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Nanda K, Mathura P, Burns KK, Pagnoux C, Garner S, Stewart J, Yacyshyn E. Social determinants of health as barriers to care for vasculitis: perspectives of patients and healthcare providers. Clin Rheumatol 2024:10.1007/s10067-024-07082-4. [PMID: 39138700 DOI: 10.1007/s10067-024-07082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/14/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE This study examined patient and healthcare provider (HCP) perspectives on the impact of unmet social needs on healthcare barriers for patients with vasculitis. METHODS Two surveys were developed to gather perspectives from patients with vasculitis, and HCPs specializing in vasculitis care. The patient survey also included a 20-question social needs assessment. The data were analyzed using descriptive statistics. RESULTS One hundred patients and 31 HCPs completed the surveys between September 2022 and June 2023. Fifty-six percent of patients reported unmet social needs, with poor social and mental health (30%) being the most common. Sixty-three percent of patients with vasculitis perceived unmet social need(s) as barriers to healthcare access. Financial insecurity (30%), poor mental health (29%), and poor health knowledge (25%) were the most common barriers identified. Overall, HCPs perceived SDOH have a greater impact on healthcare access than the patients surveyed. Most patients (82%) and HCPs (90%) believed rheumatologists should help in the management of SDOH, specifically health knowledge and mental health. Few HCPs (10%) felt well-positioned to address patients' mental health. Suggested interventions that address social needs and improve healthcare access included referrals to community-based resources, providing educational materials, and virtual visits. CONCLUSION Through patient and HCP perspectives, the impact of SDOH on healthcare access for patients with vasculitis was explored. Understanding the positive experiences and challenges faced by patients is crucial for developing targeted interventions to enhance healthcare access. These findings underscore the importance of ongoing efforts to improve the healthcare experience for patients with vasculitis. Key Points • The impact of unmet social needs on healthcare access for patients with vasculitis, illustrates the complex relationship between SDOH and healthcare outcomes. • Unmet social needs among patients with vasculitis, included poor social and mental health, financial and food insecurity, and a lack of health literacy, which may exacerbate challenges leading to poor health outcomes. • The differences in perspectives between patients and healthcare providers regarding the impact of certain SDOH on healthcare access, necessitates the importance of co-production in the development of interventions to improve healthcare delivery. • The importance of patient-centered care and tailored solutions was highlighted by the need for various interventions to address social needs and improve healthcare access, such as referrals to community-based resources, educational materials, and interprofessional collaboration.
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Affiliation(s)
- Kareena Nanda
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | - Jon Stewart
- Vasculitis Foundation Canada, Cambridge, Canada
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Canada.
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Martins-Martinho J, Ponte A, Dourado E, Khmelinskii N, Barreira SC, Cruz-Machado AR, Macieira C, Teixeira V, Rodrigues AM, Telles-Correia D, Fonseca JE, Ponte C. Anxiety and depression in patients with giant cell arteritis. Rheumatol Adv Pract 2024; 8:rkae013. [PMID: 38384323 PMCID: PMC10879746 DOI: 10.1093/rap/rkae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives To compare the prevalence of anxiety and depression in patients with GCA with that in the general population, using the Hospital Anxiety and Depression Scale (HADS), and to identify independent predictors of these psychiatric manifestations in patients with GCA. Methods We conducted a cross-sectional study including all patients diagnosed with GCA followed during 1 year in a vasculitis outpatient clinic. The HADS and 36-item Short Form (SF-36) questionnaires were prospectively collected. Patients' HADS results were compared with an age- and gender-matched control group. HADS anxiety (HADS-A) and HADS depression (HADS-D) scores between 8 and 10 defined possible anxiety and depression and ≥11 defined probable anxiety and depression, respectively. Results We included 72 patients and 288 controls. Compared with controls, patients with GCA had a statistically significant higher prevalence of HADS-A ≥8 (48.6% vs 26.4%), HADS-A ≥11 (30.6% vs 12.2%) and HADS-D ≥11 (33.3% vs 18.1%). GCA was an independent predictor of HADS-A ≥8 [odds ratio (OR) 3.3 (95% CI 1.9, 5.9)], HADS-A ≥11 [OR 3.8 (95% CI 2.0, 7.4)] and HADS-D ≥11 [OR 2.6 (95% CI 1.4, 4.7)]. Among patients with GCA, a negative correlation was observed between HADS-A/D and SF-36 mental health scores (r = -0.780 and r = -0.742, respectively). Glucocorticoid therapy was a predictor of HADS-A ≥8 [OR 10.4 (95% CI 1.2, 94.2)] and older age of HADS-D ≥8 [OR 1.2 (95% CI 1.1, 1.3)] and HADS-D ≥11 [OR 1.1 (95% CI 1.0, 1.2)]. Conclusions Compared with the general population, patients with GCA have a higher prevalence of anxiety and depression and GCA is an independent predictor of these symptoms. Glucocorticoid treatment and older age are predictors of anxiety and depression, respectively, in patients with GCA.
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Affiliation(s)
- Joana Martins-Martinho
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - André Ponte
- Psychiatry Department, Hospital Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
- Egas Moniz Health Alliance, Aveiro, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia C Barreira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana R Cruz-Machado
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Vítor Teixeira
- Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana M Rodrigues
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Telles-Correia
- Psychiatry Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João E Fonseca
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Granath A, Pettersson S, Gunnarsson I, Welin E, Dahlberg K. How is the patient perspective captured in ANCA-associated vasculitis research? An integrative review. Rheumatol Adv Pract 2023; 7:rkad092. [PMID: 37954916 PMCID: PMC10637867 DOI: 10.1093/rap/rkad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Objective The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV). Methods This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further. Results The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management. Conclusion The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.
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Affiliation(s)
- Annika Granath
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Centre for Innovation, Research and Education, Region Vastmanland, Vastmanland Hospital Vasteras, Sweden
| | - Susanne Pettersson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Welin
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Shrivastava A, Jain S, Damaraju V, Naidu GSRSNK, Dhir V, Rathi M, Grover S, Jain S, Sharma A. Severity and determinants of psychosocial comorbidities in granulomatosis with polyangiitis and their impact on quality of life. Rheumatol Int 2023:10.1007/s00296-023-05341-2. [PMID: 37160468 DOI: 10.1007/s00296-023-05341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
Depression, anxiety, sleep disturbances, and fatigue are inadequately addressed comorbidities in granulomatosis with polyangiitis (GPA). We determined the prevalence, severity, determinants, and the impact of these comorbidities on quality-of-life (QoL) in GPA. This observational study included adult GPA patients; patients with RA and lupus were included as comparators. Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder 7-item scale for anxiety, Epworth Sleepiness Scale for sleep disturbances, and Fatigue Severity Scale for fatigue were administered prospectively to estimate prevalence and severity. QoL and disability were estimated using PROMIS-HAQ, HAQ-health and HAQ-pain. Correlations among these parameters were assessed. Stepwise regression analyses were performed to identify determinants of depression, anxiety, excessive sleepiness, and fatigue. One hundred eighty-one patients-62 GPA [mean age 43 (13) years], 57 RA and 62 SLE- were included. The prevalence of depression (47%), excessive sleepiness (21%), and fatigue (39%) in GPA were comparable to RA and lupus; anxiety was less prevalent (29% versus 46% and 53%, p = 0.02). Severity was mostly mild-moderate. Younger age [OR = 0.93 (0.89-0.98)], higher BMI [OR = 1.2 (1.0-1.4)], and greater disease damage [OR = 2.0 (1.3-3.3)] independently predicted presence of depression. Higher BMI [OR = 1.3 (1.1-1.5)] and concomitant FMS [OR = 80.9 (5.1-1289.2)] were independently associated with excessive sleepiness. No association with disease activity, duration, or gender was seen. GPA patients with depression, anxiety, excessive sleepiness, and fatigue had worse PROMIS-HAQ, HAQ-pain, and HAQ-health. In conclusion, depression, anxiety, sleep disturbances, and fatigue are common in GPA. Although their severity is mostly mild-moderate, they impair QoL significantly. Potentially modifiable determinants that can form targets for future interventions have been identified.
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Affiliation(s)
- Abhinav Shrivastava
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Damaraju
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G S R S N K Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Pittam B, Gupta S, Ahmed AE, Hughes DM, Zhao SS. The prevalence and impact of depression in primary systemic vasculitis: a systematic review and meta-analysis. Rheumatol Int 2020; 40:1215-1221. [PMID: 32494889 PMCID: PMC7316669 DOI: 10.1007/s00296-020-04611-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/28/2022]
Abstract
Objective To describe the prevalence of depression among patients with primary systemic vasculitides (PSV); compare prevalence according to vasculitis type and against controls; and examine the impact of depression on PSV outcomes. Methods We searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with PRISMA guidelines. We included all studies that reported the prevalence or impact of depression in PSV. We also included polymyalgia rheumatica (PMR) given its association with giant cell arteritis (GCA). Meta-analyses of prevalence estimates were performed using random-effects models and reported as percentages (95% confidence interval). Results We reviewed a total of 15 studies that described the prevalence of depression, categorised into small (n = 10) and large vessel vasculitis (n = 7). Pooled prevalence estimate for depression in a small vessel (predominantly ANCA-associated) vasculitis was 28% (95% CI 20–38%) with significant heterogeneity (I2 = 93%). Depression prevalence in large-vessel vasculitis (Takayasu and GCA/PMR) was 24% (95% CI 17–34%), again with significant heterogeneity (I2 = 96%). One study reported 56% prevalence of depression in medium vessel disease. The prevalence of depression in small vessel vasculitis was higher than healthy controls. In these patients, depression and depressive symptoms were associated with poorer quality of life, adherence, and work disability, but not disease activity or damage. Conclusion Depression is highly prevalent among patients with primary systemic vasculitis and associated with poorer outcomes across a range of measures in studies of small vessel disease. Further studies are needed for depression in medium and large vessel vasculitides. Electronic supplementary material The online version of this article (10.1007/s00296-020-04611-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bradley Pittam
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Sonal Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ashar E Ahmed
- Department of Rheumatology, Southport & Ormskirk Hospital, Southport, UK
| | - David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sizheng Steven Zhao
- Department of Academic Rheumatology, Liverpool University Hospitals, Liverpool, L9 7AL, UK. .,Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
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Sultana J, Azzopardi-Muscat N, Coleiro B, Grech L, Muscat M, Santoro D, Trifirò G. Pharmacological therapy in a rare disease: challenges in the long-term management of granulomatosis with polyangiitis. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1701433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Janet Sultana
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | | | | | - Louise Grech
- Pharmacy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | | | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
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Predictor of depressive disorders in patients with antineutrophil cytoplasmic antibody-associated vasculitis. Clin Rheumatol 2019; 38:3485-3491. [DOI: 10.1007/s10067-019-04657-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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Lemay J, Waheedi M, Al-Sharqawi S, Bayoud T. Medication adherence in chronic illness: do beliefs about medications play a role? Patient Prefer Adherence 2018; 12:1687-1698. [PMID: 30233149 PMCID: PMC6130270 DOI: 10.2147/ppa.s169236] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Several medicines are prescribed for chronic disease management; however, adherence to long-term therapy remains poor. Culture influences beliefs about medications and, ultimately, adherence to treatment. There is a paucity of data with regard to beliefs about medications in the Middle East region, and it remains to be determined how these beliefs would impact treatment adherence. OBJECTIVES To investigate the relationship between patients' beliefs about medications with self-reported adherence to treatment among a chronically ill multicultural patient population. METHODS A prospective cross-sectional study was conducted among patients treated for chronic illnesses in the Ministry of Health primary care clinics in Kuwait. Patients completed a questionnaire that consisted of questions to collect information about their health status and demographics using validated instruments: the Beliefs about Medication, Sensitive Soma Assessment Scale, and Medication Adherence Report Scale-5 items. The main outcome measures were self-reported adherence to medications, beliefs, and perceived sensitivity toward medications. RESULTS Of the 1,150 questionnaires distributed, 783 were collected - giving a response rate of 68.1%. Of the 783 patients, 56.7% were male, 73.7% were married, 53.3% were non-Kuwaitis, and 49.4% had low income (<1,000 KD/3,350 USD monthly). Patients self-reported having a cardiovascular illness (80.2%), diabetes mellitus (67.7%), respiratory disease (24.3%), or mood disorder (28.6%). Participants had a mean of two comorbid illnesses and indicated taking an average of four prescription medicines to treat them. A structural equation model analysis showed adherence to medications was negatively impacted by higher negative beliefs toward medications (beta = -0.46). Factors associated with negative beliefs toward medications included marital status (being unmarried; beta = -0.14), nationality (being Kuwaiti; beta = 0.15), having lower education level (beta = -0.14), and higher illness severity (beta = 0.15). Younger age (beta = 0.10) and higher illness severity (beta = -0.9) were independently associated with lower medication adherence. Income and gender did not influence medication adherence or beliefs about medications. The combined effect of variables tested in the model explained 24% of the variance in medication adherence. CONCLUSION Medication adherence is a complex, multifaceted issue and patient beliefs about medications contribute significantly, although partially, to adherence among a multicultural Middle Eastern patient population.
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Affiliation(s)
| | - Mohammad Waheedi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | | | - Tania Bayoud
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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Alexander DS, Hogan SL, Jordan JM, DeVellis RF, Carpenter DM. Examining whether the information-motivation-behavioral skills model predicts medication adherence for patients with a rare disease. Patient Prefer Adherence 2017; 11:75-83. [PMID: 28138225 PMCID: PMC5238767 DOI: 10.2147/ppa.s115272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The information-motivation-behavioral skills (IMB) model has been used to explain and promote medication adherence among patients with diabetes and HIV. The objective of this study was to examine whether the IMB model predicted medication adherence among vasculitis patients. Adult vasculitis patients (n=228) completed online questionnaires at baseline and 3-month follow-up. Linear regressions were calculated to determine the direct effects of information and motivation on medication adherence (P<0.05). A mediation analysis using a bootstrapping approach was used to test whether behavioral skills significantly mediated the effect of information and motivation on medication adherence. Participants reported high levels of information (M=4.0; standard deviation [SD]=0.68), moderate levels of motivation (M=2.7; SD=1.00), and high levels of behavioral skills (M=4.1; SD=0.74). In the regression model, only behavioral skills (B=0.38; P<0.001) were significantly associated with medication adherence; however, mediation analysis revealed that behavioral skills significantly mediated the effects of information and motivation on medication adherence. The results support the IMB-hypothesized relationships between information, motivation, behavioral skills, and medication adherence in our sample. Findings suggest that providers should work with vasculitis patients to increase their medication-related skills to improve medication adherence.
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Affiliation(s)
- Dayna S Alexander
- UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Asheville
- Correspondence: Dayna S Alexander, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, One University Heights, CPO #2125, Asheville, NC 28804, USA, Email
| | | | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Robert F DeVellis
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Delesha M Carpenter
- UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Asheville
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Brown N, Bruce IN, O'Riordan E, Dhaygude A, Helbert M, Caress AL, Sussman JD, Venning MC. Medication-related side effects in vasculitis: a patient self-report survey of awareness and reported uptake of protective therapy. Rheumatology (Oxford) 2016; 55:185-6. [PMID: 26320131 DOI: 10.1093/rheumatology/kev303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nina Brown
- Renal Unit, Manchester Royal Infirmary, Central Manchester Foundation Trust,
| | - Ian N Bruce
- Arthritis Research Epidemiology Unit, University of Manchester, Manchester
| | - Ed O'Riordan
- Renal Unit, Salford Royal Foundation Trust, Salford
| | | | - Matthew Helbert
- Department of Immunology, Central Manchester Foundation Trust
| | - Ann-Louise Caress
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester and
| | - Jon D Sussman
- Neurology Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael C Venning
- Renal Unit, Manchester Royal Infirmary, Central Manchester Foundation Trust
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Geboers B, Brainard JS, Loke YK, Jansen CJM, Salter C, Reijneveld SA, de Winter AF, deWinter AF. The association of health literacy with adherence in older adults, and its role in interventions: a systematic meta-review. BMC Public Health 2015; 15:903. [PMID: 26377316 PMCID: PMC4573285 DOI: 10.1186/s12889-015-2251-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/08/2015] [Indexed: 12/14/2022] Open
Abstract
Background Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this age group with low health literacy was also explored. Methods Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in older adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2251-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Julii S Brainard
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Yoon K Loke
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Carel J M Jansen
- Department of Communication and Information Studies, Faculty of Arts, University of Groningen, Groningen, The Netherlands.
| | - Charlotte Salter
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
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Novakovich E, Grayson PC. What matters for patients with vasculitis? Presse Med 2015; 44:e267-72. [PMID: 25986940 DOI: 10.1016/j.lpm.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/02/2015] [Indexed: 11/30/2022] Open
Abstract
Advances in clinical care for patients with vasculitis have improved survival rates and created new challenges related to the ongoing management of chronic disease. Lack of curative therapies, burden of disease, treatment-related side effects, and fear of relapse contribute to patient-perceived reduction in quality of life. Patient-held beliefs about disease and priorities may differ substantially from the beliefs of their health care providers, and research paradigms are shifting to reflect more emphasis on understanding vasculitis from the patient's perspective. Efforts are ongoing to develop disease outcome measures in vasculitis that better represent the patient experience. Health care providers who care for patients with vasculitis should be sensitive to the substantial burdens of disease commonly experienced by patients living with the disease and should strive to provide comprehensive care directed towards the medical and biopsychological needs of these patients.
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Affiliation(s)
- Elaine Novakovich
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States
| | - Peter C Grayson
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States.
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