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Biehl JT, Patel R, Lee AJ. Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers. JMIR Hum Factors 2023; 10:e40173. [PMID: 37402141 DOI: 10.2196/40173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/29/2023] [Accepted: 05/14/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die. OBJECTIVE Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension. METHODS A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies. RESULTS Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers. CONCLUSIONS There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology's ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation.
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Affiliation(s)
- Jacob T Biehl
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ravi Patel
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Adam J Lee
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
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2
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Almomani BA, Hijazi BM, Awwad O, Khasawneh RA. Prevalence and predictors of non-adherence to short-term antibiotics: A population-based survey. PLoS One 2022; 17:e0268285. [PMID: 35588114 PMCID: PMC9119442 DOI: 10.1371/journal.pone.0268285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Non-adherence to antibiotics is a well-known, core player to antibiotic resistance. The current adherence behavior toward short-term antibiotic regimens has never been investigated before in Jordan. This study assessed the prevalence and predictors of non-adherence to short-term antibiotics among Jordanians and investigated participants’ views about different reasons related to antibiotics non-adherence. A cross-sectional face-to-face survey-based interview was conducted in three hospital pharmacies in Jordan. Adults and mother of children (≤12 years old) who completed their short course treatment (<30 day) of oral antibiotic within the last month were recruited. A total of 2000 participants (adults: 1000 and mothers of children: 1000) were included in the study with a response rate of 91.60%. The prevalence of non-adherence was estimated to be 32.10%. Non-adherent respondents scored a lower Medication Adherence Report Scale [16.76±5.02 vs. 23.04 ±3.24] than adherent respondents (p<0.001). Adults without comorbidity and children with higher number of doses per regimen were significantly less adherent to antibiotic [(OR = 0.615, 95%CI = 0.444–0.853, p = 0.004) and (OR = 0.965, 95%CI = 0.950–0.981, p<0.001)], respectively. Patients-related factors were the most common antibiotic non-adherence reason reported by the participants. The multivariate analysis for all the participants (adults and children), indicated that mothers were 2.6 times more likely to be adherent in giving antibiotics to their children than adults (p<0.001). These findings highlight that more than half of the participants were adherent to short-term antibiotics. However, improving the current prescription-related practices and implementing pharmaceutical consultation services upon antibiotic dispensing are encouraged.
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Affiliation(s)
- Basima A. Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Bushra M. Hijazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Oriana Awwad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, the University of Jordan, Amman, Jordan
| | - Rawand A. Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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3
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Kan K, Shaunfield S, Kanaley M, Chadha A, Boon K, Foster CC, Morales L, Labellarte P, Vojta D, Gupta RS. Parent Experiences With Electronic Medication Monitoring in Pediatric Asthma Management: Qualitative Study. JMIR Pediatr Parent 2021; 4:e25811. [PMID: 33890861 PMCID: PMC8105758 DOI: 10.2196/25811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electronic medication monitoring (EMM) is a digital tool that can be used for tracking daily medication use. Previous studies of EMM in asthma management have been conducted in adults or have examined pediatric interventions that use EMM for less than 1 year. To understand how to improve EMM-enhanced interventions, it is necessary to explore the experiences of parents of children with asthma, recruited from outpatient practices, who completed a 12-month intervention trial. OBJECTIVE The objective of our study was to use qualitative inquiry to answer the following questions: (1) how did using an EMM-enhanced intervention change parents'/caregivers' experiences of managing their child's asthma, and (2) what do parents recommend for improving the intervention in the future? METHODS Parents were recruited from the intervention arm of a multicomponent health intervention enhanced by Bluetooth-enabled sensors placed on inhaler medications. Semistructured interviews were conducted with 20 parents of children aged 4-12 years with asthma. Interviews were audio-recorded, transcribed, and inductively analyzed using a constant comparative approach. RESULTS Interview participants reflected an even mix of publicly and privately insured children and a diverse racial-ethnic demographic. Parents discussed 6 key themes related to their experience with the EMM-enhanced intervention for the management of their child's asthma: (1) compatibility with the family's lifestyle, (2) impact on asthma management, (3) impact on the child's health, (4) emotional impact of the intervention, (5) child's engagement in asthma management with the intervention, and (6) recommendations for future intervention design. Overall, parents reported that the 12-month EMM intervention was compatible with their daily lives, positively influenced their preventive and acute asthma management, and promoted their child's engagement in their own asthma management. While parents found the intervention acceptable and generally favorable, some parents identified compatibility issues for families with multiple caregivers and frustration when the technology malfunctioned. CONCLUSIONS Parents generally viewed the intervention as a positive influence on the management of their child's asthma. However, our study also highlighted technology challenges related to having multiple caregivers, which will need to be addressed in future iterations for families. Attention must be paid to the needs of parents from low socioeconomic households, who may have more limited access to reliable internet or depend on other relatives for childcare. Understanding these family factors will help refine how a digital tool can be adopted into daily disease management of pediatric asthma.
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Affiliation(s)
- Kristin Kan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Madeleine Kanaley
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Avneet Chadha
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kathy Boon
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Carolyn C Foster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Luis Morales
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Patricia Labellarte
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Deneen Vojta
- UnitedHealth Group, Minnetonka, MN, United States
| | - Ruchi S Gupta
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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4
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Gupta RS, Fierstein JL, Boon KL, Kanaley MK, Bozen A, Kan K, Vojta D, Warren CM. Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-1330. [PMID: 33386336 PMCID: PMC9259329 DOI: 10.1542/peds.2020-1330] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear. METHODS Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline. RESULTS Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control. CONCLUSIONS Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.
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Affiliation(s)
- Ruchi S. Gupta
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jamie L. Fierstein
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathy L. Boon
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Madeleine K. Kanaley
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Bozen
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kristin Kan
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Christopher M. Warren
- Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois,Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Sean N. Parker Center for Food Allergy and Asthma Research, Stanford University, Stanford, California
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5
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Henderson BR, Flaherty CM, Floyd GC, You J, Xiao R, Bryant-Stephens TC, Miller VA, Feudtner C, Kenyon CC. Tailored Medication Adherence Incentives Using mHealth for Children With High-Risk Asthma (TAICAM): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16711. [PMID: 32459653 PMCID: PMC7459431 DOI: 10.2196/16711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Background Poor adherence to inhaled corticosteroid medications for children with high-risk asthma is both well documented and poorly understood. It has a disproportionate prevalence and impact on children of minority demographics in urban settings. Financial incentives have been shown to be a compelling method to engage those in a high-risk asthma population, but whether adherence can be maintained by offering financial incentives and how these incentives can be used to sustain high adherence are unknown. Objective The aim of this study is to determine the marginal effects of a financial incentive–based intervention on inhaled corticosteroid adherence, health care system use, and costs. Methods Participants include children aged 5 to 12 years who have had either at least two hospitalizations or one hospitalization and one emergency department visit for asthma in the year prior to their enrollment (and their caregivers). Participants are given an electronic inhaler sensor in order to track their medication use over a period of 7 months. After a 1-month period of observation, participants are randomized to 1 of 3 arms for a 3-month period. Participants in arm 1 receive daily text message reminders, feedback, and gain–framed, nominal financial incentives; participants in arm 2 receive daily text message reminders and feedback only, and participants in arm 3 receive no reminders, feedback, or incentives. All participants are subsequently observed for an additional 3-month period with no reminders, feedback, or incentives to assess whether any sustained effects are apparent. Results Study enrollment began in September 2019 with a target sample size of N=125 children. As of June 2020, 61 children have been enrolled. Data collection is estimated to be completed in June 2022, and analyses will be completed by June 2023. Conclusions This study will provide data that will help to determine whether a financial incentive–based mobile health intervention for promoting inhaled corticosteroid use can be effective in patients with high-risk asthma over longer periods. Trial Registration Clinicaltrial.gov NCT03907410; https://clinicaltrials.gov/ct2/show/NCT03907410 International Registered Report Identifier (IRRID) DERR1-10.2196/16711
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Affiliation(s)
- Brittney R Henderson
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Carina M Flaherty
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - G Chandler Floyd
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jack You
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rui Xiao
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Tyra C Bryant-Stephens
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chén Collin Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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6
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Attaway AH, Alshabani K, Bender B, Hatipoğlu US. The Utility of Electronic Inhaler Monitoring in COPD Management: Promises and Challenges. Chest 2020; 157:1466-1477. [PMID: 31981565 DOI: 10.1016/j.chest.2019.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/19/2019] [Accepted: 12/28/2019] [Indexed: 12/15/2022] Open
Abstract
COPD is a common respiratory disorder that poses a major health-care burden with societal and financial ramifications. Although effective inhaled therapies are available, nonadherence is common among patients with COPD and potentially contributes to the burden of this disease. Electronic inhaler monitoring (EIM) is a novel modality that enables real-time assessment of adherence to inhaled therapy and informs the assessment of treatment effectiveness. EIM can be combined with physician feedback, automated audiovisual reminders, and text messaging to bolster adherence. Clinical studies have suggested that EIM can diagnose nonadherence, improve adherence, and predict exacerbations. Using an EIM-guided protocol has the potential to avoid treatment escalation in the nonadherent. Coupling EIM to behavioral intervention is an area of ongoing research with mixed results, with some studies showing benefit and others showing minimal or no significant change in clinical outcomes. Further investigation is necessary to understand the incremental benefits of EIM features, delineate optimal program implementation, and target patient populations that would benefit the most from monitoring.
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Affiliation(s)
- Amy H Attaway
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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7
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Kenyon CC, Sundar KG, Gruschow SM, Quarshie WO, Feudtner C, Bryant-Stephens TC, Miller VA. Tailored medication adherence incentives for high-risk children with asthma: a pilot study. J Asthma 2019; 57:1372-1378. [PMID: 31389724 DOI: 10.1080/02770903.2019.1648503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: While reminder-based electronic monitoring systems have shown promise in enhancing inhaled corticosteroid (ICS) adherence in select populations, more engaging strategies may be needed in families of children with high-risk asthma. This study assesses the acceptability and feasibility of gain-framed ICS adherence incentives in families of urban, minority children with frequent asthma hospitalization.Methods: We enrolled children aged 5-11 years with multiple yearly asthma hospitalizations in a 2-month, mixed methods, ICS adherence incentive pilot study. All participants received inhaler sensors and a smartphone app to track ICS use. During month 1, families received daily adherence reminders and weekly feedback, and children earned up to $1/day for complete adherence. No reminders, feedback, or incentives were provided in month 2. We assessed feasibility and acceptability using caregiver surveys and semi-structured interviews and ICS adherence using electronic monitoring data.Results: Of the 29 families approached, 20 enrolled (69%). Participants were primarily Black (95%), publicly insured (75%), and averaged 2.9 asthma hospitalizations in the prior year. Fifteen of the 16 caregivers (94%) surveyed at month 2 liked the idea of receiving adherence incentives. Mean adherence was significantly higher in month 1 compared with month 2 (80% vs. 33%, mean difference = 47%; 95% CI [33, 61], p < 0.001). Caregivers reported that their competing priorities often limited adherence, while incentives helped motivate child adherence.Conclusions: ICS adherence incentives were acceptable and feasible in a high-risk cohort of children with asthma. Future studies should assess the efficacy of adherence incentives in enhancing ICS adherence in high-risk children.
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Affiliation(s)
- Chén C Kenyon
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kavya G Sundar
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Siobhan M Gruschow
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William O Quarshie
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyra C Bryant-Stephens
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria A Miller
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Borgmeyer A, Jamerson P, Gyr P, Westhus N, Glynn E. The School Nurse Role in Asthma Management: Can the Action Plan Help? J Sch Nurs 2019. [DOI: 10.1177/10598405050210010601] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asthma is the most common chronic disorder in American schoolchildren, and school nurses play a valuable role in its management. A study was conducted in which school nurses were asked to describe their role in caring for students with asthma and their use of Asthma Action Plans (AAPs). The nurses indicated that they frequently provided direct care and education. They were comfortable with providing care to students with asthma and familiar with AAPs. Having an AAP increased their confidence in managing students with asthma. This emphasizes the need for continued education regarding the AAP and the development of policies that direct care and encourage use of an AAP at school.
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Affiliation(s)
- Anne Borgmeyer
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
| | | | - Patricia Gyr
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
| | - Nina Westhus
- School of Nursing, Saint Louis University, St. Louis, MO
| | - Emily Glynn
- Asthma Intervention Model at St. Louis Children's Hospital, St. Louis, MO
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Lycett HJ, Raebel EM, Wildman EK, Guitart J, Kenny T, Sherlock JP, Cooper V. Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review. J Med Internet Res 2018; 20:e293. [PMID: 30541741 PMCID: PMC6306620 DOI: 10.2196/jmir.9666] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma is a chronic disease requiring effective self-management to control it and prevent mortality. The use of theory-informed digital interventions promoting asthma self-management is increasing. However, there is limited knowledge concerning how and to what extent psychological theory has been applied to the development of digital interventions, or how using theory impacts outcomes. OBJECTIVE The study aimed to examine the use and application of theory in the development of digital interventions to enhance asthma self-management and to evaluate the effectiveness of theory-based interventions in improving adherence, self-management, and clinical outcomes. METHODS Electronic databases (CENTRAL, MEDLINE, EMBASE, and PsycINFO) were searched systematically using predetermined terms. Additional studies were identified by scanning references within relevant studies. Two researchers screened titles and abstracts against predefined inclusion criteria; a third resolved discrepancies. Full-text review was undertaken for relevant studies. Those meeting inclusion criteria were assessed for risk of bias using the Cochrane Collaboration tool. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Study outcomes were classified as medication adherence, self-management, asthma control, clinical markers of health, quality of life, other quality of life outcomes, and health care utilization. Effectiveness was calculated as an average outcome score based on the study's reported significance. The Theory Coding Scheme (TCS) was used to establish the extent to which each intervention had applied theory and which theoretical constructs or behavioral determinants were addressed. Associations between TCS scores and asthma outcomes were described within a narrative synthesis. RESULTS Fourteen studies evaluating 14 different digital interventions were included in this review. The most commonly cited theories were Social Cognitive Theory, Health Belief Model, and Self-Efficacy Theory. A greater use of theory in the development of interventions was correlated with effective outcomes (r=.657; P=.01): only the 3 studies that met >60% of the different uses of theory assessed by the TCS were effective on all behavioral and clinical outcomes measured. None of the 11 studies that met ≤60% of the TCS criteria were fully effective; however, 3 interventions were partially effective (ie, the intervention had a significant impact on some, but not all, of the outcomes measured). Most studies lacked detail on the theoretical constructs and how they were applied to the development and application of the intervention. CONCLUSIONS These findings suggest that greater use of theory in the development and application of digital self-management interventions for asthma may increase their effectiveness. The application of theory alone may not be enough to yield a successful intervention, and other factors (eg, the context in which the intervention is used) should be considered. A systematic approach to the use of theory to guide the design, selection, and application of intervention techniques is needed.
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Affiliation(s)
| | | | | | | | | | - Jon-Paul Sherlock
- Pharmaceutical Technology & Development, AstraZeneca, Macclesfield, United Kingdom
| | - Vanessa Cooper
- UCL School of Pharmacy, University College London, London, United Kingdom
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10
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Where does health communication technology fit into allergy practice? Ann Allergy Asthma Immunol 2018; 121:24-30. [PMID: 29852292 DOI: 10.1016/j.anai.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 01/12/2023]
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11
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Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR. Medication adherence in pediatric asthma: A systematic review of the literature. Pediatr Pulmonol 2018; 53:668-684. [PMID: 29461017 DOI: 10.1002/ppul.23966] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains. METHODS Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality. RESULTS Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies. CONCLUSIONS All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University, Auburn University, AL
| | - Mallory Netz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Scott T Wagoner
- Department of Psychology, Auburn University, Auburn University, AL
| | - Megan R Schaefer
- Department of Psychology, Auburn University, Auburn University, AL
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12
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Kenyon CC, Gruschow SM, Quarshie WO, Griffis H, Leach MC, Zorc JJ, Bryant-Stephens TC, Miller VA, Feudtner C. Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders. J Asthma 2018; 56:95-103. [PMID: 29437489 DOI: 10.1080/02770903.2018.1424195] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma. METHODS Children aged 2-13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. RESULTS Forty-one participants (mean age 5.9) were randomized to intervention (n = 21) or control (n = 20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention = 36%; control = 32%, P = 0.73). Three adherence trajectories were identified with none ever exceeding 80% adherence. CONCLUSIONS Within a high-risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.
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Affiliation(s)
- Chén C Kenyon
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Siobhan M Gruschow
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - William O Quarshie
- c Healthcare Analytics Unit , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Heather Griffis
- c Healthcare Analytics Unit , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Michelle C Leach
- d Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , Pennsylvania
| | - Joseph J Zorc
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Tyra C Bryant-Stephens
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Victoria A Miller
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
| | - Chris Feudtner
- a PolicyLab and Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,b Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania
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Fedele DA, McConville A, Graham Thomas J, McQuaid EL, Janicke DM, Turner EM, Moon J, Abu-Hasan M. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT): Development and design of a randomized controlled trial. Contemp Clin Trials 2017; 64:230-237. [PMID: 28986245 DOI: 10.1016/j.cct.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/01/2023]
Abstract
Early adolescents have difficulties performing asthma self-management behaviors, placing them at-risk for poor asthma control and reduced quality of life. This paper describes the development and plans for testing an interactive mobile health (mHealth) tool for early adolescents, ages 12-15years, and their caregivers to help improve asthma management. Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT) is informed by the Pediatric Self-management model, which posits that helpful caregiver support is facilitated by elucidating disease management behaviors and allocating treatment responsibility in the family system, and subsequently engaging in collaborative caregiver-adolescent asthma management. The AIM2ACT intervention was developed through iterative feedback from an advisory board composed of adolescent-caregiver dyads. A pilot randomized controlled trial of AIM2ACT will be conducted with 50 early adolescents with poorly controlled asthma and a caregiver. Adolescent-caregiver dyads will be randomized to receive the AIM2ACT smartphone application (AIM2ACT app) or a self-guided asthma control condition for a 4-month period. Feasibility and acceptability data will be collected throughout the trial. Efficacy outcomes, including family asthma management, lung function, adolescent asthma control, asthma-related quality of life, and self-efficacy for asthma management, will be collected at baseline, post-treatment, and 4-month follow-up. Results from the current study will inform the utility of mHealth to foster the development of asthma self-management skills among early adolescents.
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Affiliation(s)
- David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States.
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Elise M Turner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Jon Moon
- MEI Research, Ltd, Edina, MN, United States
| | - Mutasim Abu-Hasan
- Pediatric Pulmonary Division, University of Florida, Gainesville, FL, United States
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14
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Yeh EA, Grover SA, Powell VE, Alper G, Banwell BL, Edwards K, Gorman M, Graves J, Lotze TE, Mah JK, Mednick L, Ness J, Obadia M, Slater R, Waldman A, Waubant E, Schwartz CE. Impact of an electronic monitoring device and behavioral feedback on adherence to multiple sclerosis therapies in youth: results of a randomized trial. Qual Life Res 2017; 26:2333-2349. [PMID: 28393317 PMCID: PMC6149210 DOI: 10.1007/s11136-017-1571-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the results of a randomized controlled trial using an electronic monitoring device (EM) plus a motivational interviewing (MI) intervention to enhance adherence to disease-modifying therapies (DMT) in pediatric MS. METHODS Fifty-two youth with MS (16.03 ± 2.2 years) were randomized to receive either MI (n = 25) (target intervention) or a MS medication video (n = 27) (attention control). Primary endpoint was change in adherence. Secondary outcomes included changes in quality of life, well-being and self-efficacy. Random effects modeling and Cohen's effect size computation evaluated intervention impact. RESULTS Longitudinal random effect models revealed that the MI group decreased their EM adherence (GroupxTime interaction = -0.19), while increasing frequency of parental DMT reminder (26.01)/administration (11.69). We found decreased EM use in the MI group at 6 months (Cohen's d = -0.61), but increased pharmacy refill adherence (d = 0.23). Parental reminders about medication increased in MI subjects vs controls (d = 0.59 at 3 months; d = 0.70 at 6 months). We found increases in self-reported adherence (d = 0.21) at 3 but not 6 months, fewer barriers to adherence at three (d = -0.58) and six months (d = -0.31), better physical (d = 0.23 at 3 months; d = 0.45 at 6 months), emotional (d = 0.25 at 3 months) and self-efficacy function (d = 0.55 at 3 months; 0.48 at 6 months), but worse well-being, including self-acceptance (d = -0.53 at 6 months) and environmental mastery (d = -0.42 at 3 and 6 months) in intervention as compared to control patients. CONCLUSIONS Participants receiving MI + EM experienced worsening on objective measures of adherence and increased parental involvement, but improved on some self- and parent-reported measures. MI participants reported improvements in quality of life and self-efficacy, but worsened well-being.
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Affiliation(s)
- E Ann Yeh
- Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology, Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Hospital for Sick Children, 555 University Avenue, Rm 6D33, Toronto, ON, M5G1X8, Canada.
- Faculty of Medicine, The University of Toronto, 1 King's College Circle #3172, Toronto, ON, M5S 1A8, Canada.
| | - Stephanie A Grover
- Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology, Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Hospital for Sick Children, 555 University Avenue, Rm 6D33, Toronto, ON, M5G1X8, Canada
| | - Victoria E Powell
- DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | - Gulay Alper
- Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Kim Edwards
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Mark Gorman
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jennifer Graves
- University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Timothy E Lotze
- Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030, USA
| | - Jean K Mah
- Alberta Children's Hospital, 2888 Shanganappi Trail NW, Calgary, AB, T3B 6A8, Canada
| | - Lauren Mednick
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jayne Ness
- University of Alabama at Birmingham, 1720 2nd Avenue, Birmingham, AL, 35294, USA
| | - Maya Obadia
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, University Health Network, 585 University Avenue, Toronto, ON, M5G 2C4, Canada
- Department of Psychology, Faculty of Medicine, University of Toronto, 1 King's College Circle #3172, Toronto, ON, M5S 1A8, Canada
| | - Ruth Slater
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Amy Waldman
- Division of Neurology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Emmanuelle Waubant
- University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Carolyn E Schwartz
- DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA, 01742, USA
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, 800 Washington Street, Boston, MA, 02111, USA
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Carpenter DM, Roberts CA, Sage AJ, George J, Horne R. A Review of Electronic Devices to Assess Inhaler Technique. Curr Allergy Asthma Rep 2017; 17:17. [PMID: 28290015 DOI: 10.1007/s11882-017-0684-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.). RECENT FINDINGS We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all. Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, CPO 2125, Asheville, NC, 28804, USA.
| | - Courtney A Roberts
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Adam J Sage
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
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16
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Abstract
OBJECTIVES Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. METHODS We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit. RESULTS Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit. CONCLUSION Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.
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Adams SA, Leach MC, Feudtner C, Miller VA, Kenyon CC. Automated Adherence Reminders for High Risk Children With Asthma: A Research Protocol. JMIR Res Protoc 2017; 6:e48. [PMID: 28347975 PMCID: PMC5387114 DOI: 10.2196/resprot.6674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of inhaled corticosteroid (ICS) medications has been shown to improve asthma control and reduce asthma-related morbidity and mortality. Two recent randomized trials demonstrated dramatic improvements in ICS adherence by monitoring adherence with electronic sensors and providing automated reminders to participants to take their ICS medications. Given their lower levels of adherence and higher levels of asthma-related emergency department (ED) visits, hospitalizations, and death, urban minority populations could potentially benefit greatly from these types of interventions. OBJECTIVE The principal objective of this study will be to evaluate the feasibility, acceptability, and limited efficacy of a text message (short message service, SMS) reminder intervention to enhance ICS adherence in an urban minority population of children with asthma. We will also assess trajectories of ICS adherence in the 2 months following asthma hospitalization. METHODS Participants will include 40 children aged 2-13 years, who are currently admitted to the Children's Hospital of Philadelphia (CHOP) for asthma, and their parent or legal guardian. Participants will be assigned to intervention and control arms using a 1:1 randomization scheme. The intervention arm will receive daily text message reminders for a 30-day intervention phase following hospitalization. This will be followed by a 30-day follow-up phase, in which all participants may choose whether or not to receive the text messages. Feasibility will be assessed by measuring (1) retention of the participants through the study phases and (2) perceived usefulness, acceptability, and preferences regarding the intervention components. Limited efficacy outcomes will include percent adherence to prescribed ICS regimen measured using Propeller Health sensors and change in parent-reported asthma control. We will perform an exploratory analysis to assess for discrete trajectories of adherence using group-based trajectory modeling (GBTM). RESULTS Study enrollment began in December 2015 and the intervention and follow-up phases are ongoing. Results of the data analysis are expected to be available by December 2016. CONCLUSIONS This study will add to the literature by providing foundational feasibility data on which elements of a mobile health text-message reminder intervention may need to be modified to suit the needs and constraints of high-risk urban minority populations. TRIAL REGISTRATION Clinicaltrials.gov NCT02615743; https://www.clinicaltrials.gov/ct2/show/study/NCT02615743 (Archived with WebCite at http://www.webcitation.org/6ji59rAXN).
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Affiliation(s)
- Sarah A Adams
- The Children's Hospital of Philadelphia, PolicyLab and Center for Pediatric Clinical Effectiveness, Philadelphia, PA, United States
| | - Michelle Chan Leach
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chris Feudtner
- The Children's Hospital of Philadelphia, PolicyLab and Center for Pediatric Clinical Effectiveness, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Victoria A Miller
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chén Collin Kenyon
- The Children's Hospital of Philadelphia, PolicyLab and Center for Pediatric Clinical Effectiveness, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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18
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Kenyon CC, Chang J, Wynter SA, Fowler JC, Long J, Bryant-Stephens TC. Electronic Adherence Monitoring in a High-Utilizing Pediatric Asthma Cohort: A Feasibility Study. JMIR Res Protoc 2016; 5:e132. [PMID: 27335355 PMCID: PMC4935791 DOI: 10.2196/resprot.5362] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 04/30/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inner-city, minority children with asthma have the highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. Some recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower-risk populations. The feasibility and acceptability of such an intervention in the highest-risk children with asthma has not been studied. OBJECTIVE Our objective was to assess the feasibility and acceptability of a community health worker-delivered electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner-city practice. METHODS This was a prospective cohort pilot study targeting children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. We measured acceptability by using a modified technology acceptability model and changes in asthma control using the Asthma Control Test (ACT). Given prominent feasibility issues, we describe qualitative patterns of medication use at baseline only. RESULTS We enrolled 14 non-Hispanic black children with a median age of 3.5 years. Participants averaged 7.8 emergency or hospital visits in the year preceding enrollment. We observed three distinct patterns of baseline controller use: 4 patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within 2 weeks. All participants initiated use of the electronic devices; however, no modem signal was transmitted for 5 or the 14 participants after a mean of 45 days. Of the 9 (64% of total) caregivers who completed the final study visit, all viewed the electronic monitoring device favorably and would recommend it to friends, and 5 (56%) believed that the device helped to improve asthma control. ACT scores improved by a mean of 2.7 points (P=.05) over the 3-month intervention. CONCLUSIONS High-utilizer, minority families who completed a community health worker-delivered electronic adherence intervention found it generally acceptable. Prominent feasibility concerns, however, such as recruitment, data transmission failure, and lost devices, should be carefully considered when designing interventions in this setting.
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Affiliation(s)
- Chén Collin Kenyon
- Center for Pediatric Clinical Effectiveness and PolicyLab, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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19
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Ellis DA, King P, Naar-King S. Mediators of Treatment Effects in a Randomized Clinical Trial of Multisystemic Therapy-Health Care in Adolescents With Poorly Controlled Asthma: Disease Knowledge and Device Use Skills. J Pediatr Psychol 2016; 41:522-30. [PMID: 26628249 PMCID: PMC4888112 DOI: 10.1093/jpepsy/jsv114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/29/2015] [Accepted: 11/01/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Determine whether Multisystemic Therapy-Health Care (MST-HC) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management. METHODS A randomized controlled trial was conducted with 170 adolescents with moderate to severe asthma. Families were randomized to MST-HC or attention control. Data were collected at baseline and 6 and 12 months after intervention completion. RESULTS In linear mixed models, adolescents in the MST-HC group had increases in asthma knowledge; asthma knowledge was unchanged for attention control. Controller device use skills increased for adolescents in the MST-HC group, while skills declined for attention control. Both knowledge and skills mediated the relationship between intervention condition and changes in illness management. CONCLUSIONS Tailored, home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved.
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Affiliation(s)
- Deborah A Ellis
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Pamela King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Sylvie Naar-King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
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20
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Chan AHY, Stewart AW, Foster JM, Mitchell EA, Camargo CA, Harrison J. Factors associated with medication adherence in school-aged children with asthma. ERJ Open Res 2016; 2:00087-2015. [PMID: 27730181 PMCID: PMC5005164 DOI: 10.1183/23120541.00087-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/28/2016] [Indexed: 11/23/2022] Open
Abstract
Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6–15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17–48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (−3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations. Girls, children of Asian ethnicity, small household size and younger diagnosis age have better adherence to asthmahttp://ow.ly/Z1y6Q
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Affiliation(s)
- Amy H Y Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alistair W Stewart
- Epidemiology & Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Edwin A Mitchell
- Dept of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Carlos A Camargo
- Dept of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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21
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The Relationship of Transition Readiness, Self-Efficacy, and Adherence to Preferred Health Learning Method by Youths with Chronic Conditions. J Pediatr Nurs 2015; 30:e83-90. [PMID: 26138374 DOI: 10.1016/j.pedn.2015.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health care transition preparation, medication adherence, and self-efficacy are important skills to achieve optimal health outcomes. It is unclear how pediatric patients with chronic conditions obtain health information that may impact the acquisition of these skills. METHODS In this cross-sectional study, we determined the preferred sources/methods for health information among youths with chronic conditions and their relationship to health care transition readiness (STARx Questionnaire), self-efficacy (Iannotti's Diabetes Management Self-efficacy Scale), and medication adherence (Morisky Medication Adherence Scale). Youths with various chronic health conditions attending Victory Junction, a therapeutic camp, were invited to complete these online surveys. RESULTS A total of 160 youths with different chronic conditions from multiple institutions, ages 6 to 16 years participated. Most commonly preferred sources of medical information were family/parents (n=122, 76.3%) and health care providers (n=88, 55.0%). Youths who favored family/parents had the highest medication adherence rates. In turn, youths who favored health care providers over other sources, scored highest on self-efficacy and transition readiness of all groups. CONCLUSION Our novel findings represent important areas of intervention to improve transition readiness, self-efficacy, and medication adherence. Ascertaining the patients' preferred method of learning about the disease and its management is important in order to customize and enhance health care transition readiness, self-efficacy, and medication adherence.
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Craven VE, Morton RW, Spencer S, Devadason SG, Everard ML. Electronic monitoring and reminding devices for improving adherence to inhaled therapy in patients with asthma. Hippokratia 2015. [DOI: 10.1002/14651858.cd011554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vanessa E Craven
- Sheffield Children's Hospital; Department of Respiratory Medicine; Sheffield UK
| | - Robert W Morton
- Sheffield Children's Hospital; Department of Respiratory Medicine; Sheffield UK
| | - Sally Spencer
- Lancaster University; Faculty of Health and Medicine; Bailrigg Lancaster Lancashire UK LA1 4YD
| | - Sunalene G Devadason
- The University of Western Australia; School of Paediatrics and Child Health; Crawley Western Australia Australia
| | - Mark L Everard
- The University of Western Australia, Princess Margaret Hospital; School of Paediatrics and Child Health; Subiaco Western Australia Australia
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Wilson C, Rapp KI, Jack L, Hayes S, Post R, Malveaux F. Asthma Risk Profiles of Children Participating in an Asthma Education and Management Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2014.977412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carpenter DM, Stover A, Slota C, Ayala GX, Yeatts K, Tudor G, Davis S, Williams D, Sleath B. An evaluation of physicians' engagement of children with asthma in treatment-related discussions. J Child Health Care 2014; 18:261-74. [PMID: 23818146 PMCID: PMC5379471 DOI: 10.1177/1367493513489780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela Stover
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Slota
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- Graduate School of Public Health, San Diego State University, California, USA
| | - Karen Yeatts
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Maine, USA
| | | | - Dennis Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA Cecil G Sheps Center for Health Services Research, North Carolina, USA
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Cohn RC. A review of the effects of medication delivery systems on treatment adherence in children with asthma. Curr Ther Res Clin Exp 2014; 64:34-44. [PMID: 24944355 DOI: 10.1016/s0011-393x(03)00002-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2002] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A patient's adherence to an appropriate treatment regimen is necessary to minimize morbidity and mortality associated with childhood asthma. Many factors influence the success of treatment adherence. OBJECTIVE The goal of this article was to examine the effect of the mode of medication delivery on the success of treatment adherence in children with asthma. METHODS Relevant clinical studies were identified through a MEDLINE search of articles published from 1966 to 2002, using the search terms adherence, aerosol, asthma, children, compliance, dry powder inhaler, metered-dose inhaler, nebulizer, and pediatric. RESULTS A relationship seems to exist between treatment adherence and the type of medication delivery system used in childhood asthma. The highest rates of adherence appear to be associated with oral medications. CONCLUSIONS Clinicians should consider the mode of medication delivery as 1 factor that can influence the success of treatment adherence.
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Affiliation(s)
- Robert C Cohn
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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26
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Using technology to assess and promote adherence to medical regimens in pediatric chronic illness. J Pediatr 2014; 164:922-7. [PMID: 24359939 DOI: 10.1016/j.jpeds.2013.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/11/2013] [Accepted: 11/06/2013] [Indexed: 12/15/2022]
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Lavoie KL, Moullec G, Lemiere C, Blais L, Labrecque M, Beauchesne MF, Pepin V, Cartier A, Bacon SL. Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial. Patient Prefer Adherence 2014; 8:1555-69. [PMID: 25422587 PMCID: PMC4231985 DOI: 10.2147/ppa.s66966] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Daily adherence to inhaled corticosteroid (ICS) regimens is one of the most important factors linked to achieving optimal asthma control. Motivational interviewing (MI) is a client-centered communication style that focuses on enhancing intrinsic motivation to engage in appropriate self-management behaviors. MI has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This pilot "proof of concept" trial assessed the feasibility of MI to improve daily ICS adherence and asthma control levels in adult asthmatics. METHODS Fifty-four poorly controlled (Asthma Control Questionnaire [ACQ] score ≥1.5), highly nonadherent (filled <50% of ICS medication in the last year) adult asthmatics were recruited from the outpatient asthma clinic of a university-affiliated hospital. Participants underwent baseline assessments and were randomly assigned to MI (3×30 minutes sessions within a 6-week period, n=26) or a usual care (UC) control group (n=28). ICS adherence (% pharmacy refills) and asthma control (ACQ, Asthma Control Test [ACT]) were measured at 6 and 12 months postintervention. Mixed model repeated measure analyses for both intent-to-treat and per-protocol were used. Results were adjusted for a priori-defined covariates including baseline adherence. Patients in the MI group also reported their impressions of the intervention. RESULTS Six-month adjusted intent-to-treat analyses revealed a mean change in the percentage of ICS refills of 13% in the MI group vs 6% in the UC group (between group net improvement associated with MI =+6% [-12% to 24%]). Twelve-month analyses revealed a mean change in the percentage of ICS refills of 11% (MI group) vs 7% in the UC group (between group net improvement associated with MI =+3% [-11% to 18%]) representing an effect size (ES) of d=0.20 (medium). Six-month adjusted net improvement in ACQ and ACT scores between MI and control groups was -0.2 and +0.7, respectively, with improvements being even more pronounced at 12 months (ACQ =-0.5; ACT =+1.1; ES, d=0.12 and 0.18 [small], respectively). Interestingly, 6- and 12-month net improvements in asthma self-efficacy (which is specifically targeted by MI) improved by +0.4 and +0.4, respectively, with an ES of d=0.46 (marginally large). Patients in the MI group rated the intervention overwhelmingly positively in terms of usefulness, pertinence, feasibility, enjoyableness, and likelihood to change adherence behavior. CONCLUSION Results suggest that a brief (90 minutes) MI intervention that targets ICS adherence can produce clinically significant improvements in adherence behavior, asthma control levels, and asthma self-efficacy in poorly controlled nonadherent asthmatics at 6 months that are maintained for 1 year, and it is well accepted by patients. Future studies including larger sample sizes, modified intervention designs (eg, MI "booster" sessions), and assessments of the extent behavior changes translate into clinical improvements (eg, in asthma control and quality of life) are warranted.
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Affiliation(s)
- Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Psychology, University of Quebec at Montreal (UQAM), Succursale Center-Ville, Montreal, Quebec, Canada
- Correspondence: Kim L Lavoie, Department of Psychology, University of Quebec at Montreal (UQAM), PO Box 8888, Succursale Center-Ville, Montreal, Quebec H3C 3P8, Canada, Tel +1 514 987 3000 (3835), Fax +1 514 987 7953, Email
| | - Gregory Moullec
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Catherine Lemiere
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Lucie Blais
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Manon Labrecque
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Marie-France Beauchesne
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Veronique Pepin
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - André Cartier
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
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Chan AHY, Reddel HK, Apter A, Eakin M, Riekert K, Foster JM. Adherence monitoring and e-health: how clinicians and researchers can use technology to promote inhaler adherence for asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:446-54. [PMID: 24565615 DOI: 10.1016/j.jaip.2013.06.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/20/2013] [Accepted: 06/28/2013] [Indexed: 01/30/2023]
Abstract
In the past decade, rapid technological developments have advanced electronic monitoring devices (EMD) for asthma inhalers beyond simple recording of actuations to providing adherence promotion features and detailed information about patterns of medication use. This article describes currently available EMDs, discusses their utility and limitations in assessing adherence, and describes the potential for EMD-based adherence promotion interventions in clinical settings. To date, the main use of EMDs has been in clinical research. In selected populations, simple EMD-based adherence interventions, delivered either through clinician-to-patient feedback about medication use or by direct-to-patient reminders for missed doses, can significantly improve adherence. Further work is now needed to determine the impact of EMDs on clinical outcomes and their cost-effectiveness and feasibility for different clinical settings, including in disadvantaged populations. If this evidence can be provided, then the use of EMDs could expand into the management of asthma in populations with high health care costs, eg, severe asthma. In the future, medication monitoring could help distinguish poor treatment response from poor adherence, guide prescribing decisions, and prompt providers to discuss barriers to adherence; electronic health records may provide the gateway for integrating medication-use monitoring into digital chronic care management.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Helen Kathryn Reddel
- Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia
| | - Andrea Apter
- Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Michelle Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Md
| | - Kristin Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Md
| | - Juliet Michelle Foster
- Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia.
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29
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Duncan CL, Hogan MB, Tien KJ, Graves MM, Chorney JM, Zettler MD, Koven L, Wilson NW, Dinakar C, Portnoy J. Efficacy of a parent-youth teamwork intervention to promote adherence in pediatric asthma. J Pediatr Psychol 2012; 38:617-28. [PMID: 23248342 DOI: 10.1093/jpepsy/jss123] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.
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Affiliation(s)
- Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV 26506-6040, USA.
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30
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DeFulio A, Silverman K. The use of incentives to reinforce medication adherence. Prev Med 2012; 55 Suppl:S86-94. [PMID: 22580095 PMCID: PMC3424340 DOI: 10.1016/j.ypmed.2012.04.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 04/24/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Poor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence. METHODS We conducted a systematic review of peer-reviewed empirical evaluations of incentives provided to patients contingent upon medication adherence. RESULTS This review suggests that incentive-based medication adherence interventions can be very effective, but there are few controlled studies. The studies on incentive-based medication adherence interventions most commonly feature patients taking medication for drug or alcohol dependence, HIV, or latent tuberculosis. Across studies that reported percent adherence comparisons, incentives increased adherence by a mean of 20 percentage points, but effects varied widely. Cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention. Post-intervention evaluations were rare, but tended to find that adherence effects diminish after the interventions are discontinued. CONCLUSIONS Incentive-based medication adherence interventions are promising but understudied. A significant challenge for research in this area is the development of sustainable and cost-effective long-term interventions.
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Affiliation(s)
- Anthony DeFulio
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore MD 21224, USA.
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31
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Abstract
Negotiated treatment plans are increasingly recommended in asthma clinical care. However, limited data are available to indicate whether this more patient-engaged process results in improved health outcomes. The aim of this study was to determine the associations between the presence of a negotiated treatment plan and the outcomes related to adherence to the medical regimen, symptom control, and health care use. The focus of the study was on women, the subgroup of adult patients, who are most vulnerable for negative asthma outcomes. Data were collected by telephone interview and medical record review from 808 women diagnosed with asthma at baseline, first year, and second year follow-up. Associations were examined between the presence of a negotiated treatment plan at baseline and subsequent asthma outcomes. Women with a negotiated treatment plan reported more adherent to prescribed asthma medicines (odds ratio (OR) = 2.41, 95% confidence interval (CI) = (1.82, 3.19)) and those with a plan and using oral steroids at baseline had less oral steroid use at follow-up (OR = 0.21, 95% CI = (0.05, 0.93)). Women with a negotiated plan also had more days (17%, 95% CI = (8, 27)) and nights (31%, 95% CI = (16, 48)) with symptoms than those without such a plan. No differences in hospitalizations, emergency department visits, or urgent physician office visits were noted between the groups. Patients with higher education levels were more likely to have a negotiated treatment plan. Negotiated treatment plans appear to have achieved greater adherence to prescribed asthma medicines and less need for oral steroids but were not related to fewer symptoms of asthma or reductions in urgent health care use. Additional strategies may be needed to reduce symptom and health services utilization outcomes.
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Affiliation(s)
- Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109, USA.
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32
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Ingerski LM, Hente EA, Modi AC, Hommel KA. Electronic measurement of medication adherence in pediatric chronic illness: a review of measures. J Pediatr 2011; 159:528-34. [PMID: 21722917 PMCID: PMC3176987 DOI: 10.1016/j.jpeds.2011.05.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/11/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Lisa M. Ingerski
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Elizabeth A. Hente
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Avani C. Modi
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
| | - Kevin A. Hommel
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology
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Spaulding SA, Devine KA, Duncan CL, Wilson NW, Hogan MB. Electronic monitoring and feedback to improve adherence in pediatric asthma. J Pediatr Psychol 2011; 37:64-74. [PMID: 21852340 DOI: 10.1093/jpepsy/jsr059] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of electronic monitoring and feedback to improve adherence in children taking daily asthma controller medications. METHOD Five patients with asthma and considered nonadherent participated. Inhalers were electronically monitored with the MDILogII(TM) device, and feedback was given by medical staff. Using a nonconcurrent multiple-baseline design, patients and their parents received bimonthly feedback regarding medication use. Following treatment, feedback was withdrawn and effects of monitoring alone were observed. RESULTS Three participants showed improvements in adherence following treatment, with more notable increases when baseline adherence was low. Improvements in the inhaler technique occurred for all patients. Some patients demonstrated improvements in lung functioning and functional severity. When feedback was withdrawn, adherence decreased for some participants, but technique improvements maintained. CONCLUSIONS Results support the use of objective monitoring devices for assessing pediatric asthma patients' adherence and indicate that feedback from medical staff may improve and maintain medication adherence for some patients.
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Affiliation(s)
- Scott A Spaulding
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
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Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B. A pilot study to enhance preventive asthma care among urban adolescents with asthma. J Asthma 2011; 48:523-30. [PMID: 21599562 DOI: 10.3109/02770903.2011.576741] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications. OBJECTIVE To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity. DESIGN/METHODS SUBJECTS/SETTING Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. DESIGN Single group pre-post pilot study during the 2009-2010 school year. INTERVENTION Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year. RESULTS We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again. CONCLUSIONS This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA.
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35
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Adherence with preventive medication in childhood asthma. Pulm Med 2011; 2011:973849. [PMID: 21660201 PMCID: PMC3109699 DOI: 10.1155/2011/973849] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/12/2011] [Indexed: 12/01/2022] Open
Abstract
Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.
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Abstract
Adherence monitoring is an important issue in inhaled drug delivery. Adherence is commonly found to be low and poor adherence is associated with increased mortality and morbidity and increased use of health services. Improving adherence is essential to maintaining disease and symptom control for patients and decreasing health costs. Feedback on actual adherence has been shown to increase subsequent adherence. In addition, education programs, reminder systems and increased patient-clinician interaction can also improve adherence. However, improved adherence is not sufficient if inhalation devices are being used incorrectly; the emphasis must be on devices being used in accordance with both the prescribed regimen and the instructions for use. As a result of technological advancements, drug delivery devices that both monitor adherence and address poor inhaler technique are now available. These devices combine monitoring systems with various feedback mechanisms in order to 'coach' the patient to use the device correctly. Some devices also incorporate connectivity to communicate accurate adherence and inhaler technique data to the clinician. This editorial considers current and future adherence monitoring devices and the impact that such technology could have on improving the patient's adherence and inhaler technique.
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Bauer S, de Niet J, Timman R, Kordy H. Enhancement of care through self-monitoring and tailored feedback via text messaging and their use in the treatment of childhood overweight. PATIENT EDUCATION AND COUNSELING 2010; 79:315-319. [PMID: 20418046 DOI: 10.1016/j.pec.2010.03.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This paper first illustrates the general potential of the short message service (SMS) for symptom and behavior monitoring and the provision of tailored feedback. Second, an SMS-based maintenance treatment (SMSMT) is introduced aimed at enhancing the treatment of childhood overweight. METHODS After a 12-week cognitive behavioral group treatment (CBGT), 40 children were assigned to the SMSMT for a period of 36 weeks. Children were asked to send weekly self-monitoring data on eating behavior, exercise behavior, and emotions and received tailored feedback. The adherence to SMSMT and changes in Body Mass Index Standard Deviation Scores (BMI-SDS) during the first and second treatment phase were analysed. RESULTS Children (mean age=10.05, SD=1.28) submitted 67% of the weekly SMS that they were expected to send in. During CBGT a significant reduction by 0.20 BMI-SDS was observed. The reduction by 0.07 BMI-SDS during the SMSMT did not reach statistical significance. CONCLUSION The results support the feasibility of SMSMT in the treatment of childhood overweight. The efficacy of the intervention needs to be demonstrated in an RCT. PRACTICE IMPLICATIONS SMSMT is a promising intervention that may extend the reach of treatment centers for childhood overweight at reasonable cost and effort.
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In the Shadow of Academic Medical Centers: A Systematic Review of Urban Health Research in Baltimore City. J Community Health 2010; 35:433-52. [PMID: 20422444 DOI: 10.1007/s10900-010-9258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burgess SW, Sly PD, Devadason SG. Providing feedback on adherence increases use of preventive medication by asthmatic children. J Asthma 2010; 47:198-201. [PMID: 20170329 DOI: 10.3109/02770900903483840] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%, p <.01). There were significant improvements in clinical measures of disease control compared with baseline in both groups. The change in forced expiratory volume in 1 s (FEV(1)) (% predicted) was greater in those subjects receiving feedback (13.8% versus 9.8%). However, lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance. Measuring adherence and providing feedback increases the use of preventive medication. A larger study is required to explore implications for disease control.
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Affiliation(s)
- Scott W Burgess
- Department of Paediatrics, Redland Hospital, Brisbane, Queensland, 4163 Australia.
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Bane C, Hughe CM, McElnay JC. Determinants of medication adherence in hypertensive patients: an application of self-efficacy and the Theory of Planned Behaviour. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.3.0006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
The study aimed to identify the determinants of medication adherence in a population of hypertensive outpatients. The principle objective of the present study was to determine the utility of self-efficacy and the Theory of Planned Behaviour (TPB) in predicting adherence with antihypertensive medication.
Setting
An outpatient hypertension clinic at the Belfast City Hospital, Northern Ireland.
Method
Outpatients who had attended the hypertension clinic on at least one previous occasion were invited to participate in the study. Participants completed a questionnaire incorporating measures of adherence with medication, medical and sociodemographic factors, together with measures of self-efficacy and the TPB. There were no specific study exclusion criteria.
Key findings
A total of 139 participants took part in the study; 20.9% of the participants reported non-adherence with their prescribed antihypertensive medication. A statistically significant difference in self-efficacy scores between the adherent and non-adherent groups was revealed by a Mann-Whitney test, with adherent patients perceiving higher levels of self-efficacy. Regression analysis with the TPB variables revealed that adherence was predicted by intentions and subjective norms, with 41% of the variance explained. Intention was predicted by attitudes and perceived behavioural control, with 61.9% of the variance explained.
Conclusion
The present study provides support for the use of self-efficacy and the TPB in predicting medication adherence; however, further research is required on the application of the TBP in the prediction of health behaviour. These findings have implications for the design of adherence-enhancing interventions.
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Affiliation(s)
- Catherine Bane
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
| | - Carmel M Hughe
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
| | - James C McElnay
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
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Otsuki M, Eakin MN, Rand CS, Butz AM, Hsu VD, Zuckerman IH, Ogborn J, Bilderback A, Riekert KA. Adherence feedback to improve asthma outcomes among inner-city children: a randomized trial. Pediatrics 2009; 124:1513-21. [PMID: 19948623 PMCID: PMC5450495 DOI: 10.1542/peds.2008-2961] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We evaluated the longitudinal effects of home-based asthma education combined with medication adherence feedback (adherence monitoring with feedback [AMF]) and asthma education alone (asthma basic care [ABC]) on asthma outcomes, relative to a usual-care (UC) control group. METHODS A total of 250 inner-city children with asthma (mean age: 7 years; 62% male; 98% black) were recruited from a pediatric emergency department (ED). Health-outcome measures included caregiver-frequency of asthma symptoms, ED visits, hospitalizations, and courses of oral corticosteroids at baseline and 6-, 12-, and 18-month assessments. Adherence measures included caregiver-reported adherence to inhaled corticosteroid (ICS) therapy and pharmacy records of ICS refills. Multilevel modeling was used to examine the differential effects of AMF and ABC compared with UC. RESULTS ED visits decreased more rapidly for the AMF group than for the UC group, but no difference was found between the ABC and UC groups. The AMF intervention led to short-term improvements in ICS adherence during the active-intervention phase relative to UC, but this improvement decreased over time. Asthma symptoms and courses of corticosteroids decreased more rapidly for the ABC group than for the UC group. Hospitalization rates did not differ between either intervention group and the UC group. No differences were found between the ABC and AMF groups on any outcome. CONCLUSIONS Asthma education led to improved adherence and decreased morbidity compared with UC. Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children. Adherence feedback did not improve outcomes over education alone.
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Affiliation(s)
- Michiko Otsuki
- Department of Psychology, University of South Florida St Petersburg, St Petersburg, Florida
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arlene M. Butz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Van Doren Hsu
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Ilene H. Zuckerman
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Jean Ogborn
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andrew Bilderback
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Clark N, Lachance L, Milanovich AF, Stoll S, Awad DF. Characteristics of successful asthma programs. Public Health Rep 2009; 124:797-805. [PMID: 19894421 DOI: 10.1177/003335490912400606] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We identified characteristics of interventions associated with positive asthma outcomes to understand how programs can be improved. METHODS We identified asthma interventions from the peer-reviewed literature or through a nomination process for unpublished programs. Initially, we identified 532 interventions. Of those, 223 met our eligibility criteria (e.g., focus on asthma, completed an evaluation, and demonstrated at least one asthma-related health outcome) and provided information on program components and processes, administration, evaluation, and findings through telephone interviews, program documents, and published reports. We analyzed bivariate relationships between programmatic factors and outcomes using Chi-square statistics, Fisher's exact tests, and unconditional logistic regression. We confirmed findings for all programs by analyzing the subset with published results in peer-reviewed journals. RESULTS Our findings indicated that programs were more likely to report a positive impact on health outcomes if they (1) were community based, (2) engaged the participation of community-based organizations, (3) provided program components in a clinical setting, (4) provided asthma training to health-care providers, (5) collaborated with other organizations and institutions and with government agencies, (6) designed a program for a specific racial/ethnic group, (7) tailored content or delivery based on individual health or educational needs, and (8) conducted environmental assessments and tailored interventions based on these assessments. CONCLUSIONS Positive asthma outcomes were associated with specific program characteristics: being community centered, clinically connected, and continuously collaborative. Program developers and implementers who build these characteristics into their interventions will be more likely to realize desired asthma outcomes.
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Affiliation(s)
- Noreen Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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43
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Chisholm-Burns MA, Spivey CA, Rehfeld R, Zawaideh M, Roe DJ, Gruessner R. Immunosuppressant therapy adherence and graft failure among pediatric renal transplant recipients. Am J Transplant 2009; 9:2497-504. [PMID: 19681814 DOI: 10.1111/j.1600-6143.2009.02793.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (<or=18 years) who received their only transplant during 1995-2000, experienced graft survival more than 6 months posttransplant, had 36 months of USRDS data (or had data until graft failure or death), utilized Medicare IST coverage, and were prescribed cyclosporine/tacrolimus were included. IST adherence was measured by medication possession ratio (MPR). Cox proportional hazards analysis was used to assess the relationship between time to graft failure and continuous MPR. MPR quartiles were used to examine MPR as a categorical variable (Quartile 4 = adherent group, Quartiles 1-3 = nonadherent group). Kaplan-Meier estimates of time to graft failure were compared between adherent and nonadherent groups. 877 RTRs met inclusion criteria. Cox proportional hazards modeling suggested that greater adherence was significantly associated with longer time to graft failure (p = 0.009), after adjusting for relevant clinical factors. Kaplan-Meier analysis found a difference between adherent and nonadherent groups in graft survival by time (chi(2)= 5.68, p = 0.017). Interventions promoting adherence should be implemented among pediatric RTRs and parents/guardians to optimize graft survival.
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Graves MM, Roberts MC, Rapoff M, Boyer A. The efficacy of adherence interventions for chronically ill children: a meta-analytic review. J Pediatr Psychol 2009; 35:368-82. [PMID: 19710248 DOI: 10.1093/jpepsy/jsp072] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To provide quantitative information about the overall effectiveness of adherence interventions to improve adherence and health outcomes for children with chronic illnesses. To evaluate statistically the potential moderators. METHODS A meta-analysis was performed on 71 adherence intervention studies. RESULTS Weighted-mean effect size (ES) across all the adherence outcomes for group design studies was in the medium range (mean d = 0.58) and for single-subject design studies was in the large range (mean d = 1.44). The weighted mean ES across all health outcome measures for studies using group designs was in the medium range (mean d = 0.40) and for studies using single-subject designs was in the large range (mean d = 0.74). CONCLUSIONS Adherence interventions for children with chronic illnesses effectively increase adherence and result in some positive health benefits. Intervention and methodological variables had significant impact on ESs. High levels of heterogeneity characterized the data.
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Davis DP, Jandrisevits MD, Iles S, Weber TR, Gallo LC. Demographic, socioeconomic, and psychological factors related to medication non-adherence among emergency department patients. J Emerg Med 2009; 43:773-85. [PMID: 19464136 DOI: 10.1016/j.jemermed.2009.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 04/08/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many Emergency Department (ED) visits are related to medication non-adherence; however, the contributing factors are poorly understood. OBJECTIVES To explore the relative contributions of demographic, socioeconomic, and psychological factors to medication non-adherence in an ED population. METHODS This was a cross-sectional analysis enrolling patients with one of three illnesses requiring chronic medication usage (hypertension, diabetes, or seizures). Trained research associates administered a 60-item survey that assessed demographic and socioeconomic information, as well as a variety of psychological factors potentially relevant to adherence (health attitudes, health beliefs, depression, anxiety, social support, and locus of control). Patients rated their overall prescription medication adherence and estimated the number of days in the preceding month on which doses were missed. In addition, treating physicians estimated the degree to which the ED visit was related to medication non-adherence; clinical data were abstracted to help validate patient and physician assessments. The relationships between non-adherence and demographic, socioeconomic, and psychological variables were explored using multivariate statistics and logistic regression. Covariance analysis was performed to validate subscales, and receiver-operator curves were used to define optimal threshold values. RESULTS A total of 472 patients consented to participate, with good representation for various demographic and socioeconomic groups. Each psychological factor related significantly to both patient and physician ratings of non-adherence (p < 0.05). Of all demographic and socioeconomic factors examined, only current or historical drug use predicted non-adherence. CONCLUSIONS Psychological factors seem to be important determinants of medication non-adherence among ED patients. These data may help define future research directions and interventions.
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Affiliation(s)
- Daniel P Davis
- Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103-8240, USA
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Jentzsch NS, Camargos PAM. Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice. J Bras Pneumol 2009; 34:614-21. [PMID: 18797747 DOI: 10.1590/s1806-37132008000800012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 02/20/2008] [Indexed: 11/22/2022] Open
Abstract
Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis. Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil. The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.
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De Bleser L, Matteson M, Dobbels F, Russell C, De Geest S. Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int 2009; 22:780-97. [PMID: 19386076 DOI: 10.1111/j.1432-2277.2009.00881.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Reports of interventions to improve adherence to medical regimens in solid organ transplant recipients are scarce. A systematic review identified 12 intervention studies. These studies focused on renal, heart, and liver transplant recipients. Five reports used randomized controlled trial (RCT) designs. Sample sizes varied between 18 and 110 subjects. The interventions are difficult to evaluate and categorize because of brief descriptions of intervention details. Of the 12 studies identified in this review, only five studies found a statistically significant improvement in at least one medication-adherence outcome with the intervention. In general, most included a combination of patient-focused cognitive/educational, counseling/behavioral, and psychologic/affective dimensions. Eight studies intervened at the healthcare provider, healthcare setting or healthcare system level, but showed a limited improvement in adherence. No single intervention proved to be superior at increasing medication-adherence in organ transplantation, but a combination of interventions in a team approach for the chronic disease management of organ transplant patients may be effective in a long-term perspective. In conclusion, finding the most effective combination of interventions to enhance adherence is vital. Utilizing an RCT design and adhering to the CONSORT guidelines can lead to higher quality studies and possibly more effective intervention studies to enhance medication-adherence.
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Affiliation(s)
- Leentje De Bleser
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, Belgium
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48
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Kamps JL, Rapoff MA, Roberts MC, Varela RE, Barnard M, Olson N. Improving Adherence to Inhaled Corticosteroids in Children With Asthma: A Pilot of a Randomized Clinical Trial. CHILDRENS HEALTH CARE 2008. [DOI: 10.1080/02739610802437335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van Dellen QM, van Aalderen WMC, Bindels PJE, Ory FG, Bruil J, Stronks K. Asthma beliefs among mothers and children from different ethnic origins living in Amsterdam, the Netherlands. BMC Public Health 2008; 8:380. [PMID: 18980690 PMCID: PMC2603023 DOI: 10.1186/1471-2458-8-380] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 11/03/2008] [Indexed: 11/12/2022] Open
Abstract
Background Doctors and patients hold varying beliefs concerning illness and treatment. Patients' and families' explanatory models (EMs) vary according to personality and sociocultural factors. In a multi-ethnic society, it is becoming increasingly significant that doctors understand the different beliefs of their patients in order to improve patient/doctor communication as well as patient adherence to treatment. Methods Twelve focus groups were formed, consisting of 40 children diagnosed with asthma, as well as 28 mothers of these children. These groups included mothers and children of different ethnicities who were living in Amsterdam, the Netherlands. In order to understand the beliefs that both mothers and children hold regarding asthma and its treatment, the explanatory models were analysed and compared. Results Study findings show that mothers and children, regardless of ethnicity and age, have their own EMs. Overall, there is a great deal of uncertainty related to the causes, consequences, problems, and symptoms of asthma and its treatment. It also seems that many concerns and feelings of discomfort are the result of lack of knowledge. For instance, the fact that asthma is not seen as a chronic disease requiring daily intake of an inhaled corticosteroid, but rather as an acute phenomenon triggered by various factors, may be very relevant for clinical practice. This particular belief might suggest an explanation for non-adherent behaviour. Conclusion A thorough understanding of the mothers' and children's beliefs regarding the illness and its treatment is an important aspect in the management of asthma. Gaining an understanding of these beliefs will provide a foundation for a solid clinician-patient/family partnership in asthma care. Although ethnic differences were observed, the similarities between the mothers' and children's beliefs in this multi-ethnic population were striking. In particular, a common belief is that asthma is considered an acute rather than a chronic condition. In addition, there is a lack of knowledge about the course and the self-management of asthma. Health care providers should be aware of these commonly held beliefs, and this information could be shared in educational programs.
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Affiliation(s)
- Q M van Dellen
- Department of Paediatric Pulmonology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Shapiro JR, Bauer S, Hamer RM, Kordy H, Ward D, Bulik CM. Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40:385-391. [PMID: 18984496 PMCID: PMC2592683 DOI: 10.1016/j.jneb.2007.09.014] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 09/28/2007] [Accepted: 09/30/2007] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine acceptability, attrition, adherence, and preliminary efficacy of mobile phone short message service (SMS; text messaging) for monitoring healthful behaviors in children. DESIGN All randomized children received a brief psychoeducational intervention. They then either monitored target behaviors via SMS with feedback or via paper diaries (PD) or participated in a no-monitoring control (C) for 8 weeks. SETTING University of North Carolina at Chapel Hill. PARTICIPANTS Fifty-eight children (age 5-13) and parents participated; 31 completed (SMS: 13/18, PD: 7/18, C: 11/22). INTERVENTION Children and parents participated in a total of 3 group education sessions (1 session weekly for 3 weeks) to encourage increasing physical activity and decreasing screen time and sugar-sweetened beverage consumption. MAIN OUTCOME MEASURES Treatment acceptability, attrition, and adherence to self-monitoring. ANALYSIS Descriptive statistics and nonparametric tests were used to analyze differences across time and group. RESULTS Children in SMS had somewhat lower attrition (28%) than both PD (61%) and C (50%), and significantly greater adherence to self-monitoring than PD (43% vs 19%, P < .02). CONCLUSIONS AND IMPLICATIONS Short message service may be a useful tool for self-monitoring healthful behaviors in children, although the efficacy of this approach needs further study. Implications suggest that novel technologies may play a role in improving health.
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Affiliation(s)
- Jennifer R Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC 27599, USA.
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