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Reach G. How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities. Patient Prefer Adherence 2023; 17:1705-1720. [PMID: 37484740 PMCID: PMC10362896 DOI: 10.2147/ppa.s419277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Patient non-adherence is a major contemporary medical issue because of its consequences in terms of frequency, morbidity and mortality, and health care costs. This article aims to propose a mechanistic model of adherence based on the tenet that non-adherence is the default option, as long-term adherence in chronic diseases requires sustained effort. The real question becomes, how is patient adherence possible? By focusing on adherent patients, the paper explains the mental mechanisms of adherence using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses. The analysis first demonstrates the relationship between patient adherence and temporality and the influence of character traits. Further, it points out the importance of habit, which allows adherence to become non-intentional, thereby sparing patients' cognitive efforts. Finally, it points out the importance of the quality of the interaction between the person with a chronic disease and the health professional. These features explain why adherence is a syndrome (the healthy adherer phenotype), separating people into those who are safe and those who are at risk of non-adherence, non-control of diabetes, and complications. The concepts presented in this article summarize 20 years of personal clinical and philosophical reflection on patient adherence. They are mainly illustrated by examples from diabetes care but can be applied to all chronic diseases. This novel model of adherence has major practical and ethical implications, explaining the importance of patient education and shared medical decision-making in chronic disease management.
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Affiliation(s)
- Gérard Reach
- Education and Health Promotion Laboratory, Sorbonne Paris Nord University, Bobigny, Île-de-France, 93000, France
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Tang J, Yang Z, Kee F, Congdon N. Time and risk preferences and the perceived effectiveness of incentives to comply with diabetic retinopathy screening among older adults with type 2 diabetes. Front Psychol 2023; 14:1101909. [PMID: 37138986 PMCID: PMC10149913 DOI: 10.3389/fpsyg.2023.1101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Behavioral economics has the potential to inform the design of incentives to improve disease screening programs by accounting for various behavioral biases. We investigate the association between multiple behavioral economics concepts and the perceived effectiveness of incentive strategies for behavioral change among older patients with a chronic disease. This association is examined by focusing on diabetic retinopathy screening, which is recommended but very variably followed by persons living with diabetes. Five time and risk preference concepts (i.e., utility curvature, probability weighting, loss aversion, discount rate, and present-bias) are estimated simultaneously in a structural econometric framework, based on a series of deliberately-designed economic experiments offering real money. We find that higher discount rates and loss aversion and lower probability weighting are significantly associated with lower perceived effectiveness of intervention strategies whereas present-bias and utility curvature have an insignificant association with it. Finally, we also observe strong urban vs. rural heterogeneity in the association between our behavioral economic concepts and the perceived effectiveness of intervention strategies.
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Affiliation(s)
- Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ziwei Yang
- College of Economics and Management, Huazhong Agricultural University, Wuhan, China
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Reach G, Calvez A, Sritharan N, Boubaya M, Lévy V, Sidorkiewicz S, Fiani M. Patients' Perceived Importance of Medication and Adherence in Polypharmacy, a Quantitative, Cross-Sectional Study Using a Questionnaire Administered in Three Doctors' Private Practices in France. Drugs Real World Outcomes 2023:10.1007/s40801-023-00361-7. [PMID: 36997772 DOI: 10.1007/s40801-023-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Among the determinants of nonadherence, polypharmacy (common in people with multiple pathologies and especially in elderly patients), plays a major role. OBJECTIVE In patients who are subject to polypharmacy involving different classes of medications, the first aim is to assess the impact of medication importance given by patients on (i) medication adherence and (ii) the respective effect of intentionality and habit in medication importance and medication adherence. The second objective is to compare the importance given to medication and adherence in the different therapeutic classes. PATIENTS AND METHODS Patients taking 5-10 different medications for at least 1 month were included in a cross-sectional survey in three private practices in one region in France. RESULTS This study included 130 patients (59.2 % female) with 851 medications in total. The mean ± standard deviation (SD) age was 70.5 ± 12.2 years. The mean ± SD of medications taken was 6.9 ± 1.7. Treatment adherence had a strong positive correlation with the patient-perceived medication importance (p < 0.001). Counter-intuitively, taking a large number of medications (≥7) was associated with being fully adherent (p = 0.02). A high intentional nonadherence score was negatively associated with high medication importance (p = 0.003). Furthermore, patient-perceived medication importance was positively associated with taking treatment by habit (p = 0.03). Overall nonadherence more strongly correlated with unintentional nonadherence (p < 0.001) than with intentional nonadherence (p = 0.02). Compared to the antihypertensive class, a decrease in adherence by medication was observed in psychoanaleptics (p < 0.0001) and drugs used in diabetes class (p = 0.002), and a decrease in importance in lipid-modifying agents class (p = 0.001) and psychoanaleptics (p < 0.0001). CONCLUSION The perception of the importance of a medicine is associated with the place of intentionality and habit in patient adherence. Therefore, explaining the importance of a medicine should become an important part of patient education.
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Affiliation(s)
- Gérard Reach
- Health Education and Promotion Laboratory (LEPS UR 3412), Sorbonne Paris Nord University, 74 rue Marcel Cachin 93017, Bobigny Cedex, France.
| | - Aurélie Calvez
- Department of General Practice, University of Picardy Jules Verne, Amiens, France
| | | | - Marouane Boubaya
- Department of Clinical Research, CHU Avicenne, APHP, Bobigny, France
| | - Vincent Lévy
- Department of Clinical Research, CHU Avicenne, APHP, Bobigny, France
| | - Stéphanie Sidorkiewicz
- Department of General Medicine, University of Paris Cité, 75014, Paris, France
- University of Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, UMR 1153, 75004, Paris, France
| | - May Fiani
- Health Education and Promotion Laboratory (LEPS UR 3412), Sorbonne Paris Nord University, 74 rue Marcel Cachin 93017, Bobigny Cedex, France
- Department of General Practice, University of Picardy Jules Verne, Amiens, France
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Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12051981. [PMID: 36902770 PMCID: PMC10004070 DOI: 10.3390/jcm12051981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.
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Reach G, Benarbia L, Benhamou PY, Delemer B, Dubois S, Gouet D, Guerci B, Jeandidier N, Lachgar K, Le Pape G, Leroy R, Masgnaux JH, Raclet P, Reznik Y, Riveline JP, Schaepelynck P, Vambergue A, Vergès B. An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients' Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes. Patient Prefer Adherence 2022; 16:1333-1350. [PMID: 35642243 PMCID: PMC9148599 DOI: 10.2147/ppa.s365398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness. AIM To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs. PATIENTS AND METHODS An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed. RESULTS The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life. CONCLUSION This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.
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Affiliation(s)
- Gérard Reach
- Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, Bobigny, France
- Correspondence: Gérard Reach, Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, 74 Rue Marcel Cachin, Bobigny Cedex, 93017, France, Tel + 33 (0)6 60 84 53 25, Email
| | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital; Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Brigitte Delemer
- Service d’Endocrinologie – Diabète – Nutrition, CHU de Reims - Hôpital Robert Debré, and Université de Reims Champagne Ardenne, UFR Sciences Exactes Et Naturelles, Reims, France
| | - Séverine Dubois
- Department of Diabetology and Endocrinology, CHU Angers, Angers, France
| | - Didier Gouet
- Department of Diabetology and Endocrinology, Saint Louis Hospital, La Rochelle, France
| | - Bruno Guerci
- Department of Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, and ILCV Lorraine University, Vandoeuvre-les-Nancy, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, Hôpitaux Universitaires de Strasbourg, and Université de Strasbourg, Strasbourg, France
| | - Karim Lachgar
- Department of Diabetology and Endocrinology, Centre Hospitalier Simone Veil, Eaubonne, France
| | | | - Rémy Leroy
- Private Medical Practice, Endocrinology and Diabetology, Lille, France
| | | | - Philippe Raclet
- Association Française des Diabétiques de Bourgogne Franche-Comté, Dijon, France
| | - Yves Reznik
- Department oEndocrinology and Diabetology, CHU Côte de Nacre, Caen, and University of Caen Basse-Normandie, Medical School, Caen, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Diseases, Pôle ENDO, APHM-Hôpital la Conception, Marseille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, CHU Lille, and University Hospital European Genomic Institute for Diabetes, Lille, France
| | - Bruno Vergès
- Department of Endocrinology-Diabetology,CHU Dijon, and University of Burgundy, INSERM LNC UMR1231, Dijon, France
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Zhu L, Shi Q, Zeng Y, Ma T, Li H, Kuerban D, Hamal S, Li M. Use of health locus of control on self-management and HbA1c in patients with type 2 diabetes. Nurs Open 2021; 9:1028-1039. [PMID: 34841737 PMCID: PMC8859056 DOI: 10.1002/nop2.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/10/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
Aim To assess the effects of health locus of control‐based education programme (HLCEP) on self‐management, health locus of control and glycated haemoglobin (HbA1c) among type 2 diabetes mellitus (T2DM). Design Quasi‐experimental study. Methods The study recruited 120 T2DM participants from May–September 2020. The control group received one‐week in‐hospital care and 12‐week follow‐up. The intervention group received additional HLCEP. The self‐management and the health locus of control were measured by using the Summary of Diabetes Self‐care Activities and the Multidimensional Health Locus of Control at baseline and the 4th and 12th week after discharge. The HbA1c was collected at baseline and the 12th week after discharge. The generalized estimating equation analysis was performed to assess the intervention effects. Results The intervention group has statistically significantly higher scores on the overall level of self‐management, dietary management, foot care, medication management and internal health locus of control, while a lower HbA1c level than the control group.
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Affiliation(s)
- Lingxiao Zhu
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qifang Shi
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Zeng
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tong Ma
- The First People's Hospital of Lianyungang, Lianyungang, China
| | - Haomiao Li
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dilihumaer Kuerban
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sarita Hamal
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Meng Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Klonoff DC, Zhang JY, Shang T, Mehta C, Kerr D. Pharmacoadherence: An Opportunity for Digital Health to Inform the Third Dimension of Pharmacotherapy for Diabetes. J Diabetes Sci Technol 2021; 15:177-183. [PMID: 33289578 PMCID: PMC7783015 DOI: 10.1177/1932296820973185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The basis of pharmacotherapy requires knowledge of two properties of a drug: pharmacokinetics (PK) and pharmacodynamics (PD). In the era of precision medicine, there is growing interest in determining between-individual variations in PK and PD. While these two dimensions of pharmacotherapy are key foci of investigation, a third property is also emerging as a critical factor in understanding how a drug affects an individual. This third property of a drug is known as phamacoadherence (PA). There can be wide variation in PA among people with diabetes, whether they are using oral or injectable medications. The use of new digital health interventions and telehealth communication tools, such as smart insulin pens, is now creating opportunities for health care professionals to have a more complete understanding of the PA of drugs, which allows for more personalized prescribing practices.
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Affiliation(s)
- David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Dr, Room 5147, San Mateo, CA 94401, USA.
| | | | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | - Chhavi Mehta
- Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
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Reach G, Benarbia L, Bruckert E, Kevorkian JP, Farnier M, Mourad JJ, Vaisse BC. Intentionality in adherence to long-term therapies. Results from an online survey of 3,001 patients with cardio-metabolic pathologies in France. Patient Prefer Adherence 2021; 15:1739-1753. [PMID: 34408407 PMCID: PMC8366034 DOI: 10.2147/ppa.s318116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Some patients make a rational choice not to follow medical prescriptions; others fail to take their medications for reasons beyond their control, such as mere forgetfulness or a weak medication routine. The aim of this study was to elucidate the functioning of patient intentionality in medication adherence. PATIENTS AND METHODS This online study was conducted in metropolitan France in 2019. A cross-sectional survey of 50 questions was conducted with 3001 respondents diagnosed with diabetes, hypertension, and/or hypercholesterolemia identified from a panel of 54,000 people. These questions included a validated six-item questionnaire to detect nonadherence, two questions to detect intentional nonadherence by patients, and three questions on the effects of habit. Our questionnaire also included questions on the feelings of respondents regarding their doctor's attitude to their problems and needs, their trust in general practitioners (GP) and specialists, their sense of being involved in treatment decisions, and the influence of side effects and habits on patients' adherence. This study used the strategy of focusing on strictly adherent patients in the hope of finding ways to improve adherence. For this reason, we defined adherence as the absence of a positive response to the 6-item nonadherence screening questionnaire. RESULTS Of 3001 respondents, 1804 were diagnosed with hypertension, 1458 with hypercholesterolemia, and 774 with diabetes. Of the total number of patients, 72% were afflicted with one disease, 21% with two ailments, and 7% with three simultaneous illnesses. One-third (33%) of the patients did not tender a positive answer to the adherence questionnaire and were deemed adherent. 1) Thirty-two percent of the patients reported occasionally omitting their medication deliberately, and 84% said they had a reason for missing doses. These statements suggesting intentional nonadherence were negatively associated with adherence as identified via multivariate analysis (P = 0.0012 and P < 0.0001, for the first and second statement, respectively). 2) Univariate analyses revealed strong associations (P < 0.0001) between strict adherence on one hand and lack of intentional nonadherence, patient age, absence of drug side effects, taking drugs by habit, feeling involved in treatment decisions, getting information about treatment, and disease, and trust in doctors, on the other hand. 3) Specifically, univariate analysis of the absence of reported side effects revealed strong associations (P < 0.0001) with adequate information about medicines and diseases and trust in GP. These original data were consistent with the concept of the nocebo effect. 4) We observed a strong association between the absence of intentional nonadherence (statement of never deliberately missing medication) and respondent statements about generally sticking to the routine (P < 0.0001), ie, "I take my medication because I am used to taking it." This important result suggests that patients are strictly adherent in two ways: the absence of intentional nonadherence and reliance on habit, which we term as "unintentional adherence." 5) Finally, a multiple correspondence analysis illustrated all statistically significant relationships found in this study. CONCLUSION We present a new global model of adherence in which patient adherence was improved both by reducing intentional nonadherence and by promoting the abovementioned unintentional adherence by habit. This model highlights the role of shared decision-making and the trust felt by patients in their doctors. These results could exert a major impact on medical practice and education by demonstrating the importance of physicians' attitudes, involving the patient in decisions (shared decision-making), offering information about medicines and diseases (patient education), understanding the problems of patients, and taking their needs into account (empathy). The development of these attitudes should be an important aspect of the medical curricula.
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Affiliation(s)
- Gérard Reach
- Health Education and Practices Laboratory (LEPS), Sorbonne Paris-Nord University, Bobigny, France
- Correspondence: Gérard Reach Health Education and Practices Laboratory (LEPS), Sorbonne Paris-Nord University, 74 rue Marcel Cachin, Bobigny, 93017, FranceTel +33 6 60 84 53 25 Email
| | | | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Diseases, Institute of Cardiometabolism and Nutrition (ICAN), La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Jean-Philippe Kevorkian
- Department of Diabetes and Endocrinology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, 75010, France
| | - Michel Farnier
- PEC2, EA 7460, University of Bourgogne Franche-Comté, Dijon, France
- Cardiology Department, University Hospital Centre of Dijon Bourgogne, Dijon, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine and ESH Excellence Centre, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Bernard-Charles Vaisse
- Hypertension Unit -Vascular Medicine, Department of Cardiology, CHU Timone, Marseille, France
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Zhuang Q, Chen F, Wang T. Effectiveness of short message service intervention to improve glycated hemoglobin control and medication adherence in type-2 diabetes: A meta-analysis of prospective studies. Prim Care Diabetes 2020; 14:356-363. [PMID: 31653588 DOI: 10.1016/j.pcd.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Distance education or reminder by texting short message may improve HbA1c level and medication adherence to type-2 diabetes. METHODS Electronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) were searched systematically for published studies up to Mar 2019. SMD and 95% confidence interval (CI) were used to evaluate the intervention effect on HbA1c level and medication adherence. The heterogeneity of the study was estimated with the I2 statistic. The publication bias was described by Beggs' test, Egger's test and plot. RESULTS Ten studies with 380 interventions and 275 controls were included in this meta-analysis. The Hba1c overall SMD was -0.49%, 95% CI -0.75 to 0.22%, and the overall SMD was 0.96%, 95% CI 0.45-1.47 for medication adherence. The I2 and P were 64.90%, 0.002 and 56.40%, 0.10 respectively for Hba1c level and medication adherence. CONCLUSION SMS intervention was effective for HbA1c level and medication adherence according to this study for T2DM over first 6 months.
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Affiliation(s)
- Qianling Zhuang
- Department of Nursing, Suzhou Vocational Health College, Suzhou, Jiangsu, China.
| | - Fengmei Chen
- Department of Medical Science, Suzhou Vocational Health College, Suzhou, Jiangsu, China
| | - Ting Wang
- Department of Nursing, Suzhou Vocational Health College, Suzhou, Jiangsu, China
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Briot K, Grange L, Cortet B, Feron JM, Chauvin P, Coulomb A, Alliot-Launois F, Sellami R, Touboul C, Perrin L, Joubert JM, Launois R. Real-world care for individuals aged over fifty with fractures in France: Evidence for a wide care gap-The EPIFRACT Study. Joint Bone Spine 2020; 87:467-473. [PMID: 32387150 DOI: 10.1016/j.jbspin.2020.04.007] [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: 01/30/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the care trajectories of adults aged ≥50 years with fragility fractures in France. METHODS A postal questionnaire was sent to 15,000 individuals aged ≥50 years extracted from a representative panel of the French population (METASKOPE) in April-May 2018. Respondents experiencing a single fragility fracture in the previous three years constituted the study population. Information was collected regarding diagnosis, hospitalisations, physician visits and treatment related to the fractures. RESULTS 13,914 participants returned a questionnaire (92.8%), of whom 436 reported a single fragility fracture. Their mean age was 68.7±10.3 years. 11.9% of this sample had undergone bone densitometry (DXA) prior to the fracture and 11.9% had received a diagnostic of osteoporosis. Following the fracture, a further 17.4% underwent DXA and 8.5% were diagnosed with osteoporosis. 74.3% of fractures were initially managed in an emergency department and 29.6% led to immediate hospitalisation. Prior to fracture, 3.4% received a specific anti-osteoporotic treatment, 10.1% vitamin D and 6.4% calcium supplementation. After the fracture, these figures rose to 10.8%, 26.8% and 19.0% respectively. 86.2% participants made at least one follow-up visit to a physician. CONCLUSIONS The rate of DXA screening following fragility fractures in subjects over fifty is very low. Most patients with fragility fractures did not receive a diagnosis of osteoporosis. The proportion of patients treated with a specific anti-osteoporotic treatment after a fracture is low even though around half consulted their general practitioner after the fracture. Practice guidelines are thus not being adhered to in everyday clinical practice in France.
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Affiliation(s)
- Karine Briot
- Service de rhumatologie, hôpital Cochin, Paris, France.
| | - Laurent Grange
- Service de rhumatologie, CHU Grenoble Alpes, Hôpital Sud, Echirolles, France; AFLAR - Association Française de Lutte Anti-Rhumatismale, Paris, France
| | - Bernard Cortet
- Service de rhumatologie, EA 4490, CHU Lille, Lille, France
| | - Jean-Marc Feron
- Service de chirurgie orthopédique, HUEP Saint Antoine, Sorbonne université, Paris, France
| | - Pierre Chauvin
- Department of social epidemiology, Inserm, Sorbonne université, institut Pierre Louis d'épidémiologie et de santé publique (UMRS 1136), Paris, France
| | | | | | | | | | | | | | - Robert Launois
- Réseau d'évaluation en économie de la santé, Paris, France
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Cortet B, Chauvin P, Feron JM, Grange L, Coulomb A, Launois R, Alliot-Launois F, Sellami R, Touboul C, Vincent B, Joubert JM, Briot K. Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study). Arch Osteoporos 2020; 15:46. [PMID: 32170512 DOI: 10.1007/s11657-019-0674-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/21/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. PURPOSE To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. METHODS In April-May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. RESULTS Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. CONCLUSIONS Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.
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Affiliation(s)
- Bernard Cortet
- Centre Hospitalier Régional Universitaire de Lille, Département Universitaire de Rhumatologie, Hôpital Roger Salengro, CHU Lille, Avenue du Professeur Emile Laine, 59037, Lille Cedex, France.
| | - Pierre Chauvin
- Department of Social Epidemiology, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), INSERM, Sorbonne Université, Paris, France
| | - Jean-Marc Feron
- Service de Chirurgie Orthopédique, HUEP Saint Antoine, Sorbonne Université, Paris, France
| | - Laurent Grange
- Service de Rhumatologie, CHU Grenoble Alpes, Hôpital Sud, Échirolles, France
- AFLAR - Association Française de Lutte Anti-Rhumatismale, Paris, France
| | | | | | | | | | | | | | | | - Karine Briot
- Service de Rhumatologie, Hôpital Cochin, Paris, France
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12
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Knowles SR, Apputhurai P, O’Brien CL, Ski CF, Thompson DR, Castle DJ. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. PSYCHOL HEALTH MED 2019; 25:214-228. [DOI: 10.1080/13548506.2019.1695865] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Simon R Knowles
- Department of Psychology, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
| | - Pragalathan Apputhurai
- Department of Psychology, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Casey L O’Brien
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
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13
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Madsen KP, Kjaer T, Skinner T, Willaing I. Time preferences, diabetes self-management behaviours and outcomes: a systematic review. Diabet Med 2019; 36:1336-1348. [PMID: 31392757 DOI: 10.1111/dme.14102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
AIM Time preferences, i.e. individuals' degree of patience/impatience in intertemporal choice, have been found to be associated with suboptimal health behaviours and health outcomes such as smoking, physical inactivity, unhealthy food intake and obesity. In this systematic review, we aimed to synthesise reported associations between time preferences, diabetes self-management behaviours, including use of diabetes technology, and outcomes. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit and all databases in the Web of Science Core Collection. Peer-reviewed studies of people with diabetes that included at least one diabetes-related behaviour or outcome and a measure of time preferences were included. Non-English language studies were excluded. RESULTS A total of 961 records were identified, of which 12 articles were included. Three studies analysed both time-consistent and time-inconsistent preferences, three studies solely analysed time-inconsistent preferences and six studies did not explicitly define a time preference model. Measured outcomes across studies included self-care activities, such as medication-taking, exercising and eating a healthy diet, and biomedical outcomes, such as HbA1c and diabetes-related complications. There were 10 cross-sectional studies and two panel-data studies. No studies explicitly analysed the relationship between time preferences and diabetes technology use. CONCLUSIONS Associations between measures of time preferences, diabetes self-management behaviours and clinical outcomes exist. Higher discount rates determined by both time-consistent and time-inconsistent models predict less diabetes-related self-care and worse outcomes. These findings may add to explanations of the observed variation in diabetes-related health and provide new insights for tailoring interventions and policies aimed at improving diabetes self-management.
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Affiliation(s)
- K P Madsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - T Kjaer
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - T Skinner
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - I Willaing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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14
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Booysen V, Burger JR, du Plessis JM, Cockeran M. Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study. Int J Orthop Trauma Nurs 2019; 36:100718. [PMID: 31585861 DOI: 10.1016/j.ijotn.2019.100718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Patients struggle to adhere to prescribed pain medication after surgery because of, inter alia, side effects, sleep disturbances and pain severity. This study aimed to determine the influence of various factors on, the extent of adherence to prescribed post-operative pain medication (POPM) measured by participant-reported pill count (PRPC) following day case orthopaedic surgery at a private South African hospital. METHODS This prospective, quantitative cross-sectional study involving 120 participants (51 males, 69 females), used a structured questionnaire completed through a telephonic survey, 4 days after orthopaedic surgery. Measurements included PRPC adherence (adherent vs. non-adherent), in relation to post-operative adherence behaviour (POAB), normal medicine adherence behaviour (NMAB), pain severity affecting sleep and mobility, treatment side effects and patient demographic characteristics. RESULTS Based on PRPC measurement 56.7% (n = 68) of participants were adherent. PRPC was significantly associated with severe pain affecting falling sleep (p = .001), pain causing awakening from sleep (p = .035) and POAB (p < .001, Cramér's V = 0.5). PRPC adherence was independent from gender (p = .140), age (p = .822), smoking status (p = 1.000), type and event of side effects (p > .300), NMAB (p = .601) and the treatment regimen (i.e. unimodal vs. bimodal or multimodal) (p = .511). CONCLUSION Non-adherence (overuse or misuse) of prescribed POPM can be a result of severe pain, influencing sleep and movement after orthopaedic surgery, indicating a need for the review of these regimens in order to optimise care.
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Affiliation(s)
- Vanessa Booysen
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Jesslee M du Plessis
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- Statistics, School of Computer, Statistical and Mathematical Sciences, North-West University, Potchefstroom, South Africa
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15
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Reach G, Chenuc G, Maigret P, Elias-Billon I, Martinez L, Flipo RM. Implication Of Character Traits In Adherence To Treatment In People With Gout: A Reason For Considering Nonadherence As A Syndrome. Patient Prefer Adherence 2019; 13:1913-1926. [PMID: 31806940 PMCID: PMC6844210 DOI: 10.2147/ppa.s227329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/11/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Various aspects of nonadherence to therapy (including medication and lifestyle nonadherence) often appear together. Here we report the association between treatment adherence in gout and the two character traits of patience and obedience, which may explain this observation. METHODS Data were collected from a cross-sectional study conducted in a French cohort of 1441 adult patients. Patience was assessed using the choice between receiving €1500 in 1 year or €500 immediately. Obedience was evaluated with a single question assessing the use of the seatbelt in the rear seat of a car. Adherence to recommendations for medication, beverage, food and physical activity and smoking status was assessed using self-report questionnaires. RESULTS Patience and obedience were strong determinants of adherence to medication in multivariate analysis (OR 2.056, 95% CI [1.414-2.989], P< 0.001; OR 1.844, 95% CI [1.273-2.671], P=0.001). In univariate analysis, adherence to medication was also associated with compliance with dietary directives (P<0.001), lower alcohol consumption on an ordinary day (P< 0.001), never consuming soda (P<0.001) or beer (P<0.001), practice of physical activity (P=0.002), being a nonsmoker (P<0.001) and monitoring serum levels of uric acid regularly (P=0.011). Multiple-correspondence analysis illustrated the associations of these different aspects of adherence (medication, diet and exercise, smoking status and monitoring of disease control) with patience and obedience. Finally, we observed a link between patience and obedience (P< 0.001). CONCLUSION Character traits, which shape preferences, may cause the clustering of different aspects of nonadherence in the form of a syndrome, elucidating the still enigmatic link between nonadherence to placebo and mortality in randomised clinical trials. This concept may also explain, at least in part, the difficulty of improving adherence to long-term therapies and may lead to ethical issues.
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Affiliation(s)
- Gérard Reach
- Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, APHP, Bobigny, France
- Health Education and Practices Laboratory (LEPS, EA 3412), Paris 13 University, Sorbonne Paris Cité, Bobigny, France
- Correspondence: Gérard Reach Direction Qualité, Hôpital Avicenne, APHP, 125 Route de Stalingrad, Bobigny93000, FranceTel +33 6 60 84 53 25 Email
| | | | | | | | | | - René-Marc Flipo
- Department of Rheumatology, University Hospital, Lille, France
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16
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Reach G. Temporality in chronic diseases and adherence to long-term therapies: From philosophy to science and back. DIABETES & METABOLISM 2018; 45:419-428. [PMID: 30472197 DOI: 10.1016/j.diabet.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/04/2018] [Indexed: 01/30/2023]
Abstract
This narrative review exhibits the construction and validation of a hypothesis to explain how treatment non-adherence in people with chronic disease, a major issue in contemporary medicine, occurs. I propose that non-adherence to long-term therapies is at least in part due to failure to prioritize the future, which is caused by a condition I dub disruption in time projection. This article gives the rationale for this hypothesis, which is largely grounded on philosophical arguments. Then, it demonstrates the plausibility of the hypothesis: on the one hand, it is consistent with certain epidemiological data found in the literature. On the other, it is possible to predict the underlying mechanisms of this lack of prioritization from recent achievements of neuro-economics and neuroscience. Next, it reviews empirical data that provide an experimental verification for this explanatory hypothesis. Finally, a general evolutionary and philosophical meaning for adherence is proposed, considering the advantages of its preconditions, namely, patience and foresight.
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Affiliation(s)
- G Reach
- Endocrinology, diabetes and metabolic diseases department, Avicenne hospital, AP-HP, Health education and practices laboratory (LEPS), EA 3412, Paris 13 University, Paris Sorbonne Cité, 93000 Bobigny, France.
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17
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Reach G, Boubaya M, Brami Y, Lévy V. Disruption in time projection and non-adherence to long-term therapies. Patient Prefer Adherence 2018; 12:2363-2375. [PMID: 30519002 PMCID: PMC6234996 DOI: 10.2147/ppa.s180280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients' non-adherence to medical prescriptions is a crucial issue in contemporary medicine because it can jeopardize care efficacy. Non-adherence is especially frequent in patients with chronic diseases. In this article, we propose that a particular condition, which we call disruption in time projection, is a cause of non-adherence to medication therapies in chronic diseases. METHODS A questionnaire was administered to 120 hospitalized people with type 2 diabetes addressing three psychological constructs defining time projection: patience/impatience in a fictive monetary scenario (preferring to receive €1,500 in 1 year or €500 today), magnitude of temporal horizon (greater or lesser ability to imagine future events) and perception of the degree of physical similarity of current self to self at 1 year, 5 years and 10 years from the present. In addition, the questionnaire evaluated adherence to medication, social deprivation and depression. RESULTS In the multivariate analyses, two factors were associated with adherence to medication: patience (P<0.001) and long temporal horizon (P=0.006). Two factors were associated with HbA1c ≥8% (64 mmol/mol): non-adherence to medication (P=0.003) and short temporal horizon (P=0.011). Three factors were associated with long temporal horizon: adherence to medication (P<0.001), patience (P<0.001) and the existence of grandchildren (P=0.002). Social deprivation (P<0.001), non-adherence (P<0.001), female gender (P=0.002) and short temporal horizon (P=0.050) were associated with impatience. Finally, an association of adherence to expected similarity in the future to current self, impatience, short temporal horizon, social deprivation and depression was also shown in a multiple correspondence analysis. CONCLUSION What we termed a disruption in time projection may be a unique determinant for non-adherence to long-term therapy and, therefore, may influence the outcome of chronic diseases. We hypothesize that this is involved in both intentional and unintentional non-adherence and that it represents the loss of a protective mechanism. If this novel concept is to be confirmed in other settings and generalized to other chronic diseases, the recognition of its role in disease prognosis may help orient the teaching and practice of medicine.
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Affiliation(s)
- Gérard Reach
- Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, APHP, Bobigny, France,
- EA 3412, Health Education and Practices Laboratory (LEPS), Paris 13 University, Sorbonne Paris Cité, Bobigny, France,
| | - Marouane Boubaya
- Clinical Research Unit and Clinical Research Center, Avicenne Hospital, APHP, Bobigny, France
| | - Yoann Brami
- Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, APHP, Bobigny, France,
| | - Vincent Lévy
- Clinical Research Unit and Clinical Research Center, Avicenne Hospital, APHP, Bobigny, France
- INSERM UMR 1153 (Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité), ECSTRRA team (Epidemiology and Clinical Statistics for Tumor, Respiratory, and Ressuscitation Assessments), Hôpital Saint Louis, Paris, France
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