
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, Lund, Sweden
| | - Inga Thorsdottir
- Unit for Nutrition Research, Landspitali, The National University of Iceland, Reykjavík, Iceland Faculty of Food Science and Nutrition and School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| |
Collapse
|
40
|
Ma C, Zhou Y, Zhou W, Huang C. Evaluation of the effect of motivational interviewing counselling on hypertension care. PATIENT EDUCATION AND COUNSELING 2014; 95:231-237. [PMID: 24530144 DOI: 10.1016/j.pec.2014.01.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/03/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study tests the effectiveness of motivational interviewing compared with the usual care for Chinese hypertensive patients. METHODS A randomised controlled trial was used. One hundred and twenty eligible participants were randomly assigned to either the control group (usual care group) or the intervention group (motivational interviewing group). RESULTS The results of this study demonstrated that the total scores and the mean scores for each dimension of the adherence questionnaire were increased in the intervention group (P<0.05), and the systolic blood pressure and diastolic blood pressure of the hypertensive patients greatly decreased in the intervention group during the six months of the motivational interviewing counselling (P<0.05). CONCLUSION The application of motivational interviewing for hypertensive patients is a promising approach for sustaining the clinical benefits of adherence behaviour. PRACTICE IMPLICATIONS Motivational interviewing should be provided to hypertensive patients at hospitals and community health centres to assist patients in controlling their BP and to enhance treatment adherence. A series of training courses on the motivational interviewing technique should be provided to nurses.
Collapse
Affiliation(s)
- Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China.
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China.
| | - Wei Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China.
| | - Chunfeng Huang
- The First Affiliated Hospital of SUN YAT-SEN University, Guangzhou, China.
| |
Collapse
|
41
|
A qualitative study of CVD management and dietary changes: problems of 'too much' and 'contradictory' information. BMC FAMILY PRACTICE 2014; 15:25. [PMID: 24495674 PMCID: PMC3916316 DOI: 10.1186/1471-2296-15-25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
Abstract
Background Nutrition education for cardiovascular disease (CVD) management is not effective for all population groups. There is little understanding of the factors that hinder patients from adhering to dietary recommendations. Methods 37 interviews were conducted with people living with CVD in Adelaide, Australia. Recruitment occurred via General Practitioner (GP) clinics and hospital cardiac rehabilitation programs. Participants were either receiving preventive treatment or active treatment for established CVD. Results The volume and contradictory nature of dietary information were the most prominent barriers to making changes identified in interviews, especially by order participants. Conclusion Patients will seek out, or come into contact with information which contradicts advice from their GPs. The volume of information may lead them to resort to old and familiar habits. GPs play a valuable role in highlighting key take-home messages and reliable external sources of information. The findings have implications for GP practice given that lifestyle changes are a cost- and clinically-effective means of managing CVD.
Collapse
|
42
|
Zhuo X, Zhang P, Kahn HS, Gregg EW. Cost-effectiveness of alternative thresholds of the fasting plasma glucose test to identify the target population for type 2 diabetes prevention in adults aged ≥45 years. Diabetes Care 2013; 36:3992-8. [PMID: 24135386 PMCID: PMC3836092 DOI: 10.2337/dc13-0497] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study objective was to evaluate the cost-effectiveness of alternative fasting plasma glucose (FPG) thresholds to identify adults at high risk for type 2 diabetes for diabetes preventive intervention. RESEARCH DESIGN AND METHODS We used a validated simulation model to examine the change in lifetime quality-adjusted life years (QALYs) and medical costs when the FPG threshold was progressively lowered in 5-mg/dL decrements from 120 to 90 mg/dL. The study sample includes nondiabetic adults aged ≥45 years in the United States using 2006-2010 data from the National Health and Nutrition Examination Survey. High-risk individuals were assumed to receive a lifestyle intervention, as that used in the Diabetes Prevention Program. We calculated cost per QALY by dividing the incremental cost by incremental QALY when lowering the threshold to the next consecutive level. Medical costs were assessed from a health care system perspective. We conducted univariate and probabilistic sensitivity analyses to assess the robustness of the results using different simulation scenarios and parameters. RESULTS Progressively lowering the FPG threshold would monotonically increase QALYs, cost, and cost per QALY. Reducing (in 5-mg/dL decrements) the threshold from 120 to 90 mg/dL cost $30,100, $32,900, $42,300, $60,700, $81,800, and $115,800 per QALY gained, respectively. The costs per QALY gained were lower for all thresholds under a lower-cost and less-effective intervention scenario. CONCLUSIONS Lowering the FPG threshold leads to a greater health benefit of diabetes prevention but reduces the cost-effectiveness. Using the conventional benchmark of $50,000 per QALY, a threshold of 105 mg/dL or higher would be cost effective. A lower threshold could be selected if the intervention cost could be lowered.
Collapse
|
43
|
Loon MSKV, van Dijk-de Vries A, van der Weijden T, Elwyn G, Widdershoven GAM. Ethical issues in cardiovascular risk management. Nurs Ethics 2013; 21:540-53. [DOI: 10.1177/0969733013505313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle.
Collapse
|
44
|
Petry NM, Andrade LF, Barry D, Byrne S. A randomized study of reinforcing ambulatory exercise in older adults. Psychol Aging 2013; 28:1164-73. [PMID: 24128075 DOI: 10.1037/a0032563] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many older adults do not meet physical activity recommendations and suffer from health-related complications. Reinforcement interventions can have pronounced effects on promoting behavior change; this study evaluated the efficacy of a reinforcement intervention to enhance walking in older adults. Forty-five sedentary adults with mild to moderate hypertension were randomized to 12-week interventions consisting of pedometers and guidelines to walk 10,000 steps/day or that same intervention with chances to win $1-$100 prizes for meeting recommendations. Patients walked an average of about 4,000 steps/day at baseline. Throughout the intervention, participants in the reinforcement intervention met walking goals on 82.5% ± 25.8% of days versus 55.3% ± 37.1% of days in the control condition, p < .01. Even though steps walked increased significantly in both groups relative to baseline, participants in the reinforcement condition walked an average of about 2,000 more steps/day than participants in the control condition, p < .02. Beneficial effects of the reinforcement condition relative to the control condition persisted at a 24-week follow-up evaluation, p < .02, although steps/day were lower than during the intervention period in both groups. Participants in the reinforcement intervention also evidenced greater reductions in blood pressure and weight over time and improvements in fitness indices, ps < .05. This reinforcement-based intervention substantially increased walking and improved clinical parameters, suggesting that larger-scale evaluations of reinforcement-based interventions for enhancing active lifestyles in older adults are warranted. Ultimately, economic analyses may reveal reinforcement interventions to be cost-effective, especially in high-risk populations of older adults.
Collapse
|
45
|
Khalesi M, Whiteman DC, Tran B, Kimlin MG, Olsen CM, Neale RE. A meta-analysis of pigmentary characteristics, sun sensitivity, freckling and melanocytic nevi and risk of basal cell carcinoma of the skin. Cancer Epidemiol 2013; 37:534-43. [DOI: 10.1016/j.canep.2013.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/23/2013] [Accepted: 05/29/2013] [Indexed: 01/03/2023]
|
46
|
Predictors of better self-care in patients with heart failure after six months of follow-up home visits. Nurs Res Pract 2013; 2013:254352. [PMID: 24083023 PMCID: PMC3777135 DOI: 10.1155/2013/254352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/01/2013] [Indexed: 11/25/2022] Open
Abstract
This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care.
Collapse
|
47
|
LaHaye SA, Lacombe SP, Koppikar S, Lun G, Parsons TL, Hopkins-Rosseel D. High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors. Eur J Prev Cardiol 2013; 21:1456-64. [DOI: 10.1177/2047487313497604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Grace Lun
- Queen’s University, Kingston, Ontario, Canada
| | | | | |
Collapse
|
48
|
O’Neil A. The Relationship Between Coronary Heart Disease (CHD) and Major Depressive Disorder (MDD): Key Mechanisms and the Role of Quality of Life. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i1.466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database Syst Rev 2013:CD008722. [PMID: 23450587 PMCID: PMC4900876 DOI: 10.1002/14651858.cd008722.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. OBJECTIVES To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. SEARCH METHODS We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client's adherence to dietary advice. We defined 'client' as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. MAIN RESULTS We included 38 studies involving 9445 participants. Among studies that measured diet adherence outcomes between an intervention group and a control/usual care group, 32 out of 123 diet adherence outcomes favoured the intervention group, 4 favoured the control group whereas 62 had no significant difference between groups (assessment was impossible for 25 diet adherence outcomes since data and/or statistical analyses needed for comparison between groups were not provided). Interventions shown to improve at least one diet adherence outcome are: telephone follow-up, video, contract, feedback, nutritional tools and more complex interventions including multiple interventions. However, these interventions also shown no difference in some diet adherence outcomes compared to a control/usual care group making inconclusive results about the most effective intervention to enhance dietary advice. The majority of studies reporting a diet adherence outcome favouring the intervention group compared to the control/usual care group in the short-term also reported no significant effect at later time points. Studies investigating interventions such as a group session, individual session, reminders, restriction and behaviour change techniques reported no diet adherence outcome showing a statistically significant difference favouring the intervention group. Finally, studies were generally of short duration and low quality, and adherence measures varied widely. AUTHORS' CONCLUSIONS There is a need for further, long-term, good-quality studies using more standardized and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases.
Collapse
Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François d’Assise Hôpital, Québec, Canada.
| | | | | | | | | | | |
Collapse
|
50
|
Zandman-Goddard G, Amital H, Shamrayevsky N, Raz R, Shalev V, Chodick G. Rates of adherence and persistence with allopurinol therapy among gout patients in Israel. Rheumatology (Oxford) 2013; 52:1126-31. [PMID: 23392592 DOI: 10.1093/rheumatology/kes431] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the adherence and persistence with allopurinol therapy among gout patients and to identify risk factors for therapy discontinuation. METHODS The study population included adults in Maccabi Healthcare Services, a 2-million member health maintenance organization in Israel, who were diagnosed with gout between 2002 and 2008. Adherence with allopurinol was retrospectively assessed by calculating the proportion of days covered of dispensed prescriptions. Persistence was assessed by calculating the mean proportion of follow-up days covered with allopurinol for every study participant. RESULTS A total of 7644 patients were identified. Among men, the incidence of gout was strongly associated with age, ranging from 0.5 per 1000 among adults younger than 45 years to more than 36 per 1000 among elderly men aged 85 or older). A total of 1331 gout patients (17% of the study population) were adherent to allopurinol therapy, 36% and 47% had partial and poor adherence, respectively. Persistence analysis indicated that the average duration until therapy was discontinued was similar among men (358 days) and women (379 days). Women aged 45-64 years, non-married individuals, those of low socioeconomic status and those with lower body weight were more likely to discontinue therapy. Logistic regression (n = 2471, 32% of the study sample) showed a 4.5 risk of non-compliance among 45- to 65-year-old women. Better compliance was achieved among those with comorbidities, particularly among patients with concomitant cardiovascular disease. CONCLUSION Only one out of six gout patients is adherent with allopurinol. Intervention programmes to increase adherence with treatment should focus on high-risk populations.
Collapse
|