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Seiffert J, Ortelbach N, Hummel A, O'Malley G, Stamm T, Haller K. How do the guideline recommendations work for you? Patients' perceived effectiveness of therapeutic approaches in arterial hypertension. J Hum Hypertens 2024:10.1038/s41371-024-00951-0. [PMID: 39266686 DOI: 10.1038/s41371-024-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/14/2024]
Abstract
Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline's recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients' perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients' views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.
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Affiliation(s)
- Johanna Seiffert
- University Hospital Ruppin-Brandenburg, Department of Psychiatry, Psychotherapy and Psychosomatics, Campus Neuruppin, Neuruppin, Germany.
| | - Niklas Ortelbach
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Anja Hummel
- University Hospital Ruppin-Brandenburg, Department of Child and Adolescent Psychiatry and Psychotherapy, Campus Neuruppin, Neuruppin, Germany
| | - Grace O'Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Thomas Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Germany
| | - Karl Haller
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Hematology, Oncology and Cancer Immunology, CVK, Berlin, Germany
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Guignet M, Vuong J, Martinez A, Ballapapinan T, White HS. Temporal relationship between levetiracetam nonadherence and breakthrough seizures in a preclinical model of temporal lobe epilepsy. Epilepsia 2024; 65:497-510. [PMID: 38031477 DOI: 10.1111/epi.17835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Poor medication adherence remains a concern for individuals managing their epilepsy with antiseizure medicines (ASMs); however, ethical concerns around withholding medication make it impossible to study the causal relationship between missed doses and seizures in patients. Previous preclinical studies from our group suggest that mechanistically distinct ASMs have varying degrees of forgiveness when a dose is missed. However, with only a few ASMs studied in the context of nonadherence, we sought to expand on previous work to understand the relationship between levetiracetam (LEV) nonadherence and breakthrough seizures. METHODS Chronic oral dosing was initiated in rats with established epilepsy via our automated medication-in-food delivery system coupled to 24/7 video-electroencephalographic recording. Baseline seizure burden was established for 4 weeks before enrolling subjects into a 4-week treatment period with LEV in a 100% fully adherent (75 mg/kg four times daily) or 50% variably adherent paradigm. The temporal relationship between missed doses and breakthrough seizures was correlated with LEV plasma and brain concentrations in separate cohorts of animals. RESULTS Full adherence to LEV significantly improved seizure control by 50% in half of the animals. Poor adherence worsened seizure frequency by 85%, with most rats having more severe seizures that formed in clusters following missed doses. LEV concentrations remained below therapeutic levels (<10 μg/mL) in nonadherent animals, with brain and plasma levels directly correlating with the degree of adherence in a 24-h period. Missed doses of LEV immediately increased the risk of breakthrough seizures; however, this risk was significantly reduced with improved adherence in a 24-h period. SIGNIFICANCE These findings enhance our understanding of ASM nonadherence in preclinical models, highlighting that the timing of missed doses and their impact on seizures may vary between different ASMs. Notably, LEV demonstrates a robust pharmacokinetic reliance on missed doses leading to breakthrough seizures.
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Affiliation(s)
- Michelle Guignet
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jonathan Vuong
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Alejandra Martinez
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Ticha Ballapapinan
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - H Steve White
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
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3
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Fortini C, Daeppen JB. How do hospital providers perceive and experience the information-delivery process? A qualitative exploratory study. PEC INNOVATION 2023; 3:100222. [PMID: 37842173 PMCID: PMC10570693 DOI: 10.1016/j.pecinn.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
Objective To explore how professionals deal with informing their patients and how they experience the process per se, in order to deepen understanding of the issues involved and to identify areas of focus for improvement. Methods Semi-structured qualitative interviews were conducted with 13 hospital professionals at Lausanne University Hospital, Switzerland. Results Information includes feedback, practical information, patient condition, treatment/process of care, and educational material. Information-delivery is a process that involves informing the patient then checking patient reception of the information. The main expected outcome is patient action. Providers can feel trapped, guilty, inadequate, powerless, disenchanted when the process fails to achieve its expected purpose. Conclusions Informing and checking strategies are not implemented optimally, and providers could benefit from guidance in order to decrease discomfort and become more proficient at delivering information. Innovation Addressing the information-delivery process per se provides us with a novel insight into the complexity of the process and contributes to identifying essential ingredients of future innovative training programs for providers at large.
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Affiliation(s)
- Cristiana Fortini
- Addiction Medicine, Lausanne University Hospital CHUV, 23A rue du Bugnon, Lausanne 1011, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Lausanne University Hospital CHUV, 23A rue du Bugnon, Lausanne 1011, Switzerland
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Rault P, Chabrier A, Roy H, Bussières JF, Métras MÉ, Leguelinel-Blache G. Assessment of adherence to at-home oral anti-infective therapy among paediatric patients discharged from a Quebec hospital. Eur J Hosp Pharm 2023; 30:35-40. [PMID: 33926986 PMCID: PMC9811558 DOI: 10.1136/ejhpharm-2020-002656] [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: 12/11/2020] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Non-adherence to anti-infective therapy contributes to treatment failure and the emergence of bacterial resistance. This study aimed to assess at-home adherence, by paediatric patients, to oral anti-infective (OAI) therapy prescribed for treatment of acute infections and to explore the factors contributing to non-adherence. METHODS This prospective descriptive study involved French-speaking patients under 16 years of age who were discharged with one or more OAIs prescribed for home administration for a maximum of 30 days. Telephone surveys were used to assess overall adherence, which consisted of primary adherence (patient's ability to procure the medication) and secondary adherence (patient's ability to take the treatment as prescribed). RESULTS Overall, 51.7% (30/58) of patients were adherent to OAI therapy, with 100% primary adherence (n=69/69) and 51.7% secondary adherence (n=30/58). On average, patients took 98% of the total number of doses prescribed, and non-adherence was related mostly to not following medication administration schedules (63.3% of patients followed the exact schedule). Indeed, the adherence rate for patients taking one or two doses per day was twice the rate for patients taking more than two doses per day (81.8% vs 44.7%, p=0.043). CONCLUSIONS Half of the paediatric patients treated for acute infections were non-adherent to OAI therapy at home. Interventions are needed to improve this situation.
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Affiliation(s)
- Pauline Rault
- Pharmacy, CHU Sainte-Justine, Montreal, Québec, Canada
| | | | - Helene Roy
- Pharmacy, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jean-François Bussières
- Pharmacy, CHU Sainte-Justine, Montreal, Québec, Canada
- Faculté de pharmacie, Université de Montréal, Montreal, Québec, Canada
| | | | - Geraldine Leguelinel-Blache
- Pharmacy, CHU Nimes, Nimes, Languedoc-Roussillon, France
- INSERM, Université Montpellier 1, Montpellier, Languedoc-Roussillon, France
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5
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Serhal S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Bosnic-Anticevich S, Saini B, Billot L, Armour C. Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review. NPJ Prim Care Respir Med 2022; 32:53. [DOI: 10.1038/s41533-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
AbstractUptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers (consulted their GP on pharmacist’s advice) or action avoiders (did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients (n = 148) received a GP referral, of whom 78% (n = 115) were action takers, and 44% (n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers. Action takers were more likely to have an asthma action plan (P = 0.001) at month 12, and had significantly more GP visits during the trial period (P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.
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Pinto MD, Downs CA, Huang Y, El-Azab SA, Ramrakhiani NS, Barisano A, Yu L, Taylor K, Esperanca A, Abrahim HL, Hughes T, Herrera MG, Rahamani AM, Dutt N, Chakraborty R, Mendiola C, Lambert N. A distinct symptom pattern emerges for COVID-19 long-haul: a nationwide study. Sci Rep 2022; 12:15905. [PMID: 36151129 PMCID: PMC9508141 DOI: 10.1038/s41598-022-20214-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/09/2022] [Indexed: 11/09/2022] Open
Abstract
Long-haul COVID-19, also called post-acute sequelae of SARS-CoV-2 (PASC), is a new illness caused by SARS-CoV-2 infection and characterized by the persistence of symptoms. The purpose of this cross-sectional study was to identify a distinct and significant temporal pattern of PASC symptoms (symptom type and onset) among a nationwide sample of PASC survivors (n = 5652). The sample was randomly sorted into two independent samples for exploratory (EFA) and confirmatory factor analyses (CFA). Five factors emerged from the EFA: (1) cold and flu-like symptoms, (2) change in smell and/or taste, (3) dyspnea and chest pain, (4) cognitive and visual problems, and (5) cardiac symptoms. The CFA had excellent model fit (x2 = 513.721, df = 207, p < 0.01, TLI = 0.952, CFI = 0.964, RMSEA = 0.024). These findings demonstrate a novel symptom pattern for PASC. These findings can enable nurses in the identification of at-risk patients and facilitate early, systematic symptom management strategies for PASC.
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Affiliation(s)
- Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA.
| | | | - Yong Huang
- Department of Computer Science, Donald Bren School of Information and Computer Science, University of California Irvine, Irvine, CA, USA
| | - Sarah A El-Azab
- Department of Health Management and Policy, University of Michigan, Lansing, MI, USA
| | | | | | - Lu Yu
- School of Labor and Employment Relations, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kaitlyn Taylor
- Lambert Health Lab, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alvaro Esperanca
- Electrical and Computer Engineering Department, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Heather L Abrahim
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Thomas Hughes
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Maria Giraldo Herrera
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Amir M Rahamani
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
- Department of Computer Science, Donald Bren School of Information and Computer Science, University of California Irvine, Irvine, CA, USA
| | - Nikil Dutt
- Department of Computer Science, Donald Bren School of Information and Computer Science, University of California Irvine, Irvine, CA, USA
| | - Rana Chakraborty
- Division of Infectious Disease, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christian Mendiola
- School of Engineering and Technology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Natalie Lambert
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, USA
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Amdie FZ, Sawhney M, Woo K. The Weakness of Will: The Role of Free Will in Treatment Adherence. Patient Prefer Adherence 2022; 16:1131-1139. [PMID: 35517044 PMCID: PMC9064064 DOI: 10.2147/ppa.s362706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic disease prevention and management requires a lifelong commitment and adherence to lifestyle modifications, monitoring of symptoms, medication use, and other forms of therapy. Treatment adherence is a crucial and complex concept in patient care provision, and it requires the voluntary active involvement of patients for the best possible outcome. Multiple factors, which may or may not be under the patient's control, can influence treatment adherence. However, adherence or non-adherence to a certain treatment is predominantly influenced by one's sense of agency, values, beliefs, attitudes, and willpower. It is evident that mental states appear to influence patients' decision-making, and the best treatment outcome occurs when a patient identifies their goals, needs, and desires and exercises their decision-making and free will during the course of receiving care. The role of healthcare providers is critical in promoting treatment adherence, thereby enhancing patient outcomes. Thus, this paper highlights the importance of promoting a sense of agency and integrating patients' values, beliefs, attitudes, and intentions during the provision of healthcare. It is indispensable to recognize the individual's ability and initiative to control and manage their illness in the face of challenging socioeconomic and cultural reality. On logical grounds, it is not enough to appreciate the value of free will and mental states, it is also essential to empower and cultivate an individual patient's willpower to make a well-informed, free decision based on their mental state for the most optimal treatment outcomes.
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Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
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8
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Castillo AF, Davis AL, Fischhoff B, Krishnamurti T. Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients. Health Informatics J 2021; 27:14604582211059463. [PMID: 34825829 DOI: 10.1177/14604582211059463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient-provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.
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Affiliation(s)
| | - Alexander L Davis
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
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9
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Kovoor JG, McIntyre D, Chik WWB, Chow CK, Thiagalingam A. Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study. J Med Internet Res 2021; 23:e26732. [PMID: 34633292 PMCID: PMC8546530 DOI: 10.2196/26732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/11/2021] [Accepted: 07/05/2021] [Indexed: 12/22/2022] Open
Abstract
Background The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner. Objective The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation. Methods We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module’s utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient’s value for clinician narration and the module’s utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales. Results This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were “very satisfied” with the educational video content across the 4 videos ranged from 93% (86/92) to 96.3% (104/108) and this was between 98% (90/92) and 99.1% (107/108) for “satisfied” or “very satisfied.” There were no reports of dissatisfaction for the first 3 videos, and only 1% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician’s narration adding benefit to the patient experience. Conclusions Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input.
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Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Daniel McIntyre
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
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10
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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11
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Sharma-Kumar R, Puljević C, Morphett K, Meurk C, Gartner C. The Acceptability and Effectiveness of Videos Promoting Smoking Cessation Among Australians Experiencing Mental Illness. HEALTH EDUCATION & BEHAVIOR 2021; 49:506-515. [PMID: 34496656 DOI: 10.1177/10901981211034738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are high rates of tobacco smoking among people who experience mental illness (MI). While videos are an effective method of disseminating health-related information, there is limited research investigating the effectiveness of video-delivered education promoting smoking cessation among people living with MI. This formative study aimed to investigate the effectiveness and acceptability of targeted video resources providing smoking cessation information and advice to smokers with MI. This study used a mixed-method design; 29 Australian smokers living with MI completed a preinterview survey including 12 questions assessing knowledge about smoking cessation, watched six videos developed by the research team providing information about smoking cessation, took part in semistructured interviews about the videos' quality, content, and format, and then completed a postinterview survey identical to the preinterview survey to assess changes in smoking cessation-related knowledge. A Wilcoxon signed rank test was used to calculate changes in cessation-related knowledge, and thematic analysis was used to identify common themes in qualitative data. We found a statistically significant increase in participants' smoking cessation-related knowledge scores after watching the videos. Participants indicated an overall high level of acceptability of the videos' quality, content, and format, and findings from the semistructured interviews reflected these favorable views. This study's findings provide a new understanding of the effectiveness and acceptability of customized video-based education to promote smoking cessation among people living with MI, and can be used to inform the content and focus of video resources aimed at increasing knowledge about smoking cessation for people experiencing MI.
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Affiliation(s)
- Ratika Sharma-Kumar
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Cheneal Puljević
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kylie Morphett
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Carla Meurk
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Coral Gartner
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
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12
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Painter MR, Tapp T, Painter JE. Use of the Health Belief Model to identify factors associated with owner adherence to elimination diet trial recommendations in dogs. J Am Vet Med Assoc 2020; 255:446-453. [PMID: 31355724 DOI: 10.2460/javma.255.4.446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To use the Health Belief Model to identify factors associated with owner adherence to elimination diet trial (EDT) recommendations by veterinarians for dogs with suspected cutaneous adverse food reactions (CAFRs). SAMPLE 192 owners of dogs prescribed an EDT between April 1, 2012, and April 1, 2017. PROCEDURES Owners of dogs prescribed an EDT to diagnose CAFRs were identified through review of medical records from a single veterinary dermatology specialty practice. Identified owners were invited to participate in an anonymous online survey that was developed on the basis of the Health Belief Model. Multivariable logistic regression was used to evaluate associations between potential predictor variables and 100% adherence to EDT recommendations. RESULTS 665 owners were invited to participate, and 192 (28.9%) completed the survey. Of the 192 respondents, 77 (40.1%) reported 100% adherence to EDT recommendations, and 115 (59.9%) reported < 100% adherence. Results indicated that the odds of owners reporting 100% adherence to EDT recommendations were significantly decreased by owner perception of barriers (adjusted OR [ORa] = 0.86) and were significantly increased by owner knowledge regarding diets and CAFRs in dogs (ORa = 1.30) and by self-efficacy or confidence in performing an EDT as directed (ORa = 1.18). CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated that most prescribed EDTs were not followed strictly. Interventions to help owners reduce perceived barriers, increase self-efficacy, and improve related knowledge could improve adherence to EDT recommendations and, thereby, increase the diagnostic utility of EDTs.
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Rangabashyam MS, Lee SY, Tan SY, Mueller S, Sultana R, Ho J, Skanthakumar T, Tan NC, Tan HK, Soo KC, Iyer NG. Adherence of head and neck squamous cell carcinoma patients to tumor board recommendations. Cancer Med 2020; 9:5124-5133. [PMID: 32472749 PMCID: PMC7367636 DOI: 10.1002/cam4.3097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multidisciplinary team (MDT) meetings or tumor boards (TBs) are fundamental components of cancer treatment. Although their primary function is improved outcomes, this aspect is often underreported. The main objective of this study was to analyze the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) discussed at TBs, and to compare the effect of adherence and nonadherence to recommended treatment plans on outcomes. METHODS Retrospective data analysis was conducted of HNSCC patients those who were adherent and nonadherent to TB therapy recommendations during 2008-2009 at a comprehensive cancer center. Fisher's exact test and t test were used for group-wise comparison, and Kaplan-Meier and logistic regression models, for survival analysis and determination of the contributing factors to nonadherence. RESULTS Comprehensive Treatment plans were recommended by TBs in 293 HNSCC patients with curative intent. Seventy-two patients were excluded based on the selection criteria. Among the remaining 221 patients, 172 (77.9%) were adherent to TB recommendations, while 49 (22.1%) failed to comply. Patient (n = 36; 73.5%), clinician (n = 2; 4.1%), and disease-related (n = 11; 22.4%) factors were significant contributors to nonadherence. Mean (±standard deviation (SD)) survival time was 55.6 ± 2.32 and 29.1 ± 4 months in the adherent and nonadherent groups, (P < .0001, respectively). Multivariate analyses showed that gender, ethnicity, higher T-stage, and multimodal treatment were associated with nonadherence. CONCLUSION Adherence to TB recommendations improved overall survival, reflecting the importance of interdisciplinary expertise in contemporary cancer treatment. Early identification and intervention is crucial in "at risk" patients to prevent subsequent drop-out from optimal cancer care.
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Affiliation(s)
- Mahalakshmi S Rangabashyam
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore
| | - Shi Yan Lee
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore
| | - Sher Yin Tan
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore
| | - Stefan Mueller
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Johnatton Ho
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore
| | | | - Ngian Chye Tan
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Hiang Khoon Tan
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Khee Chee Soo
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - N Gopalakrishna Iyer
- Department of Head & Neck Surgery, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
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Shanmugalingam R, Mengesha Z, Notaras S, Liamputtong P, Fulcher I, Lee G, Kumar R, Hennessy A, Makris A. Factors that influence adherence to aspirin therapy in the prevention of preeclampsia amongst high-risk pregnant women: A mixed method analysis. PLoS One 2020; 15:e0229622. [PMID: 32106237 PMCID: PMC7046289 DOI: 10.1371/journal.pone.0229622] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Non-adherence with medications in pregnancy is increasingly recognized and often results in a higher rate of preventable maternal and fetal morbidity and mortality. Non-adherence with prophylactic aspirin amongst high-risk pregnant women is associated with higher incidence of preeclampsia, preterm delivery and intrauterine growth restriction. Yet, the factors that influences adherence with aspirin in pregnancy, from the women's perspective, remains poorly understood. OBJECTIVE The study is aimed at understanding the factors, from the women's perspective, that influenced adherence with prophylactic aspirin in their pregnancy. STUDY DESIGN A sequential-exploratory designed mixed methods quantitative (n = 122) and qualitative (n = 6) survey of women with recent high-risk pregnancy necessitating antenatal prophylactic aspirin was utilized. Women recruited underwent their antenatal care in one of three high-risk pregnancy clinics within the South Western Sydney Local Health District, Australia. The quantitative study was done through an electronic anonymous survey and the qualitative study was conducted through a face-to-face interview. Data obtained was analysed against women's adherence with aspirin utilizing phi correlation (φ) with significance set at <0.05. RESULTS Two key themes, from the women's perspective, that influenced their adherence with aspirin in pregnancy were identified; (1) pill burden and non-intention omission (2) communication and relationship with health care provider (HCP). Pill burden and its associated non-intentional omission, both strongly corelated with reduced adherence (Φ = 0.8, p = 0.02, Φ = 0.8, p<0.01) whilst the use of reminder strategies minimized accidental omission and improved adherence (Φ = 0.9, p<0.01). Consistent communication between HCPs and a good patient-HCP relationship was strongly associated with improved adherence (Φ = 0.7, p = 0.04, Φ = 0.9, p = <0.01) and more importantly was found to play an important role in alleviating factors that had potentials to negatively influence adherence with aspirin in pregnancy. CONCLUSION This study identified factors that both positively and negatively influenced adherence with aspirin amongst high-risk pregnant women. Is highlights the importance in recognizing the impact of pill burden in pregnancy and the need to counsel women on the utility of reminder strategies to minimize non-intentional omission. Importantly, it emphasizes on the importance of a positive patient-HCP relationship through effective and consistent communication to achieve the desired maternal and fetal outcomes.
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Affiliation(s)
- Renuka Shanmugalingam
- Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Vascular Immunology Group, Heart Research Institute, University of Sydney, Newtown, NSW, Australia
- Women’s Health Initiative Translational Unit (WHITU), Ingham Institute For Applied Medical Research and South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Zelalem Mengesha
- Research and Social Policy Team, Uniting Australia, Sydney, NSW, Australia
| | - Stephanie Notaras
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Pranee Liamputtong
- School of Health Sciences and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Ian Fulcher
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Gaksoo Lee
- Women’s Health Initiative Translational Unit (WHITU), Ingham Institute For Applied Medical Research and South Western Sydney Local Health District, Liverpool, NSW, Australia
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Roshika Kumar
- Department of Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Annemarie Hennessy
- Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Vascular Immunology Group, Heart Research Institute, University of Sydney, Newtown, NSW, Australia
- Women’s Health Initiative Translational Unit (WHITU), Ingham Institute For Applied Medical Research and South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Angela Makris
- Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Vascular Immunology Group, Heart Research Institute, University of Sydney, Newtown, NSW, Australia
- Women’s Health Initiative Translational Unit (WHITU), Ingham Institute For Applied Medical Research and South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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Almuhanadi S, Alhammadi H, Suresh A, Al Alawi S. Assessing Service Quality Dimensions and Their Effect on Patients Satisfaction in Bahrain Primary Healthcare Using a Modified Version of the General Practice Assessment Questionnaire. Patient Prefer Adherence 2020; 14:2541-2549. [PMID: 33408466 PMCID: PMC7781035 DOI: 10.2147/ppa.s285440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to have an instrument for assessing Bahrain healthcare. For such purpose, we used the General Practice Assessment Questionnaire (GPAQ-R2) and a modified shorter version of it, GPAQ-R2-BDF. The GPAQ-R2-BDF was modified based on the healthcare system and the cultural behavior in Bahrain. SUBJECTS AND METHODS This cross-sectional study was conducted at the general practice (GP) of the Bahrain Defense Force (BDF) Hospital from March 2018 to April 2018. Five hundred and twenty patients visiting the clinics completed the original GPAQ-R2 questionnaire. A validity, reliability, and rotated factor analysis were performed on the original and modified questionnaire. Patients' characteristics such as age, gender, long-standing health conditions, and employment status were recorded. The score responses of the questionnaire were analyzed, and areas of weakness were identified. RESULTS The validity, reliability, and correlation matrix values of the original GPAQ-R2 in the GP access and GP practice components were unsatisfactory in BDF hospital assessment. However, the modified GPAQ-R2-BDF revealed higher overall validity, reliability, and correlation matrix, and the rotated factor analysis showed values between 0.704 and 0.928. Furthermore, the reliability values ranged from 0.77 to 0.936. As for patients' satisfaction scores were highest (~90%) in confidence and enablement, and doctor care but lowest in GP access, and GP practice (~77%) (P<0.001). On the other hand, patients with long-standing health conditions were less satisfied with doctor care, confidence and enablement, and GP access (p<0.05-0.01). CONCLUSION The present findings demonstrated high reliability and validity for the GPAQ-R2-BDF, which supports its use to assess Bahrain's GP healthcare system. Furthermore, such an instrument should be adapted in a longitudinal research design to assess Bahrain's healthcare system better. Lastly, BDF hospital healthcare clinics showed concerns in GP access, GP practice, and quality services for patients with long-standing health conditions requiring strategic interventions to reach better quality services.
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Affiliation(s)
- Shawq Almuhanadi
- General Practice Clinic
- Correspondence: Shawq Almuhanadi Bahrain Defense Force Hospital, P. O. Box 28743, Riffa, Kingdom of BahrainTel +973 34444003 Email
| | | | - Aaruni Suresh
- Crown Prince Center for Training & Medical Research, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
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Moffatt CJ, Murray S, Aubeeluck A, Quere I. Communication with patients using negative wound pressure therapy and their adherence to treatment. J Wound Care 2019; 28:738-756. [DOI: 10.12968/jowc.2019.28.11.738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The purpose of this study was to explore the challenges of communication between patients and health professionals, and patient adherence to treatment for hard-to-heal wounds when using negative wound pressure therapy (NPWT). Methods: Face-to-face, semi-structured interviews were conducted with patients undergoing NPWT. Specific features of the NPWT device were the priority for discussion although other factors central to communication and adherence were also explored. Results: A total of 24 patients took part in the study. Data saturation was achieved during the analysis. Patients required ongoing support to understand complex and often protracted treatment and this was particularly important when specialist technology was used. A distinction was highlighted between those who decided not to adhere with therapy and those who did so unintentionally. Participants faced difficulties in their communications with health professionals and in ensuring their needs were listened to and addressed. Conclusion: Further research is needed to achieve a better understanding of this distinction and to evaluate interventions which can sustain adherence behaviours. Further exploration of how to establish concordant patient/health professional communications is warranted.
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Affiliation(s)
- Christine J. Moffatt
- Nottingham Trent University, Nottingham, UK
- Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Eloi, Montpellier, France
| | - Susie Murray
- Centre for Research and Implementation of Clinical Practice (CRICP), London, UK
| | | | - Isabelle Quere
- Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Eloi, Montpellier, France
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17
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Linn AJ, van Weert JCM, Gebeyehu BG, Sanders R, Diviani N, Smit EG, van Dijk L. Patients' Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence. HEALTH COMMUNICATION 2019; 34:1461-1468. [PMID: 30052088 DOI: 10.1080/10410236.2018.1500430] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research on the longitudinal impact of using the internet as an information source on patients' beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients' online information seeking behavior is particular relevant in affecting patients' beliefs and medication adherence.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | | | - Beniam G Gebeyehu
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Remco Sanders
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Nicola Diviani
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
- Department of Health Sciences & Health Policy, Faculty of Humanities and Social Sciences, University of Lucerne
- Swiss Paraplegic Research , Nottwil
| | - Edith G Smit
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Liset van Dijk
- Department of Primary Care, NIVEL, Netherlands Institute for Health Services Research
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18
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Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res 2019; 11:583-592. [PMID: 31413770 PMCID: PMC6681861 DOI: 10.14740/jocmr3894] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Background Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence. Methods A cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records. Patient groups were compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous variables and the Chi-square test for paired categorical variables (significance level of 0.05). The odds ratio (OR) was calculated to identify independent predictors of non-adherence to medication. Results The final sample (n = 94) had a mean age of 75.2 years (standard deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low education level (61.7%). Also, 22.3% with cognitive impairment, 16% with depression and 23.4% with anxiety were found. Patients non-adherent to medication had higher depression (P = 0.048) and anxiety (P = 0.010), compared to adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P = 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients who had insulin prescribed presented a higher risk of non-adherence to medication (OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the risk of non-adherence to medication is higher by an increase of one unit in anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014). Conclusions Higher anxiety and depression were associated with non-adherence to medication and to PA. Insulin prescribed and high anxiety scores were predictors of medication non-adherence. This study appears to contribute to the knowledge about the influence of cognitive and psychological factors in therapeutic adherence in these older diabetic patients.
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Affiliation(s)
- Rosa Mendes
- Department of Internal Medicine, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Sonia Martins
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal.,Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal
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20
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Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101814. [PMID: 31121850 PMCID: PMC6571581 DOI: 10.3390/ijerph16101814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023]
Abstract
Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.
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Küper AM, Merle R. Being Nice Is Not Enough-Exploring Relationship-Centered Veterinary Care With Structural Equation Modeling. A Quantitative Study on German Pet Owners' Perception. Front Vet Sci 2019; 6:56. [PMID: 30873422 PMCID: PMC6403131 DOI: 10.3389/fvets.2019.00056] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
During the last years, the philosophy of relationship-centered care gained increasing attention in veterinary medicine. Relationship-centered care is based on a joint venture between pet owner and veterinarians and therefore offers the opportunity to satisfy the pet owners' need for participation in medical decision-making and to provide the best care for the patient. Although research on relationship-centered care in the veterinary consultation is still limited, the available findings suggest that the characteristics of relationship-centered care reflect the pet owners' expectations on satisfactory veterinary care. In this study a quantitative survey was conducted among German pet owners that collected information regarding their perception of the veterinarians' communication during the last appointments. Questionnaires were available online and paper-based. Data were analyzed using exploratory factor analysis and structural equation modeling using SAS. First aim of the study was to explore structural equation modeling (SEM) as an opportunity to evaluate quantitative data in the field of research on relationship-centered care. Further, SEM was used to evaluate associations between the implementation of different characteristics of relationship-centered care in the veterinary practice (empathic communication, partnership-building) and latent outcome variables regarding the pet owners (pet owners' need for further information, consultation of competing health care providers). N = 1,270 valid questionnaires were completed. Participants owned small companion animals (55.6%), horses (7.6%), or both (36.9%) within the last 2 years. Results of SEM suggest that partnership-centered and empathic communication decreased the pet owners' needs for further information (e.g., from online sources) and their need to consult alternative health providers (e.g., homeopaths). Especially addressing the pet owners' worries and fears, discussing pros and cons of diagnostic and therapeutic options as well as providing the required amount of information were shown to be large influence factors within the model. Therefore, veterinarians are recommended to implement the concept of partnership-centered care in their daily practice, for it may increase pet owners' loyalty and satisfaction. Results may motivate future research in this field. Further development of the proposed model assumptions may enable valuable progress in the field of quantitative research on relationship-centered care.
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Affiliation(s)
| | - Roswitha Merle
- Department of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
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Halcomb EJ, McInnes S, Patterson C, Moxham L. Nurse-delivered interventions for mental health in primary care: a systematic review of randomized controlled trials. Fam Pract 2019; 36:64-71. [PMID: 30364968 DOI: 10.1093/fampra/cmy101] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental health issues are increasingly prevalent within the community. Many people experiencing mental health issues have established relationships with primary care providers, including general practice nurses (GPNs). With the recent growth of general practice nursing, it is timely to explore the evidence for GPNs to provide mental health interventions for adults with mental illness within their scope of practice. OBJECTIVE To synthesize the evidence about nurse-delivered interventions in primary care for adults with mental illness. METHODS A systematic review of randomized control trials (RCTs) retrieved from the CINAHL, Ovid MEDLINE and EBSCO electronic databases between 1998 and 2017. RESULTS Nine randomized controlled trials were identified, which reported nurse-delivered interventions in primary care for the management of mental health in adults with mental illness. The heterogeneity of interventions and outcomes made comparison of studies difficult. Seven studies demonstrated significant improvement in at least one outcome following the intervention. In some studies, these improvements were sustained well beyond the intervention. Additionally, consumers were satisfied with the interventions and the role of the GPN. CONCLUSION There is currently limited evidence of the impact of nurse-delivered interventions in primary care for adults with mental illness. Given the significant improvements in symptoms and the acceptability of interventions seen in included studies, there is a need for further robust research exploring the role of the GPN both individually and within the multidisciplinary team. Such research will enable stronger conclusions to be drawn about the impact of nurse-delivered interventions in primary care for adults with mental illness.
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Affiliation(s)
| | - Susan McInnes
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, Australia
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Iosifyan M, Arina G, Nikolaeva V. Values and Fears: Value Priorities and Fear of Health Impairments. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2019. [DOI: 10.17759/cpse.2019080107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The evaluation of health states is involved in a patient’s medical decision making. This evaluation includes cognitive and affective components. The affective component of this evaluation may include the emotion of fear. For instance, some health states are more frightening than others. However, it is not yet known why. The present study investigates the link between the fear of health impairments and individual value priorities. Participants evaluated 14 health impairments from most to least frightening and selected three valued goals which could be lost in the event of those previously evaluated health states. Participants also answered the Schwarz’s Values Survey. The results confirm that value preferences are related to the fear of different health states. From one side, this link is related to personal importance of value priorities: the most frightening health states are associated with the loss of preferred value goals. From another side, this link is related to value types: the more a health state is associated with a loss of security and self-direction, the more frightening it is; the more a health state is associated with a loss of hedonism and universalism, the less frightening it is. Overall, the study showed that affective evaluation of negative health states, particularly, fear of negative health states, is related to value preferences.
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De Silva D, Ranasinghe W, Bandaragoda T, Adikari A, Mills N, Iddamalgoda L, Alahakoon D, Lawrentschuk N, Persad R, Osipov E, Gray R, Bolton D. Machine learning to support social media empowered patients in cancer care and cancer treatment decisions. PLoS One 2018; 13:e0205855. [PMID: 30335805 PMCID: PMC6193663 DOI: 10.1371/journal.pone.0205855] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background A primary variant of social media, online support groups (OSG) extend beyond the standard definition to incorporate a dimension of advice, support and guidance for patients. OSG are complementary, yet significant adjunct to patient journeys. Machine learning and natural language processing techniques can be applied to these large volumes of unstructured text discussions accumulated in OSG for intelligent extraction of patient-reported demographics, behaviours, decisions, treatment, side effects and expressions of emotions. New insights from the fusion and synthesis of such diverse patient-reported information, as expressed throughout the patient journey from diagnosis to treatment and recovery, can contribute towards informed decision-making on personalized healthcare delivery and the development of healthcare policy guidelines. Methods and findings We have designed and developed an artificial intelligence based analytics framework using machine learning and natural language processing techniques for intelligent analysis and automated aggregation of patient information and interaction trajectories in online support groups. Alongside the social interactions aspect, patient behaviours, decisions, demographics, clinical factors, emotions, as subsequently expressed over time, are extracted and analysed. More specifically, we utilised this platform to investigate the impact of online social influences on the intimate decision scenario of selecting a treatment type, recovery after treatment, side effects and emotions expressed over time, using prostate cancer as a model. Results manifest the three major decision-making behaviours among patients, Paternalistic group, Autonomous group and Shared group. Furthermore, each group demonstrated diverse behaviours in post-decision discussions on clinical outcomes, advice and expressions of emotion during the twelve months following treatment. Over time, the transition of patients from information and emotional support seeking behaviours to providers of information and emotional support to other patients was also observed. Conclusions Findings from this study are a rigorous indication of the expectations of social media empowered patients, their potential for individualised decision-making, clinical and emotional needs. The increasing popularity of OSG further confirms that it is timely for clinicians to consider patient voices as expressed in OSG. We have successfully demonstrated that the proposed platform can be utilised to investigate, analyse and derive actionable insights from patient-reported information on prostate cancer, in support of patient focused healthcare delivery. The platform can be extended and applied just as effectively to any other medical condition.
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Affiliation(s)
- Daswin De Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
- * E-mail:
| | - Weranja Ranasinghe
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
- Austin Hospital, Heidelberg, Victoria, Australia
| | - Tharindu Bandaragoda
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Nishan Mills
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Lahiru Iddamalgoda
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | | | - Raj Persad
- North Bristol, NHS Trust, Bristol, United Kingdom
| | - Evgeny Osipov
- Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Luleå, Sweden
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
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Haque M, Sa B, Majumder MAA, Islam MZ, Othman NSAB, Lutfi SNNB, Kibria GM, Salam A, Ismail MH, Abdullah SL. Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school. Ann Afr Med 2018; 17:183-188. [PMID: 30588931 PMCID: PMC6330787 DOI: 10.4103/aam.aam_57_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is one of the cardinal components for physician-patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia. Methods This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80. Results Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic. Conclusions To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Bidyadhar Sa
- The Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies, Trinidad and Tobago
| | - Md. Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados, West Indies
| | - Md. Zakirul Islam
- The Department of Pharmacology, Eastern Medical College, Comilla, Kabila, Dhaka-Chittagong Highway, Burichang 3520, Bangladesh
| | - Nur Syamirah Aishah Binti Othman
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Siti Nur Najihah Binti Lutfi
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Golam Mohammad Kibria
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Abdus Salam
- Medical Education and Quality Assurance, Asia Metropolitan University, No.6, Jalan Lembah Bandar Seri Alam, 81750 Johor Bahru, Malaysia
| | - Mohd Hafizi Ismail
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Shahidah Leong Abdullah
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
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Tuazon JR, Jahan A, Jutai JW. Understanding adherence to assistive devices among older adults: a conceptual review. Disabil Rehabil Assist Technol 2018; 14:424-433. [PMID: 30132355 DOI: 10.1080/17483107.2018.1493753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: The aim of this study was to identify and examine how existing literature has conceptualized adherence to assistive devices (ADs) among older adults. Methods: English articles were searched in MEDLINE, PubMed, and CINAHL (January 1990 to October 2017) for the key words "acceptance", "adherence", "assistive devices", "compliance", "concept," and relevant synonyms. Bibliographies of selected articles were also examined. Articles were analyzed if the following conditions were met conjointly: (1) attempted to define or conceptualize adherence to some degree; (2) were concerned with any AD for older adults; (3) were concerned with adults aged 65 years or older. Results: Sixteen of the 484 articles were included. Adherence to ADs among older adults seemed to be conceptualized under three core themes: psychological, contextual, and functional factors; each with their own unique considerations related to adherence that are analyzed in this study. Conclusion: This review identified a large gap in knowledge about adherence to ADs. Adherence is multi-factorial and highly specific to the individual's circumstances and their relationship with their health care practitioner. Further empirical research should focus on how the three core themes of adherence interact with and influence each other. Implications for rehabilitation Health care professionals who assess for, and recommend ADs should foster a shared decision-making relationship with their clients This review identifies some of the key themes that practitioners should consider when developing and implementing AD regimens with older adults Conceptualizing AD adherence among older adults will help improve monitoring of and quality of care for AD users.
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Affiliation(s)
- Joshua R Tuazon
- a Interdisciplinary School of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | - Alhadi Jahan
- a Interdisciplinary School of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | - Jeffrey W Jutai
- a Interdisciplinary School of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada.,b LIFE Research Institute , Ottawa , Ontario , Canada
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Almansour HA, Chaar B, Saini B. Perspectives and experiences of patients with type 2 diabetes observing the Ramadan fast. ETHNICITY & HEALTH 2018; 23:380-396. [PMID: 27998181 DOI: 10.1080/13557858.2016.1269156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Diabetes is a common chronic disease among Australians. Culturally and linguistically diverse groups are observed to have higher prevalence rates of diabetes. Continuing management needs adherence to medication and diet regimens. Religious practices such as fasting can affect diabetes management and medication use. Pharmacists as medication specialists have a significant role in helping people observing religious practices such as the Ramadan fast, which involves month-long absolute abstinence from food during daylight hours, to maintain good control over their condition. OBJECTIVE This study investigated the perspective of patients with type 2 diabetes (T2D) who undertake the fast of Ramadan, to understand their experiences, health-related needs and service preferences regarding diabetes management. METHODS A qualitative, exploratory design was used in this study. Data collection comprised the conduct of semi-structured interviews with a purposive convenient sample of patients in areas of ethnic diversity in Sydney, using a standardised interview guide. Interview data were transcribed verbatim and thematically analysed. RESULTS Twenty-five semi-structured interviews (68% males) among a heterogeneous sample of fasting T2D patients were conducted. Themes emerging from analysis of transcripts included issues relating to sociocultural pressure for T2D patients to fast; lack of awareness about the role of pharmacists and, most importantly, the need to train pharmacists in cultural sensitivity and clinical implications thereof. CONCLUSIONS Community awareness about the role of the pharmacists in assisting medication use and adjustment during fasting periods should be enhanced. Furthermore, community pharmacists need to be trained about the unique religious and sociocultural issues of patients with diabetes opting to observe spiritual rituals such as the Ramadan fast. Clinical education in this area should up-skill pharmacists to inculcate self-management behaviours in fasting T2D patients.
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Affiliation(s)
- Hadi A Almansour
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
| | - Betty Chaar
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
| | - Bandana Saini
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
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Krekeler BN, Broadfoot CK, Johnson S, Connor NP, Rogus-Pulia N. Patient Adherence to Dysphagia Recommendations: A Systematic Review. Dysphagia 2018; 33:173-184. [PMID: 28965240 PMCID: PMC5866734 DOI: 10.1007/s00455-017-9852-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
Patient adherence to treatment recommendations is an important issue for healthcare providers, in a multitude of specialties, and is critical when assessing the efficacy and effectiveness of a particular treatment approach. Patients who have swallowing impairment often require complex and specific interventions requiring altered daily patterns of behavior. Patients with dysphagia who do not follow recommendations or prescribed exercises may not receive maximum benefit of an intervention. Poor adherence also makes it more difficult to evaluate efficacy of a treatment both clinically and in experimental settings. Further, swallow safety can be compromised if certain recommendations are not followed. Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment. We systematically identified 12 studies that tracked and reported patient-specific adherence. In this review, we found that the average adherence rate from these studies ranges between 21.9 and 51.9%. Adherence to prophylactic treatment recommendations for patients with head and neck cancer was the focus in 9/12 studies. The findings of this review identify a large gap in knowledge regarding adherence to dysphagia treatment. Few studies account for adherence within their study designs. When planning dysphagia treatment studies, it is imperative that investigators include information regarding patient adherence to accurately interpret findings. Given the variable adherence rates found in this review, factors influencing patient adherence with dysphagia treatments should be identified to increase adherence in future trials.
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Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA.
| | - Courtney K Broadfoot
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
| | - Stephen Johnson
- Ebling Library, Health Sciences Learning Center, University of Wisconsin, Room 2336, 750 Highland Avenue, Madison, WI, 53705-2221, USA
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
| | - Nicole Rogus-Pulia
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
- Department of Medicine-Geriatrics and Gerontology, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Geriatric Research Education and Clinical Center (GRECC) Veterans Administration Hospital, William S. Middleton Memorial Hospital, D5216, 2500 Overlook Terrace, Madison, WI, 53705, USA
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Lamb L, Affenzeller N, Hewison L, McPeake KJ, Zulch H, Mills DS. Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success. Front Vet Sci 2018; 5:37. [PMID: 29560356 PMCID: PMC5845580 DOI: 10.3389/fvets.2018.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/19/2018] [Indexed: 01/14/2023] Open
Abstract
Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument in any veterinary behavior practice wishing to use client feedback to rationalize areas of the consultation which might be improved.
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Affiliation(s)
- Lisanna Lamb
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Nadja Affenzeller
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.,Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Lynn Hewison
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Kevin James McPeake
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Helen Zulch
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Daniel S Mills
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
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Walker A, Williams R, Sibley F, Stamp D, Carter A, Hurley M. Improving access to better care for people with knee and/or hip pain: service evaluation of allied health professional-led primary care. Musculoskeletal Care 2018; 16:222-232. [PMID: 28401656 DOI: 10.1002/msc.1189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain. METHODS At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods. RESULTS Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice. CONCLUSIONS AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.
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Affiliation(s)
- A Walker
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
| | - R Williams
- Lewisham NHS Clinical Commissioning Group, UK
| | - F Sibley
- Health Innovation Network, London, UK
| | - D Stamp
- Lewisham and Greenwich NHS Trust, UK
| | - A Carter
- Health Innovation Network, London, UK
| | - M Hurley
- St George's, University of London and Kingston University, UK
- Health Innovation Network, London, UK
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Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities. PHARMACY 2018; 6:pharmacy6010013. [PMID: 29382062 PMCID: PMC5874552 DOI: 10.3390/pharmacy6010013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. AIM This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. METHOD Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals (n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). RESULTS Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. DISCUSSION This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.
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Britten N, Riley R, Morgan M. Resisting psychotropic medicines: a synthesis of qualitative studies of medicine-taking. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.005165] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThis article reports the results of a synthesis of qualitative research articles about lay perspectives on prescribed psychotropic medicines. It updates and elaborates on a model of medicine-taking developed by Pound and colleagues. In this model, the concept of resistance refers to the various ways in which people take prescribed medicines while trying to minimise their intake. The synthesis included 12 papers published since 1992. The findings are presented at the societal level, in terms of the social meanings of mental health problems and medication, and at the individual level; the latter covers active engagement and lay evaluation, as well as the outcomes of evaluation, including the doctor–patient relationship. Although it can be difficult to achieve in the current clinical environment, there is much scope for developing more concordant relationships with patients in relation to prescribing and using psychotropic medicines.
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Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM. Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite 2017; 123:56-71. [PMID: 29225141 DOI: 10.1016/j.appet.2017.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/18/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. PURPOSE This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. METHODS Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. INCLUSION CRITERIA participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. RESULTS Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. CONCLUSIONS The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations.
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Affiliation(s)
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Ireland
| | | | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Ireland
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Dodd S, White IR, Williamson P. A framework for the design, conduct and interpretation of randomised controlled trials in the presence of treatment changes. Trials 2017; 18:498. [PMID: 29070048 PMCID: PMC5657109 DOI: 10.1186/s13063-017-2240-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/06/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND When a randomised trial is subject to deviations from randomised treatment, analysis according to intention-to-treat does not estimate two important quantities: relative treatment efficacy and effectiveness in a setting different from that in the trial. Even in trials of a predominantly pragmatic nature, there may be numerous reasons to consider the extent, and impact on analysis, of such deviations from protocol. Simple methods such as per-protocol or as-treated analyses, which exclude or censor patients on the basis of their adherence, usually introduce selection and confounding biases. However, there exist appropriate causal estimation methods which seek to overcome these inherent biases, but these methods remain relatively unfamiliar and are rarely implemented in trials. METHODS This paper demonstrates when it may be of interest to look beyond intention-to-treat analysis for answers to alternative causal research questions through illustrative case studies. We seek to guide trialists on how to handle treatment changes in the design, conduct and planning the analysis of a trial; these changes may be planned or unplanned, and may or may not be permitted in the protocol. We highlight issues that must be considered at the trial planning stage relating to: the definition of nonadherence and the causal research question of interest, trial design, data collection, monitoring, statistical analysis and sample size. RESULTS AND CONCLUSIONS During trial planning, trialists should define their causal research questions of interest, anticipate the likely extent of treatment changes and use these to inform trial design, including the extent of data collection and data monitoring. A series of concise recommendations is presented to guide trialists when considering undertaking causal analyses.
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Affiliation(s)
- Susanna Dodd
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GS UK
| | - Ian R. White
- MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH UK
| | - Paula Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GS UK
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Medication takeovers: Covert druggings and behavioral control in Alzheimer's. Soc Sci Med 2017; 188:51-59. [PMID: 28732235 DOI: 10.1016/j.socscimed.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/31/2022]
Abstract
Older adults consume the most prescription medication in the U.S. For those who develop Alzheimer's disease, risk of medication misuse increases with the progression of the disease. Family members commonly intervene to lessen risks by taking over the management and administering of a medication regimen. Despite the potential for grave harm around the misuse of powerful drugs, few studies provide insight into the household social context of medication use for this disease. Drawing on 60 in-depth interviews conducted in four waves over 2.5 years, this study investigates how family members administered prescription and over-the-counter medications to elders with Alzheimer's. The findings detail how family members initially created and enacted the role of proxy-administrator to avoid self-administration errors and then expanded the role to manage disruptive behaviors. During this process, family members perceived themselves as working in partnership with doctors, especially in the effort to craft a regimen that controlled the affected individual's mood and sleep/wake cycle. The paper concludes by discussing the implications that family members used medications to improve conformity to a preferred household social order. The study offers conceptual advances in understanding 1) the process of proxy-administration in Alzheimer's care and 2) the role of proxy-administrators in the medicalization of deviant behavior.
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Czajkowska Z, Wang H, Hall NC, Sewitch M, Körner A. Validation of the English and French versions of the Brief Health Care Climate Questionnaire. Health Psychol Open 2017; 4:2055102917730675. [PMID: 29379621 PMCID: PMC5779926 DOI: 10.1177/2055102917730675] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patient autonomy is a central value in medicine and critical component of adherence to medical advice. This article reports on a validation of the 6-item version of the Health Care Climate Questionnaire (HCCQ), a measure of autonomy support in health care settings, in a sample of 242 melanoma patients. The HCCQ showed excellent internal consistency (α = .91), structural validity (Tucker-Lewis index = .99; comparative fit index = .99; root mean square error of approximation = .06, 90 per cent confidence interval (.00, .11); standardized root mean square residual = .02; χ2 (8, N = 235) = 13.99, p = .08) and construct validity (92.31% of hypothesized correlations with other measures confirmed). Acceptable 3-month test-retest reliability was observed (r = .55, p < .001; intraclass correlation coefficient (A, 1) = .54, p < .001). The French version was found equivalent to the English version.
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Patient factors in decision-making for orthopaedic surgery: a prospective analysis. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bahrini L, Damak R, Cheour M. The role of the affective temperament in the treatment adherence in psychiatry. Pan Afr Med J 2017; 25:2. [PMID: 28154695 PMCID: PMC5268810 DOI: 10.11604/pamj.2016.25.2.8400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/19/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Adherence to psychotropic medications is affected by factors related to the treatment, to the physician, to the environment and to the patient himself. The purpose of the present study was to investigate the influence of affective temperaments on treatment adherence. Methods Thirty six stabilized outpatients were recruited from the aftercare consultation of Psychiatry to perform Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire version (TEMPS-A) for affective temperaments and the Medication Adherence Rating Scale (MARS) for treatment adherence. Results The total MARS score was negatively correlated with the irritable temperament score. The MARS’s score relative to the attitude of patients to psychotropic medications and their negative side effects was negatively correlated with the cyclothymic, the irritable and anxious temperaments. Patients having a diagnosis of psychotic disorder had a significantly greater medication adherence and behaviour toward medication score compared to those having a diagnosis of affective disorder. A greater MARS’s score for the negative side effects and attitudes to psychotropic medication was associated with medication by neuroleptics with prolonged action. Conclusion The results of the present study suggest that patients with irritable temperament may have more difficult to follow psychotropic medications, and that patients with cyclothymic, irritable and anxious temperaments may be more attentive and sensitive toward psychotropic medications and their negative side effects.
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Affiliation(s)
- Lilia Bahrini
- Psychiatry E Department, Razi Hospital, Cité les Oranger, 2010 Manouba, Medicine University of Tunis, Tunisia
| | - Rahma Damak
- Psychiatry E Department, Razi Hospital, Cité les Oranger, 2010 Manouba, Medicine University of Tunis, Tunisia
| | - Mejda Cheour
- Psychiatry E Department, Razi Hospital, Cité les Oranger, 2010 Manouba, Medicine University of Tunis, Tunisia
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Desborough J, Bagheri N, Banfield M, Mills J, Phillips C, Korda R. The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study. Int J Nurs Stud 2016; 64:108-119. [PMID: 27768985 DOI: 10.1016/j.ijnurstu.2016.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/05/2016] [Accepted: 10/13/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. RESULTS Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care. CONCLUSIONS This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia.
| | - Nasser Bagheri
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Australia
| | - Michelle Banfield
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Australia
| | - Jane Mills
- Nursing, School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Christine Phillips
- Social Foundations of Medicine, Australian National University Medical School, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australia
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Basedow M, Hibbert P, Hooper T, Runciman W, Esterman A. Australians with osteoarthritis: satisfaction with health care providers and the perceived helpfulness of treatments and information sources. J Multidiscip Healthc 2016; 9:387-94. [PMID: 27578982 PMCID: PMC5001666 DOI: 10.2147/jmdh.s110751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the satisfaction of Australian patients who suffer from osteoarthritis (OA) with their health care providers and the perceived helpfulness of treatments and information sources. METHODS A self-administered questionnaire was conducted with a sample of 560 Australian patients who suffer from OA with questions about satisfaction with health care providers and the helpfulness of different treatment options and information sources. Logistic regression models were used to assess potential predictors of satisfaction. Thematic analysis was undertaken for attitudinal factors associated with satisfaction. RESULTS A total of 435 participants returned questionnaires (response rate 78%). Most respondents were highly satisfied with the care provided by their general practitioner (GP) (84%), communication with their GP (88%), time spent with their GP (84%), and their ability to talk freely with their GP about their medical problem (93%), but less satisfied with their ability to talk freely about associated emotional problems (77%). Satisfaction with pharmacists (80%), rheumatologists (76%), and orthopedic surgeons (72%) was high. Joint replacement surgery (91%), prescription anti-inflammatory medications (66%), aids and assistive devices (65%), intra-articular injections (63%), and prescription painkiller medications (62%) were perceived as effective treatments. Less highly rated treatments were exercise (48%), physiotherapy (43%), and complementary medicines (29%). A majority of patients were satisfied with the information to manage their OA (65%). From the multivariable logistic regression analysis, four GP satisfaction factors were found to be predictors of overall satisfaction with GP care: the amount of time that the GP spends with the patient (P=0.005), the information the GP provides about what to expect (P<0.001), the communication between patient and GP (P=0.001), and the information that the GP provides about medications (P=0.042). CONCLUSION The study showed that although patients with OA were generally satisfied with their health care providers, there was notable variation in the perceived helpfulness of therapeutic options. The importance to patients of having access to good quality information about their condition was emphasized.
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Affiliation(s)
| | | | | | | | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
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Stevenson FA, Britten N, Barry CA, Bradley CP, Barber N. Perceptions of Legitimacy: The Influence on Medicine Taking and Prescribing. Health (London) 2016. [DOI: 10.1177/136345930200600105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The terms non-compliance or non-adherence, in relation to medicine taking, contain the assumption that prescribers’ actions are legitimate and should be perceived as such by patients, and that non-adherence is deviant. Yet the high level of non-adherence suggests that patients do not necessarily perceive prescriptions in this way. We consider the relevance today of viewing non-adherence in terms of Weber’s concept of legitimacy. We also consider the more recent concept of concordance. Drawing on an analysis of interviews and consultations from a study of doctor–patient communication about drugs, we argue that decisions about prescribing and medicine taking are complex and take account of social as well as medical criteria. Moreover, any attempt to understand adherence needs to be flexible enough to encompass both a Weberian as well as a concordance approach to prescribing and medicine taking.
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Affiliation(s)
- Fiona A. Stevenson
- King’s College London, King’s College London, Brunel University, University College Cork and London University
| | | | | | | | - Nick Barber
- King’s College London, King’s College London, Brunel University, University College Cork and London University
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Zeković M, Krajnović D, Marinković V, Tasić L. THE COMPLEXITY OF ADHERENCE ISSUE: A REVIEW OF ITS SCOPE AND DETERMINANTS. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Golden SE, Wiener RS, Sullivan D, Ganzini L, Slatore CG. Primary Care Providers and a System Problem: A Qualitative Study of Clinicians Caring for Patients With Incidental Pulmonary Nodules. Chest 2015; 148:1422-1429. [PMID: 25790082 PMCID: PMC4665737 DOI: 10.1378/chest.14-2938] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/26/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND As lung cancer screening with low-dose CT scanning is implemented, an increasing number of people will be diagnosed with pulmonary nodules. Primary care clinicians care for the vast majority of these patients, but their experiences with communication and managing distress in this population are not well understood. METHODS We conducted qualitative interviews of 15 primary care providers (PCPs) at two academic medical centers who care for patients with pulmonary nodules. We used qualitative description analysis, focusing on clinicians' information exchange and other communication behaviors. RESULTS Most PCPs believed they had inadequate information to counsel patients regarding lung nodules, although this information is desired. PCPs were concerned patients could "fall through the cracks" but did not have access to a reliable system to ensure follow-up adherence. They were limited by time, knowledge, and resources in providing the preferred level of care. Most PCPs did not discuss the specific risk a nodule was lung cancer, in part because they did not have ready access to this information. PCPs believed most patients did not have substantial distress as a result of nodule detection. Most PCPs did not include patients when making decisions about the follow-up plan. CONCLUSIONS PCPs often lack systemic resources to optimize patient-centered approaches when discussing incidental pulmonary nodules with patients. With the advent of lung cancer screening, pulmonologists can assist primary care colleagues by providing accurate information to counsel patients and assisting in managing conversations about the risk of cancer. Pulmonologists should support efforts to implement reliable systems to ensure adherence to follow-up.
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Affiliation(s)
- Sara E Golden
- From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR.
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Donald Sullivan
- From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Division of Geriatric Medicine, Department of Psychiatry, Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Linda Ganzini
- From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Division of Geriatric Medicine, Department of Psychiatry, Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Christopher G Slatore
- From the Health Services Research and Development, Department of Medicine, Oregon Health and Science University, Portland, OR; Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR
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Britten N, Maguire K. Lay knowledge, social movements and the use of medicines: Personal reflections. Health (London) 2015; 20:77-93. [PMID: 26621264 DOI: 10.1177/1363459315619021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article consists of two personal reflections about the changing status of lay knowledge over the last 20 years. The first reflection is by Nicky Britten from the perspective of a sociologist working in medical schools whose interest in this topic was motivated by my own personal experience of health care and of teaching general practitioners. Starting with the problematic deficit model of 'ignorant patients', I trace the literature on patient-centredness, shared decision-making, lay knowledge, public involvement in research and social movements. Looking at medicines use in particular, I deplore the continued hegemony of the concept of compliance in the face of extensively documented problems with the licensing, regulation, prescribing and monitoring of medicines. I argue that lay knowledge is now taken more seriously, not so much because of advocacy by clinicians and academics, but because of social movements and social action. We may have moved from 'anecdotes' to 'lived experience' but there is still a way to go, particularly when it comes to medicines use. I end with a possible future scenario. The second reflection is by Kath Maguire and is a response from the perspective of someone who came to work in this field with the express purpose of improving engagement with lay knowledge. It questions my own 'layness' and explores the issues raised by Nicky Britten using the lens of lived experience. Finally, it questions the paradigm of social movements and highlights the importance of developing different ways of listening.
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Interventional Tools to Improve Prescription and Adherence to Medical Plans. BIOMED RESEARCH INTERNATIONAL 2015; 2015:602078. [PMID: 26688812 PMCID: PMC4672111 DOI: 10.1155/2015/602078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022]
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Davies MJ, Kotadia A, Mughal H, Hannan A, Alqarni H. The attitudes of pharmacists, students and the general public on mHealth applications for medication adherence. Pharm Pract (Granada) 2015; 13:644. [PMID: 26759619 PMCID: PMC4696122 DOI: 10.18549/pharmpract.2015.04.644] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND During recent years mobile technology has developed tremendously and has infiltrated the healthcare field. Mobile healthcare (mHealth) applications, or apps, may be used to support patient adherence to medication thus promoting optimal treatment outcomes and reducing medication wastage. OBJECTIVE This study shall consider the opinions of United Kingdom (UK) based pharmacists, pharmacy undergraduates and members of the general public towards the use of mHealth apps to promote adherence to prescribed medication regimens. METHODS On Liverpool John Moores University (LJMU) ethical approval, the 25 item questionnaire was distributed to UK registered pharmacists within inner city Liverpool and Manchester (n=500), pharmacy undergraduates studying at LJMU (n=420) and members of the general public within Liverpool City Centre (n=400). The questions were formatted as multiple choice, Likert scales or the open answer type. The data were analysed using simple frequencies, cross tabulations and non-parametric techniques in the SPSS v22 program. RESULTS The number of completed questionnaires from the pharmacist, student and general public cohorts were 245, 333 and 400; respectively. The data indicated that the general public rely heavily upon daily routine to take medication as prescribed (54.1%) with mHealth app use being extremely low (1.5%); a similar trend was noted for the pharmacist / student cohorts. The age of the individual is an important consideration, with the younger generation likely to engage with mHealth apps and the older generation less so. Here, education and training are important. Pharmacists (82.3%) would be happy to deliver training packages to the public who would in turn happily receive such training (84%). Key barriers precluding mHealth app use include data reliability, security and technical difficulties. CONCLUSION Adherence apps hold great promise to support the patient and their healthcare needs. In order to increase acceptance and uptake simple, user-friendly designs must be considered and constructed. In addition, such technology requires effective promotion and end user training in order to reach its full potential. Furthermore, the regulation of mobile adherence apps will be essential in order to overcome underlying patient concerns.
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Affiliation(s)
- Michael J Davies
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University . Liverpool ( United Kingdom ).
| | - Alysha Kotadia
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University . Liverpool ( United Kingdom ).
| | - Hassan Mughal
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University . Liverpool ( United Kingdom ).
| | - Ashraf Hannan
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University . Liverpool ( United Kingdom ).
| | - Hamdan Alqarni
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University . Liverpool ( United Kingdom ).
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Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, Pecorelli S, Monaco A, Marengoni A. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence 2015; 9:1303-14. [PMID: 26396502 PMCID: PMC4576894 DOI: 10.2147/ppa.s87551] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons.
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Affiliation(s)
- Elísio Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Anna Giardini
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV), Pavia, Italy
| | - Magda Savin
- European Association of Pharmaceutical Full-line Wholesalers, Brussels, Belgium
| | - Enrica Menditto
- CIRFF/Center of Pharmacoeconomics, School of Pharmacy, University of Naples FedericoII, Nápoles, Italy
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Olga Laosa
- Centro de Investigación Clínica del Anciano Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain
| | - Sergio Pecorelli
- Italian Medicines Agency – AIFA, Rome, Italy
- University of Brescia, Brescia, Italy
| | | | - Alessandra Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
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Singh JA, Qu H, Yazdany J, Chatham W, Dall'era M, Shewchuk RM. Barriers to Medication Decision Making in Women with Lupus Nephritis: A Formative Study using Nominal Group Technique. J Rheumatol 2015; 42:1616-23. [PMID: 26178276 DOI: 10.3899/jrheum.150168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the perspectives of women with lupus nephritis on barriers to medication decision making. METHODS We used the nominal group technique (NGT), a structured process to elicit ideas from participants, for a formative assessment. Eight NGT meetings were conducted in English and moderated by an expert NGT researcher at 2 medical centers. Participants responded to the question: "What sorts of things make it hard for people to decide to take the medicines that doctors prescribe for treating their lupus kidney disease?" Patients nominated, discussed, and prioritized barriers to decisional processes involving medications for treating lupus nephritis. RESULTS Fifty-one women with lupus nephritis with a mean age of 40.6 ± 13.3 years and disease duration of 11.8 ± 8.3 years participated in 8 NGT meetings: 26 African Americans (4 panels), 13 Hispanics (2 panels), and 12 whites (2 panels). Of the participants, 36.5% had obtained at least a college degree and 55.8% needed some help in reading health materials. Of the 248 responses generated (range 19-37 responses/panel), 100 responses (40%) were perceived by patients as having relatively greater importance than other barriers in their own decision-making processes. The most salient perceived barriers, as indicated by percent-weighted votes assigned, were known/anticipated side effects (15.6%), medication expense/ability to afford medications (8.2%), and the fear that the medication could cause other diseases (7.8%). CONCLUSION Women with lupus nephritis identified specific barriers to decisions related to medications. Information relevant to known/anticipated medication side effects and medication cost will form the basis of a patient guide for women with systemic lupus erythematosus, currently under development.
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Affiliation(s)
- Jasvinder A Singh
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham.
| | - Haiyan Qu
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Jinoos Yazdany
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Winn Chatham
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Maria Dall'era
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
| | - Richard M Shewchuk
- From the Medicine Service, Birmingham Veterans Affairs (VA) Medical Center; Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, and Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Medicine, University of California at San Francisco, San Francisco, California, USA.J.A. Singh, MBBS, MPH, Medicine Service, Birmingham VA Medical Center, and Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, and Department of Orthopedic Surgery, Mayo Clinic College of Medicine; H. Qu, PhD, MSHA, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham; J. Yazdany, MD, MPH, Department of Medicine, University of California at San Francisco; W. Chatham, MD, PhD, Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham; M. Dall'era, MD, Department of Medicine, University of California at San Francisco; R.M. Shewchuk, PhD, Department of Health Services Administration at School of Health Professions, University of Alabama at Birmingham
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Desborough J, Phillips C, Banfield M, Bagheri N, Mills J. Impact of nursing care in Australian general practice on the quality of care: A pilot of the Patient Enablement and Satisfaction Survey (PESS). Collegian 2015; 22:207-14. [DOI: 10.1016/j.colegn.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Halcomb EJ, Salamonson Y, Cook A. Satisfaction and comfort with nursing in Australian general practice. Collegian 2015. [DOI: 10.1016/j.colegn.2014.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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