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Penagos-Corzo JC, Ortiz-Barrero MJ, Hernández-Ramírez R, Ochoa-Ramírez Y, González Ehlinger R, Pérez-Acosta AM. Development and psychometric properties of a self-medication behavior inventory. Front Psychol 2024; 15:1366284. [PMID: 38770255 PMCID: PMC11103005 DOI: 10.3389/fpsyg.2024.1366284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Self-medication is a prevalent behavior with significant health implications. Understanding its psychosocial determinants can inform preventative strategies and interventions. Methods We evaluated the psychometric properties of the Self-Medication Behavior Inventory (SMBI-9) in a binational study with 779 Colombian and Mexican participants. Concurrent validity was assessed through correlations with related inventories, and confirmatory factor analysis tested the proposed four-factor model. Results The SMBI-9 demonstrated high model fit (CFI = 0.995, TLI = 0.991) and invariance across countries. The factors-Social Influence, Attitude toward Medicine, Avoidance, and Prevention-varied significantly with knowledge of medicine, schooling, health insurance status and gender, underscoring the role of social and personal beliefs in self-medication practices. Discussion SMBI-9 emerged as a reliable tool for capturing the multifaceted nature of self-medication behaviors. Findings highlight the influence of social norms and personal attitudes, suggesting targeted approaches for behavioral interventions.
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Affiliation(s)
- Julio C. Penagos-Corzo
- Department of Psychology, Universidad de las Américas Puebla, San Andrés Cholula, Mexico
| | | | | | - Yavne Ochoa-Ramírez
- Department of Psychology, Universidad de las Américas Puebla, San Andrés Cholula, Mexico
| | | | - Andrés M. Pérez-Acosta
- Observatory of Self-medication Behavior, Psychology Programme, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Pang J, Sanfilippo FM, Chan DC, Watts GF. Adherence to pharmacotherapy: sine qua non for reducing cumulative risk of premature coronary disease in familial hypercholesterolemia. Curr Opin Endocrinol Diabetes Obes 2024; 31:22-30. [PMID: 37902122 DOI: 10.1097/med.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to atherosclerotic cardiovascular disease (ASCVD). The risk of ASCVD can be substantially reduced with lipid-lowering treatment (LLT). However, adherence to LLT remains a major challenge in FH patients and an under-recognized issue. We review several barriers to treatment adherence and implementation strategies for improving adherence in patients with FH. RECENT FINDINGS Barriers that negatively affect patient adherence to treatment include the misunderstanding of perceived and actual risk of FH and the benefits of LLT, inadequate knowledge, lack of standardization of treatment, insufficient monitoring of LDL-cholesterol level, and inequalities in healthcare resources. Education of patients, carers and healthcare providers, guideline-directed treatment goals, regular monitoring, medication regimen simplification and greater access to established and new drugs are crucial enablers for improving adherence to treatment. However, given FH is present from birth, strategies for life-long adherence from childhood or young adulthood is critically important and requires further study. To be effective, strategies should be multifaceted, targeted and patient-centred involving a multidisciplinary-team with support from family, communities and peer groups. SUMMARY FH confers a significant risk for ASCVD from a young age. Achieving better medication adherence is foundational for improving clinical outcomes and reducing the burden of atherosclerosis over a lifetime. Identification of key barriers and enablers are critical for implementing better adherence to treatment across the life-course of patients with FH.
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Affiliation(s)
- Jing Pang
- Medical School, University of Western Australia
| | - Frank M Sanfilippo
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia
| | - Dick C Chan
- Medical School, University of Western Australia
| | - Gerald F Watts
- Medical School, University of Western Australia
- Lipid Disorders Clinic, Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Zhang H, Chen D, Zou P, Shao J, Wu J, Cui N, Lin S, Tang L, Zheng Q, Wang X, Ye Z. The integrated common-sense model of illness self-regulation: predicting healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome. BMC Public Health 2023; 23:1486. [PMID: 37542247 PMCID: PMC10401808 DOI: 10.1186/s12889-023-16403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Little is known about the potential mechanisms of healthy eating and exercise change, and design interventions which aim to promote healthy eating and exercise change among individuals at risk of metabolic syndrome. This study aimed to identify key determinants of healthy eating, exercise behaviors, and health among individuals at risk of metabolic syndrome using the integrated common-sense model of illness self-regulation. METHOD A cross-sectional study with a multi-wave data collection strategy. A total of 275 participants at risk of metabolic syndrome based on the clinical prediction model were included in the final analysis. Path analysis was employed to explore the pattern of relationships between key variables using AMOS. RESULTS The mediation analysis suggested that personal and treatment control, and coherence can positively affect self-reported health via intentions and health behaviors (exercise and healthy eating). Additionally, relationships between self-efficacy (exercise and healthy eating) and health outcomes can be mediated by health behaviors, and both intentions and health behaviors. CONCLUSIONS This current research used the integrated common-sense model of illness self-regulation to predict healthy eating, exercise behaviors, and self-reported health among individuals at risk of metabolic syndrome. The results suggested that self-efficacy, intention, consequences, personal control, treatment control, and coherence were the key determinants of behavior and health, which can help design interventions to encourage healthy eating and exercise changes among individuals with a high risk of MetS.
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Affiliation(s)
- Hui Zhang
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Dandan Chen
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Ping Zou
- School of Nursing, Nipissing University, Toronto, M6J 3S3, Ontario, Canada
| | - Jin Shao
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjie Wu
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Nianqi Cui
- School of Nursing, Kunming Medical University, Kunming, China
| | - Shuanglan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Leiwen Tang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Qiong Zheng
- Department of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiyi Wang
- School of Nursing, Shanghai JiaoTong University, Shanghai, China
| | - Zhihong Ye
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.
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Wu X, Tang F, Li H, Chen C, Zhang H, Liu X, Lai H, Li Q, Deng L, Ye Z. Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease. J Psychosom Res 2023; 171:111385. [PMID: 37301180 DOI: 10.1016/j.jpsychores.2023.111385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The high prevalence of medication non-adherence in patients with chronic kidney disease places a tremendous burden on healthcare resources. The study was designed to develop and validate a nomogram model of medication non-adherence in patients with chronic kidney disease in China. METHODS A multicenter cross-sectional study was conducted. 1206 chronic kidney disease patients were consecutively enrolled from Be Resilient to Chronic Kidney Disease (registration number: ChiCTR2200062288) between September 2021 and October 2022 in four tertiary hospitals in China. The Chinese version of four-item Morisky Medication Adherence Scale was used to assess the medication adherence of the patients and associated factors consisted of socio-demographic information, self-designed medication knowledge questionnaire, the 10-item Connor-Davidson Resilience Scale, the Beliefs about Medicine questionnaire, the Acceptance Illness Scale, and the Family Adaptation Partnership Growth and Resolve Index. Least Absolute Shrinkage and Selection Operator regression was performed to select significant factors. Concordance index, Hosmer-Lemeshow test and decision curve analysis were estimated. RESULTS The prevalence of medication non-adherence was 63.8%. Area under the curves ranged from 0.72 to 0.96 in internal and external validation sets. The predicted probabilities of the model were consistent with those of the actual observations by Hosmer-Lemeshow test (all P > .05). The final model included educational level, occupational status, duration of chronic kidney disease, medication beliefs (perceptions of the need to take medications and concerns about adverse effects), and illness acceptance (adaptation and acceptance of the disease). CONCLUSIONS There is a high prevalence of medication non-adherence among Chinese patients with chronic kidney disease. A nomogram model based on five factors has been successfully developed and validated and could be incorporated into long-term medication management.
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Affiliation(s)
- Xiaona Wu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Huanhuan Li
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cuiqing Chen
- Department of Nephrology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Haiyan Zhang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Shaoyang University, Shanoyang, China
| | - Xiuzhu Liu
- Department of Gastroenterology, Puning People's Hospital, Puning, China
| | - Huijing Lai
- Department of Pulmonology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Qiang Li
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lili Deng
- Nursing Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
| | - Zengjie Ye
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Implementation of a Novel Medication Regimen Following Cardiac Rehabilitation: an Application of the Health Action Process Approach. Int J Behav Med 2023; 30:30-37. [PMID: 35192171 DOI: 10.1007/s12529-022-10067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medication adherence is an indispensable prerequisite for the long-term management of many chronic diseases. However, published literature suggests that non-adherence is widely prevalent. Health behavior change theories can help understand the underlying processes and allow the accumulation of knowledge in the field. The present study applied the health action process approach (HAPA) in an intensive longitudinal research design to investigate medication adherence in patients after discharge from inpatient cardiac rehabilitation. METHOD In total, n = 139 patients (84.9% male, Mage = 62.2 years) completed n = 2,699 daily diaries in the 22 days following discharge from inpatient cardiac rehabilitation. Patients' intentions to take medication and predictors were assessed in daily end-of-day questionnaires. Adherence to medication was measured subjectively (self-report) and objectively. Multilevel modeling was applied to disentangle the between- and within-person level. RESULTS Higher levels of risk awareness and self-efficacy were positively associated with intentions to take medication at both levels of analysis. Contrary to theoretical assumptions, positive outcome expectations were not associated with intention, neither between- nor within-person. In contrast to published literature, patients showed very high medication adherence (95.2% self-report, 92.2% objectively). CONCLUSION In line with the theoretical assumptions, the results showed that risk awareness and self-efficacy are promising modifiable factors that could be targeted to motivate patients to take medication as prescribed. Daily measurements revealed that patients took their medication as prescribed; thus, future studies should make every effort to recruit patients vulnerable to non-adherence to avoid ceiling effects.
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Makhmudova U, Wolf M, Willfeld K, Beier L, Weingärtner O. Different Perspectives of Patients and Physicians on LDL-C Target Achievement in the Treatment of Hypercholesterolemia: Results on Secondary Prevention from the German PROCYON Survey. Adv Ther 2023; 40:460-473. [PMID: 36355313 PMCID: PMC9898401 DOI: 10.1007/s12325-022-02357-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
AIMS Low-density lipoprotein cholesterol (LDL-C) reduction in hypercholesterolemia patients at very high cardiovascular (CV) risk is essential in preventing future CV events. The objective was to assess the perception on hypercholesterolemia management in secondary prevention in Germany. METHODS PROCYON was a two-part online survey, including a patient questionnaire as well as a physician questionnaire. RESULTS A total of 109 general practitioners, internists, and cardiologists participated. The current ESC/EAS recommendation for high-risk patients is followed by 19.3% of the physicians. The majority (80.7%) reported an LDL-C target failure rate of at least 30%. More than two thirds (71.6%) have stated treating less than half of their patients with the maximum approved statin dose. The survey included 1696 secondary prevention patients. The majority (86.7%) consult their general practitioner for hypercholesterolemia; 54.0% consult a cardiologist (multiple answers allowed). Most patients (87.0%) were receiving lipid-lowering medication. Among these, 800 (54.2%) reported improved LDL-C levels since diagnosis, 569 (38.6%) reported no improvement, and 106 (7.2%) had no information. Of the treated patients with (N' = 800) and without (N' = 569) improvement, 34.3% vs. 37.3% were on their initial drug and dose, 24.8% vs. 23.7% received multiple drug therapy, 48.9% vs. 48.9% reported a dose change, and 16.1% vs. 14.2% had discontinued at least one drug (multiple answers). Disease knowledge was rated as good or very good by 29.8% of patients. CONCLUSION PROCYON demonstrated insufficient ESC/EAS guideline implementation regarding target levels and therapeutic escalation strategies. Furthermore, a lack of specialist involvement and patient education was identified.
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Affiliation(s)
- Umidakhon Makhmudova
- grid.275559.90000 0000 8517 6224Klinik Für Innere Medizin I, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Michaela Wolf
- Cholesterin & Co E. V.: Patientenorganisation Für Patienten Mit Familiärer Hypercholesterinämie Oder Anderen Schweren Genetischen Fettstoffwechselstörungen (CholCo), Frankfurt/M., Germany
| | - Kathy Willfeld
- grid.467675.10000 0004 0629 4302Novartis Pharma GmbH, Nuremberg, Germany
| | - Lea Beier
- grid.467675.10000 0004 0629 4302Novartis Pharma GmbH, Nuremberg, Germany
| | - Oliver Weingärtner
- Klinik Für Innere Medizin I, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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Patient-reported outcomes for medication-related quality of life: A scoping review. Res Social Adm Pharm 2022; 18:3501-3523. [DOI: 10.1016/j.sapharm.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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8
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Silva PRDS, Jannes CE, Oliveira TG, Krieger JE, Santos RD, Pereira AC. Pharmacological treatment with lipid-lowering agents after molecular identification of familial hypercholesterolemia: results from the Hipercol Brasil cohort. J Clin Lipidol 2022; 16:198-207. [DOI: 10.1016/j.jacl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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9
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Hilt AD, Hierck BP, Eijkenduijn J, Wesselius FJ, Albayrak A, Melles M, Schalij MJ, Scherptong RWC. Development of a patient-oriented Hololens application to illustrate the function of medication after myocardial infarction. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:511-520. [PMID: 36713611 PMCID: PMC9707881 DOI: 10.1093/ehjdh/ztab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Aims Statin treatment is one of the hallmarks of secondary prevention after myocardial infarction. Adherence to statins tends to be difficult and can be improved by patient education. Novel technologies such as mixed reality (MR) expand the possibilities to support this process. To assess if an MR medication-application supports patient education focused on function of statins after myocardial infarction. Methods and results A human-centred design-approach was used to develop an MR statin tool for Microsoft HoloLens™. Twenty-two myocardial infarction patients were enrolled; 12 tested the application, 10 patients were controls. Clinical, demographic, and qualitative data were obtained. All patients performed a test on statin knowledge. To test if patients with a higher tendency to become involved in virtual environments affected test outcome in the intervention group, validated Presence- and Immersive Tendency Questionnaires (PQ and ITQ) were used. Twenty-two myocardial infarction patients (ST-elevation myocardial infarction, 18/22, 82%) completed the study. Ten out of 12 (83%) patients in the intervention group improved their statin knowledge by using the MR application (median 8 points, IQR 8). Test improvement was mainly the result of increased understanding of statin mechanisms in the body and secondary preventive effects. A high tendency to get involved and focused in virtual environments was moderately positive correlated with better test improvement (r = 0.57, P < 0.05). The median post-test score in the control group was poor (median 6 points, IQR 4). Conclusions An MR statin education application can be applied effectively in myocardial infarction patients to explain statin function and importance.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Beerend P Hierck
- Leiden University Medical Center, Center for Innovation of Medical Education, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Leiden University, Teachers Academy, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joep Eijkenduijn
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Fons J Wesselius
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Armagan Albayrak
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Roderick W C Scherptong
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Hagger MS, Orbell S. The common sense model of illness self-regulation: a conceptual review and proposed extended model. Health Psychol Rev 2021; 16:347-377. [DOI: 10.1080/17437199.2021.1878050] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Martin S. Hagger
- Department of Psychological Sciences, University of California, Merced, CA, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
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Leventer-Roberts M, Lev Bar-Or R, Gofer I, Rosenbaum Z, Hoshen M, Feldman B, Balicer R. Choosing Wisely: Determining performance of unjustified imaging in a large healthcare system. Int J Clin Pract 2021; 75:e13644. [PMID: 32748452 DOI: 10.1111/ijcp.13644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS The Choosing Wisely Campaign identifies procedures and treatments that lack clinical justification for routine use according to expert opinion and evidence-based medicine. This study describes the rates and features of two such examples over a 10-year period. METHODS This is a cross-sectional rolling cohort study between 2008 and 2017 in Clalit Health Services, the largest healthcare delivery system in Israel, with seven main hospitals and over 4.5 million members nationwide. All adult members who visited a Clalit Emergency Department (ED), and all children members who visited a Clalit ED for abdominal pain or appendicitis were eligible to be included in this study. Our measures were routine chest radiograph (CXR) in the context of pre-admission assessment for adults and abdominal computed tomography (CT) to rule out appendicitis for children. RESULTS Of the 3 689 869 adult visits without a clinical indication for a CXR, 9.1% or 337 058 of them received a chest radiograph. Of the 35 973 children visits for presumed appendicitis, 7.2% of them had no imaging performed, 82.3% had an ultrasound (US), 6.9% had an US followed by a CT, and 3.6% or 1293 of them received a CT. There were several independent risk factors such as BMI, hospital, sex, year and diagnosis that are associated with having imaging that is not clinically indicated. CONCLUSIONS Overall, this study found that diagnostic imaging practices are applied inconsistently by hospital and by population. Intervention efforts should be focused on subpopulations at greatest risk to further reduce exposure to such imaging.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Tel Aviv, Israel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ilan Gofer
- Clalit Research Institute, Tel Aviv, Israel
| | | | | | | | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Why might visit-to visit variability of lipoproteins have an effect on cardiovascular events? Atherosclerosis 2020; 312:99-100. [DOI: 10.1016/j.atherosclerosis.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
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Pang J, Chan DC, Watts GF. The Knowns and Unknowns of Contemporary Statin Therapy for Familial Hypercholesterolemia. Curr Atheroscler Rep 2020; 22:64. [PMID: 32870376 PMCID: PMC7459268 DOI: 10.1007/s11883-020-00884-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Statins are first-line therapy for lowering low-density lipoprotein (LDL) cholesterol in familial hypercholesterolemia (FH), particularly in heterozygous patients. We review advances and new questions on the use of statins in FH. RECENT FINDINGS Cumulative evidence from registry data and sub-analyses of clinical trials mandates the value of statin therapy for prevention of atherosclerotic cardiovascular disease (ASCVD) in FH. Statins are safe in children and adolescents with FH, with longer term cardiovascular benefits. The potentially toxic effects of statins in pregnancy need to be considered, but no association has been reported in prospective cohort studies with birth defects. There is no rationale for discontinuation of statins in elderly FH unless indicated by adverse events. FH is undertreated, with > 80% of statin-treated FH patients failing to attain LDL cholesterol treatment targets. This may relate to adherence, tolerability, and genetic differences in statin responsiveness. Statin treatment from childhood may reduce the need for stringent cholesterol targets. Combination of statins with ezetimibe and PCSK9 inhibitors significantly improves the efficacy of treatment. Whether statin use could improve the clinical course of FH patients with COVID-19 and other respiratory infections remains an unsolved issue for future research. Statins are the mainstay for primary and secondary prevention of ASCVD in FH. Sustained long-term optimal statin treatment from an early age can effectively prevent ASCVD over decades of life. Despite their widespread use, statins merit further investigation in FH.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Dick C Chan
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
- Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6847, Australia.
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Elis A, Leventer-Roberts M, Bachrach A, Lieberman N, Durst R, Knobler H, Balicer R. The characteristics of patients with possible familial hypercholesterolemia-screening a large payer/provider healthcare delivery system. QJM 2020; 113:411-417. [PMID: 31883017 DOI: 10.1093/qjmed/hcz327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an under-diagnosed condition. AIM We applied standard laboratory criteria across a large longitudinal electronic medical record database to describe cross-sectional population with possible FH. METHODS A cross-sectional study of Clalit Health Services members. Subjects who met the General Population MED-PED laboratory criteria, excluding: age <10 years, documentation of thyroid, liver, biliary or autoimmune diseases, a history of chronic kidney disease stage 3 or greater, the presence of urine protein >300 mg/l, HDL-C>80 mg/dl, active malignancy or pregnancy at the time of testing were considered possible FH. Demographic and clinical characteristics are described at time of diagnosis and at a single index date following diagnosis to estimate the burden on the healthcare system. The patient population is also compared to the general population. RESULTS The study cohort included 12 494 subjects with out of over 4.5 million members of Clalit Health Services. The estimated prevalence of FH in Israel was found to be 1:285. These patients are notably positive for, and have a family history of, cardiovascular disease and risk factors. For most of them the LDL-C levels are not controlled, and only a quarter of them are medically treated. CONCLUSIONS By using the modified MED-PED criteria in a large electronic database, patients with possible FH can be identified enabling early intervention and treatment.
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Affiliation(s)
- A Elis
- Department of Internal Medicine, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | | | | | - N Lieberman
- Medical Policy Division, Clalit Health Services, Tel Aviv, Israel
| | - R Durst
- The Center for Research Prevention and Treatment of Atherosclerosis, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - H Knobler
- The Institute of Diabetes, Endocrinology, and Metabolism, Kaplan Medical Center, Rehovot, Israel
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15
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Familial hypercholesterolaemia: evolving knowledge for designing adaptive models of care. Nat Rev Cardiol 2020; 17:360-377. [DOI: 10.1038/s41569-019-0325-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 01/05/2023]
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Familial Hypercholesterolaemia in 2020: A Leading Tier 1 Genomic Application. Heart Lung Circ 2019; 29:619-633. [PMID: 31974028 DOI: 10.1016/j.hlc.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022]
Abstract
Familial hypercholesterolaemia (FH) is caused by a major genetic defect in the low-density lipoprotein (LDL) clearance pathway. Characterised by LDL-cholesterol elevation from birth, FH confers a significant risk for premature coronary artery disease (CAD) if overlooked and untreated. With risk exposure beginning at birth, early detection and intervention is crucial for the prevention of CAD. Lowering LDL-cholesterol with lifestyle and statin therapy can reduce the risk of CAD. However, most individuals with FH will not reach guideline recommended LDL-cholesterol targets. FH has an estimated prevalence of approximately 1:250 in the community. Multiple strategies are required for screening, diagnosing and treating FH. Recent publications on FH provide new data for developing models of care, including new therapies. This review provides an overview of FH and outlines some recent advances in the care of FH for the prevention of CAD in affected families. The future care of FH in Australia should be developed within the context of the National Health Genomics Policy Framework.
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Kinnear FJ, Wainwright E, Perry R, Lithander FE, Bayly G, Huntley A, Cox J, Shield JP, Searle A. Enablers and barriers to treatment adherence in heterozygous familial hypercholesterolaemia: a qualitative evidence synthesis. BMJ Open 2019; 9:e030290. [PMID: 31371299 PMCID: PMC6677970 DOI: 10.1136/bmjopen-2019-030290] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Individuals with heterozygous familial hypercholesterolaemia (FH) are at high risk of developing cardiovascular disease (CVD). This risk can be substantially reduced with lifelong pharmacological and lifestyle treatment; however, research suggests adherence is poor. We synthesised the qualitative research to identify enablers and barriers to treatment adherence. DESIGN This study conducted a thematic synthesis of qualitative studies. DATA SOURCES MEDLINE, Embase, PsycINFO via OVID, Cochrane library and CINAHL databases and grey literature sources were searched through September 2018. ELIGIBILITY CRITERIA We included studies conducted in individuals with FH, and their family members, which reported primary qualitative data regarding their experiences of and beliefs about their condition and its treatment. DATA EXTRACTION AND SYNTHESIS Quality assessment was undertaken using the Critical Appraisal Skills Programme for qualitative studies. A thematic synthesis was conducted to uncover descriptive and generate analytical themes. These findings were then used to identify enablers and barriers to treatment adherence for application in clinical practice. RESULTS 24 papers reporting the findings of 15 population samples (264 individuals with FH and 13 of their family members) across 8 countries were included. Data captured within 20 descriptive themes were considered in relation to treatment adherence and 6 analytical themes were generated: risk assessment; perceived personal control of health; disease identity; family influence; informed decision-making; and incorporating treatment into daily life. These findings were used to identify seven enablers (eg, 'commencement of treatment from a young age') and six barriers (eg, 'incorrect and/or inadequate knowledge of treatment advice') to treatment adherence. There were insufficient data to explore if the findings differed between adults and children. CONCLUSIONS The findings reveal several enablers and barriers to treatment adherence in individuals with FH. These could be used in clinical practice to facilitate optimal adherence to lifelong treatment thereby minimising the risk of CVD in this vulnerable population. PROSPERO REGISTRATION NUMBER CRD42018085946.
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Affiliation(s)
- Fiona J Kinnear
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Elaine Wainwright
- Psychology Department, Bath Spa University, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Rachel Perry
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Fiona E Lithander
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Graham Bayly
- Department of Clinical Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Alyson Huntley
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer Cox
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julian Ph Shield
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Aidan Searle
- The National Institute for Health Research (NIHR), Bristol Biomedical Research Centre (BRC), Nutrition theme, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Pang J, Chan DC, Hu M, Muir LA, Kwok S, Charng MJ, Florkowski CM, George PM, Lin J, Loi DD, Marais AD, Nawawi HM, Gonzalez-Santos LE, Su TC, Truong TH, Santos RD, Soran H, Tomlinson B, Yamashita S, Ademi Z, Watts GF. Comparative aspects of the care of familial hypercholesterolemia in the "Ten Countries Study". J Clin Lipidol 2019; 13:287-300. [PMID: 30797720 DOI: 10.1016/j.jacl.2019.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a lack of information on the health care of familial hypercholesterolemia (FH). OBJECTIVE The objective of this study was to compare the health care of FH in countries of the Asia-Pacific region and Southern Hemisphere. METHODS A series of questionnaires were completed by key opinion leaders from selected specialist centers in 12 countries concerning aspects of the care of FH, including screening, diagnosis, risk assessment, treatment, teaching/training, and research; the United Kingdom (UK) was used as the international benchmark. RESULTS The estimated percentage of patients diagnosed with the condition was low (overall <3%) in all countries, compared with ∼15% in the UK. Underdetection of FH was associated with government expenditure on health care (ϰ = 0.667, P < .05). Opportunistic and systematic screening methods, and the Dutch Lipid Clinic Network criteria were most commonly used to detect FH; genetic testing was infrequently used. Noninvasive imaging of coronary calcium and/or carotid plaques was underutilized in risk assessment. Patients with FH were generally not adequately treated, with <30% of patients achieving guideline recommended low-density lipoprotein cholesterol targets on conventional therapies. Treatment gaps included suboptimal availability and use of lipoprotein apheresis and proprotein convertase subtilsin-kexin type 9 inhibitors. A deficit of FH registries, training programs, and publications were identified in less economically developed countries. The demonstration of cost-effectiveness for cascade screening, genetic testing, and specialized treatments were significantly associated with the availability of subsidies from the health care system (ϰ = 0.571-0.800, P < .05). CONCLUSION We identified important gaps across the continuum of care for FH, particularly in less economically developed countries. Wider implementation of primary and pediatric care, telehealth services, patient support groups, education/training programs, research activities, and health technology assessments are needed to improve the care of patients with FH in these countries.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Dick C Chan
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Miao Hu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR
| | - Lauretta A Muir
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - See Kwok
- University of Manchester, Faculty of Biology, Medicine and Health, Manchester, United Kingdom; Cardiovascular Trials Unit, Clinical Trial Management Office, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Min-Ji Charng
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Christopher M Florkowski
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Peter M George
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Jie Lin
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Do Doan Loi
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - A David Marais
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, South Africa
| | - Hapizah M Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Lourdes E Gonzalez-Santos
- Department of Cardiology, Section of Preventive Cardiology, UP-Philippine General Hospital, Manila, Philippines
| | - Ta-Chen Su
- Departments of Environmental and Occupational Medicine, Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Thanh Huong Truong
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Handrean Soran
- University of Manchester, Faculty of Biology, Medicine and Health, Manchester, United Kingdom; Cardiovascular Trials Unit, Clinical Trial Management Office, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR
| | - Shizuya Yamashita
- Departments of Cardiovascular Medicine and Community Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Rinku General Medical Center, Osaka, Japan
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital, Perth, Western Australia, Australia.
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