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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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Oluwagbemi OO, Oluwagbemi FE, Jatto A, Hui C. MAVSCOT: A fuzzy logic-based HIV diagnostic system with indigenous multi-lingual interfaces for rural Africa. PLoS One 2020; 15:e0241864. [PMID: 33156877 PMCID: PMC7647102 DOI: 10.1371/journal.pone.0241864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
HIV still constitutes a major public health problem in Africa, where the highest incidence and prevalence of the disease can be found in many rural areas, with multiple indigenous languages being used for communication by locals. In many rural areas of the KwaZulu-Natal (KZN) in South Africa, for instance, the most widely used languages include Zulu and Xhosa, with only limited comprehension in English and Afrikaans. Health care practitioners for HIV diagnosis and treatment, often, cannot communicate efficiently with their indigenous ethnic patients. An informatics tool is urgently needed to facilitate these health care professionals for better communication with their patients during HIV diagnosis. Here, we apply fuzzy logic and speech technology and develop a fuzzy logic HIV diagnostic system with indigenous multi-lingual interfaces, named Multi-linguAl HIV indigenouS fuzzy logiC-based diagnOstic sysTem (MAVSCOT). This HIV multilingual informatics software can facilitate the diagnosis in underprivileged rural African communities. We provide examples on how MAVSCOT can be applied towards HIV diagnosis by using existing data from the literature. Compared to other similar tools, MAVSCOT can perform better due to its implementation of the fuzzy logic. We hope MAVSCOT would help health care practitioners working in indigenous communities of many African countries, to efficiently diagnose HIV and ultimately control its transmission.
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Affiliation(s)
- Olugbenga Oluseun Oluwagbemi
- Department of Mathematical Sciences, Stellenbosch University, Matieland, Stellenbosch, South Africa
- Department of Computer Science and Information Technology, Sol Plaatje University, Kimberley, South Africa
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | | | - Abdulwahab Jatto
- Department of Computer Science, Federal University Lokoja, Lokoja, Nigeria
| | - Cang Hui
- Department of Mathematical Sciences, Stellenbosch University, Matieland, Stellenbosch, South Africa
- African Institute for Mathematical Sciences, Cape Town, South Africa
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ART uptake and adherence among women who use drugs globally: A scoping review. Drug Alcohol Depend 2020; 215:108218. [PMID: 32916450 PMCID: PMC7899784 DOI: 10.1016/j.drugalcdep.2020.108218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the state of peer-reviewed literature surrounding uptake and adherence of antiretroviral therapy (ART) among HIV-positive women who use drugs (WWUD). METHODS Consistent with PRISMA-ScR guidelines, we conducted a scoping literature review on ART uptake and adherence among WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting at least one ART uptake or adherence related result among WWUD aged 18 or older; peer-reviewed; published in English between 1996-2018. RESULTS Our search identified 6735 studies; 86 met eligibility requirements. ART uptake ranged from 30 % to 76 % and adherence ranged from 27 % to 95 %. Substance use, co-morbid psychiatric disorders, and side effects emerged as the primary ART uptake and adherence barriers among this population. Few facilitators were identified. CONCLUSION This study is the first scoping review to look at ART uptake and adherence among WWUD globally. The wide range in uptake and adherence outcomes indicates the need for gold standard assessments, which may differ between high and low resource settings. This study offers rich insight into uptake and adherence barriers and facilitators, primarily at the intrapersonal level. More research is needed to examine interventions that focus on additional levels of the SEM (e.g., community and policy levels). These review findings can inform ART interventions, future research, and offer guidance to other support services with WWUD, such as PrEP interventions.
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Cohn AM, Elmasry H, Ehlke SJ. Utilization, receptivity and reactivity to Interactive Voice Response daily monitoring in risky drinking smokers who are motivated to quit. Tob Induc Dis 2018; 16:25. [PMID: 31516425 PMCID: PMC6659485 DOI: 10.18332/tid/84972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Interactive Voice Response (IVR) technology has become an increasingly popular and valid method for collecting Ecological Momentary Assessment (EMA) data on a variety of health-risk behaviors, including daily alcohol use and cigarette smoking, and for stimulating behavior change. However, very little research has evaluated the parameters of IVR compliance and reactivity in respondents who may have greater problem severity than samples previously examined in published IVR studies. This study examined the prevalence and correlates of use, receptivity and reactivity to IVR monitoring in 77 untreated risky drinking smokers who were motivated to quit within the next 6 months. METHODS Respondents completed twice daily IVR assessments for 28 days and were re-assessed immediately after IVR to measure receptivity and reactivity to daily monitoring and six months post-baseline. RESULTS Mean compliance rate was 70.6%, with a morning rate of 72.4% and an evening compliance rate of 68.9% out of all possible surveys. IVR assessments of drinking and smoking were significantly associated with baseline paper-pencil reports of the same. African-American participants and those who reported more daily stressful events were more compliant. Between the baseline session and the 6-month follow-up, 68% of the sample reported engaging in some form of smoking behavior change (50% reduction in CPD, a quit attempt, past-month continuous abstinence). Nearly 80% reported increased awareness of their behavior due to the IVR and 40% reported intentional behavior change from IVR monitoring. The odds of making a quit attempt at the 6-month follow-up were significantly higher among respondents who reported making purposeful changes to their smoking as a result of IVR monitoring (AOR=3.25, p<0.05). CONCLUSIONS Reactivity was associated with behavior change outcomes. IVR may be a useful tool for motivating behavior change in smokers with alcohol-use problems.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, United States
| | - Hoda Elmasry
- Hoda Elmasry was at the Schroeder Institute for Tobacco Research and Policies Studies, Washington, United States at the time of data analysis and when the manuscript was submitted
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Feasibility of Electronic Health Information and Surveillance System (eHISS) for disease symptom monitoring: A case of rural Ghana. PLoS One 2018; 13:e0197756. [PMID: 29795626 PMCID: PMC5967752 DOI: 10.1371/journal.pone.0197756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The current surge of mobile phone use in many African countries creates the opportunity to provide caregivers with limited access to the health care system with vital health recommendations. At the same time such communication system can be utilised to collect tempero-spatial data on disease symptoms. Objective We assessed the feasibility of an mHealth system among caregivers with children under-five years, designed as a health information and surveillance tool in a rural district of Ghana. Methods A mobile phone-based electronic health information and surveillance system was piloted from February to December 2015. Toll-free numbers were provided to 1446 caregivers, which they could call to receive health advice in case their children showed disease symptoms. The system was setup to evaluate the illness of a sick child. Symptoms reported via the system were evaluated and compared to clinician’s report after follow-up. Cogency of the reported symptoms was assessed using Cohen’s kappa coefficient. Results A total of 169 children with disease symptoms were identified based on phone calls from caregivers. The predominant reported symptoms were fever (64%; n = 108), cough (55%; n = 93) and diarrhoea (33%; n = 55). Temporal pattern of symptomatic cases revealed a peak saturation in the month of September, with fever registering the highest number of symptoms observed. Reported symptoms and clinician’s report revealed a very good agreement for fever (95%, kappa = 0.89); good for diarrhoea (87%, kappa = 0.73) and moderate for cough (76%, kappa = 0.49). Conclusion This pilot concept, has demonstrated the practicality of using mobile phones for assessing childhood disease symptoms and encouraging caregivers to seek early treatment for their children if needed. The strategy to use mobile phones in disease surveillance and treatment support is a promising strategy especially for areas with limited access to the health care system.
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Kipp AM, Rebeiro PF, Shepherd BE, Brinkley-Rubinstein L, Turner M, Bebawy S, Sterling TR, Hulgan T. Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care. AIDS Behav 2017; 21:1996-2004. [PMID: 28213820 PMCID: PMC5493511 DOI: 10.1007/s10461-017-1716-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine's (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose-response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.
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Affiliation(s)
- Aaron M Kipp
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, 37203, USA.
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren Brinkley-Rubinstein
- Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally Bebawy
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd Hulgan
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Rose GL, Badger GJ, Skelly JM, MacLean CD, Ferraro TA, Helzer JE. A Randomized Controlled Trial of Brief Intervention by Interactive Voice Response. Alcohol Alcohol 2017; 52:335-343. [PMID: 28069598 DOI: 10.1093/alcalc/agw102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022] Open
Abstract
Aims To determine the effect of an Interactive Voice Response (IVR) brief intervention (BI) to reduce alcohol consumption among adults seeking primary care. Methods Patients (N = 1855) with unhealthy drinking were recruited from eight academic internal medicine and family medicine clinics and randomized to IVR-BI (n = 938) versus No IVR-BI control (n = 917). Daily alcohol consumption was assessed at baseline, 3- and 6-months using the Timeline Followback. Results The IVR-BI was completed by 95% of the 938 patients randomized to that condition, and 62% of them indicated a willingness to consider a change in their drinking. Participants in both conditions significantly reduced consumption over time, but changes were not different between groups. Regardless of condition, participants with alcohol use disorder (AUD) showed significant decreases in drinking outcomes. No significant changes were observed in patients without AUD, regardless of condition. Conclusion Although the IVR intervention was well accepted by patients, there was no evidence that IVR-BI was superior to No IVR-BI for reducing drinking in the subsequent 6 months. Because both the design and the intervention tested were novel, we cannot say definitively why this particular eHealth treatment lacked efficacy. It could be useful to evaluate the effect of the pre-randomization assessment alone on change in drinking. The high treatment engagement rate and successful implementation protocol are strengths, and can be adopted for future trials. Short summary We examined the efficacy of a novel BI for patient self-administration by automated telephone. Alcohol consumption decreased over time but there were no between-group changes in consumption. Regardless of treatment condition, participants with alcohol use disorder (AUD) showed significant reduction in drinking but participants without AUD showed no change.
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Affiliation(s)
- Gail L Rose
- Department of Psychiatry, The University of Vermont, USA
| | - Gary J Badger
- Department of Medical Biostatistics, The University of Vermont, 27 Hills Building, Burlington, VT 05405, USA
| | - Joan M Skelly
- Department of Medical Biostatistics, The University of Vermont, 27 Hills Building, Burlington, VT 05405, USA
| | - Charles D MacLean
- Department of Medicine, The University of Vermont, College of Medicine, 4S Given Courtyard, Burlington, VT 05405, USA
| | - Tonya A Ferraro
- Department of Research Administrative Services, Harvard University, USA
| | - John E Helzer
- Department of Psychiatry, The University of Vermont, USA
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Nhavoto JA, Grönlund Å, Klein GO. Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers. PLoS One 2017; 12:e0176051. [PMID: 28419149 PMCID: PMC5395223 DOI: 10.1371/journal.pone.0176051] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients’ and healthcare workers’ (HCW) views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART) and tuberculosis (TB) treatment in Mozambique. Methods The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted. Results Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients’ confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system) was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones. Conclusions The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are not a main obstacle for scaling up systems of this kind.
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Affiliation(s)
- José António Nhavoto
- Informatics, School of Business, Örebro University, Örebro, Sweden
- Informatics, Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique
| | - Åke Grönlund
- Informatics, School of Business, Örebro University, Örebro, Sweden
| | - Gunnar O Klein
- Informatics, School of Business, Örebro University, Örebro, Sweden
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Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM, Pappas Y, Gagnon M, Julious SA, Xiang L, Oldenburg B, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12:CD009921. [PMID: 27960229 PMCID: PMC6463821 DOI: 10.1002/14651858.cd009921.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. OBJECTIVES To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. SEARCH METHODS We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. SELECTION CRITERIA Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to select and extract data and to appraise eligible studies. MAIN RESULTS We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. AUTHORS' CONCLUSIONS ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
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Affiliation(s)
- Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Lambert M Felix
- Edge Hill UniversityFaculty of Health and Social CareSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Marie‐Pierre Gagnon
- Traumatologie – Urgence – Soins IntensifsCentre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé10 Rue de l'Espinay, D6‐727QuébecQCCanadaG1L 3L5
| | - Steven A Julious
- University of SheffieldMedical Statistics Group, School of Health and Related ResearchRegent Court, 30 Regent StreetSheffieldUKS1 4DA
| | - Liming Xiang
- Nanyang Technological UniversityDivision of Mathematical Sciences, School of Physical and Mathematical Sciences21 Nanyang LinkSingaporeSingapore
| | - Brian Oldenburg
- University of MelbourneMelbourne School of Population and Global HealthMelbourneVictoriaAustralia
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Rendina HJ, Ventuneac A, Mustanski B, Grov C, Parsons JT. Prospective Measurement of Daily Health Behaviors: Modeling Temporal Patterns in Missing Data, Sexual Behavior, and Substance Use in an Online Daily Diary Study of Gay and Bisexual Men. AIDS Behav 2016; 20:1730-43. [PMID: 26992392 DOI: 10.1007/s10461-016-1359-0] [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] [Indexed: 11/24/2022]
Abstract
Daily diary and other intensive longitudinal methods are increasingly being used to investigate fluctuations in psychological and behavioral processes. To inform the development of this methodology, we sought to explore predictors of and patterns in diary compliance and behavioral reports. We used multilevel modeling to analyze data from an online daily diary study of 371 gay and bisexual men focused on sexual behavior and substance use. We found that greater education and older age as well as lower frequency of substance use were associated with higher compliance. Using polynomial and trigonometric functions, we found evidence for circaseptan patterns in compliance, sexual behavior, and substance use, as well as linear declines in compliance and behavior over time. The results suggest potential sources of non-random patterns of missing data and suggest that trigonometric terms provide a similar but more parsimonious investigation of circaseptan rhythms than do third-order polynomial terms.
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Affiliation(s)
- H Jonathon Rendina
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian Grov
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, USA.
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA.
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Goldstein AL, Vilhena-Churchill N, Munroe M, Stewart SH, Flett GL, Hoaken PNS. Understanding the Effects of Social Desirability on Gambling Self-Reports. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9668-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Nerini E, Bruno F, Citterio F, Schena FP. Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help? J Nephrol 2016; 29:627-36. [DOI: 10.1007/s40620-016-0273-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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13
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Predicting medication adherence in multiple sclerosis using telephone-based home monitoring. Disabil Health J 2016; 9:83-9. [DOI: 10.1016/j.dhjo.2015.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/09/2015] [Accepted: 08/15/2015] [Indexed: 11/17/2022]
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14
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Rodrigues R, Poongulali S, Balaji K, Atkins S, Ashorn P, De Costa A. 'The phone reminder is important, but will others get to know about my illness?' Patient perceptions of an mHealth antiretroviral treatment support intervention in the HIVIND trial in South India. BMJ Open 2015; 5:e007574. [PMID: 26525717 PMCID: PMC4636629 DOI: 10.1136/bmjopen-2015-007574] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The recent explosion of mHealth applications in the area of HIV care has led to the development of mHealth interventions to support antiretroviral treatment adherence. Several of these interventions have been tested for effectiveness, but few studies have explored patient perspectives of such interventions. Exploring patient perspectives enhances the understanding of how an intervention works or why it does not. We therefore studied perceptions regarding an mHealth adherence intervention within the HIVIND trial in South India. METHODS The study was conducted at three clinics in South India. The intervention comprised an automated interactive voice response (IVR) call and a pictorial short messaging service (SMS), each delivered weekly. Sixteen purposively selected participants from the intervention arm in the HIVIND trial were interviewed. All participants had completed at least 84 weeks since enrollment in the trial. Perceptions on the usefulness and perceived benefits and risks of receiving the intervention were sought. The interviews were transcribed and analysed using the framework approach to qualitative data analysis. RESULTS Despite varying perceptions of the intervention, most participants found it useful. The intervention was perceived as a sign of 'care' from the clinic. The IVR call was preferred to the SMS reminder. Two-way communication was preferred to automated calls. Participants also perceived a risk of unintentional disclosure of their HIV status and stigma thereof via the intervention and took initiatives to mitigate this risk. Targeting reminders at those with poor adherence and those in need of social support was suggested. CONCLUSIONS mHealth adherence interventions go beyond their intended role to provide a sense of care and support to the recipient. Although automated interventions are impersonal, they could be a solution for scale up. Interventions that engage both the recipient and the healthcare provider have greater potential for success. Personalising mHealth interventions could mitigate the risk of stigma and promote their uptake. TRIAL REGISTRATION NUMBER ISRCTN79261738.
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Affiliation(s)
- Rashmi Rodrigues
- Karolinska Institutet, Stockholm, Sweden
- Department of Community Health, St. John's Medical College, Bangalore, Karnataka, India
| | | | | | | | - Per Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
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15
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Medication Nonadherence, "Professional Subjects," and Apparent Placebo Responders: Overlapping Challenges for Medications Development. J Clin Psychopharmacol 2015; 35:566-73. [PMID: 26244381 PMCID: PMC4553101 DOI: 10.1097/jcp.0000000000000372] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nonadherence is a major problem in clinical trials of new medications. To evaluate the extent of nonadherence, this study evaluated pharmacokinetic sampling from 1765 subjects receiving active therapy across 8 psychiatric trials conducted between 2001 and 2011. With nonadherence defined as greater than 50% of plasma samples below the limit of quantification for study drug, the percentage of nonadherent subjects ranged from 12.8% to 39.2%. There was a trend toward increased nonadherence in studies with greater numbers of subjects, but an association with nonadherence was not apparent for other study design parameters or subject characteristics. For 2 trials with multiple recruitment sites in geographical proximity, several subjects attempted to simultaneously enroll at separate site locations. The construct of "professional subjects," those who enroll in trials only for financial gain, is gaining attention, and we therefore modeled the impact of professional subjects on medication efficacy trials. The results indicate that enrollment of professional subjects who are destined to succeed (those who will appear to achieve treatment success regardless of study drug assignment) can substantially increase both the apparent placebo response rate and the sample size requirement for statistical power, while decreasing the observed effect size. The overlapping nature of nonadherence, professional subjects, and placebo response suggests that these issues should be considered and addressed together. Following this approach, we describe a novel clinical trial design to minimize the adverse effects of professional subjects on trial outcomes and discuss methods to monitor adherence.
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16
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Rosen RC, Stephens-Shields AJ, Cunningham GR, Cifelli D, Cella D, Farrar JT, Barrett-Connor E, Lewis CE, Pahor M, Hou X, Snyder PJ. Comparison of interactive voice response (IVR) with paper administration of instruments to assess functional status, sexual function, and quality of life in elderly men. Qual Life Res 2015; 25:811-21. [PMID: 26358063 DOI: 10.1007/s11136-015-1133-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Patient-reported outcome (PRO) measures are essential for assessing subjective patient experiences. Interactive voice response (IVR) data collection provides advantages for clinical trial design by standardizing and centralizing the assessment. Prior to adoption of IVR as a mode of PRO administration in the Testosterone Trials (TTrials), we compared IVR to paper versions of the instruments to be used. METHODS IVR versions of the FACIT-Fatigue scale and Psychosexual Daily Questionnaire, Question 4, were developed. In one pilot study, IVR versions of these scales were compared to paper versions in 25 men ≥ 65 years at each of two clinical sites. In another study, IVR versions of the SF-36 Vitality Scale (SF-36), Positive and Negative Affect Scale, and Patient Health Questionnaire were evaluated in comparison with previously validated paper versions in 25 men at two clinical sites. Both paper and IVR versions of each instrument were administered in counterbalanced order, and test-retest reliability was evaluated by repeated administration of the test. Bland-Altman plots were used to assess the degree of agreement. Test-retest correlations for each measure were also determined. RESULTS Satisfactory agreement was observed between IVR and paper versions of each study measure. Specifically, linear and highly positive associations were observed consistently across the study for IVR and paper versions of all study measures. These ranged from r = 0.91-0.99. Test-retest reliability for all measures was acceptable or better (r = 0.70-0.90). CONCLUSIONS The IVR versions of TTrials endpoints in these two studies performed consistently well in comparison with paper versions.
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Affiliation(s)
| | - Alisa J Stephens-Shields
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Glenn R Cunningham
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, TX, USA
| | - Denise Cifelli
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John T Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Barrett-Connor
- Department of Family and Preventative Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Xiaoling Hou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Room 12-135, Translational Research Building (Building 421), 3400 Civic Center Boulevard, Philadelphia, PA, 19104-5160, USA.
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17
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Nelson LE, Wilton L, Agyarko-Poku T, Zhang N, Aluoch M, Thach CT, Owiredu Hanson S, Adu-Sarkodie Y. The Association of HIV Stigma and HIV/STD Knowledge With Sexual Risk Behaviors Among Adolescent and Adult Men Who Have Sex With Men in Ghana, West Africa. Res Nurs Health 2015; 38:194-206. [PMID: 25809638 DOI: 10.1002/nur.21650] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
Ghanaian men who have sex with men (MSM) have a high HIV seroprevalence, but despite a critical need to address this public health concern, research evidence has been extremely limited on influences on sexual risk behavior among MSM in Ghana. To investigate associations between HIV/STD knowledge, HIV stigma, and sexual behaviors in a sample of MSM in Ghana, we conducted a secondary data analysis of cross-sectional survey data from a non-probability sample of Ghanaian MSM (N = 137). Nearly all the men (93%) had more than one current sex partner (M = 5.11, SD = 7.4). Of those reported partners, the average number of current female sexual partners was 1.1 (SD = 2.6). Overall, knowledge levels about HIV and STDs were low, and HIV stigma was high. There was no age-related difference in HIV stigma. Younger MSM (≤25 years) used condoms less often for anal and vaginal sex than did those over 25. Relative frequency of condom use for oral sex was lower in younger men who had higher STD knowledge and also was lower in older men who reported high HIV stigma. Knowledge and stigma were not associated with condom use for anal or vaginal sex in either age group. These descriptive data highlight the need for the development of intervention programs that address HIV/STD prevention knowledge gaps and reduce HIV stigma in Ghanaian communities. Intervention research in Ghana should address age-group-specific HIV prevention needs of MSM youth.
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Affiliation(s)
- LaRon E Nelson
- Dean's Endowed Fellow in Health Disparities & Assistant Professor, School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14642
| | - Leo Wilton
- Associate Professor, Department of Human Development, State University of New York at Binghamton, Binghamton, NY.,Lecturer, Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | - Thomas Agyarko-Poku
- Lecturer, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Nanhua Zhang
- Assistant Professor, Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marilyn Aluoch
- Doctoral Student & US Fulbright Scholar, College of Nursing, University of South Florida, Tampa, FL
| | - Chia T Thach
- Postdoctoral Fellow, College of Nursing, University of South Florida, Tampa, FL
| | | | - Yaw Adu-Sarkodie
- Dean and Professor, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28:579-86. [PMID: 25290556 DOI: 10.1089/apc.2014.0156] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months (p=0.03) and decreased viral load (p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART.
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Affiliation(s)
- Anna I. Perera
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Mark G. Thomas
- Department of Molecular Medicine, University of Auckland, New Zealand
| | - John O. Moore
- Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kate Faasse
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine, University of Auckland, New Zealand
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Hermanstyne KA, Santos GM, Vittinghoff E, Santos D, Colfax G, Coffin P. Event-level relationship between methamphetamine use significantly associated with non-adherence to pharmacologic trial medications in event-level analyses. Drug Alcohol Depend 2014; 143:277-80. [PMID: 25156227 PMCID: PMC4170077 DOI: 10.1016/j.drugalcdep.2014.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Methamphetamine use has been previously associated with poor medication adherence, but, to date, there have been no studies that have conducted event-level analyses on correlates of medication adherence in studies of pharmacologic agents for methamphetamine dependence. METHODS We pooled data from two previous, randomized controlled trials (using bupropion and mirtazapine, respectively) for methamphetamine dependence and used a mixed effects logistic model to examine correlates of daily opening of the medication event monitoring system (MEMS) cap as a repeated measure. We explored whether periods of observed methamphetamine use via urine testing were associated with study medication adherence based on MEMS cap openings. RESULTS We found a significant negative association between methamphetamine-urine positivity and event-level study medication adherence as measured by MEMS cap openings (AOR: 0.69; 95% CI: 0.49-0.98). In addition, age (AOR: 1.07; 95% CI: 1.02-1.11) and depressive symptoms (AOR: 0.78; 95% CI: 0.64-0.90) were significantly associated with adherence. Finally, participants were more likely to open their study medication bottles on days when they presented for in-person urine testing. CONCLUSIONS Our event-level analysis shows that methamphetamine use can be associated with reduced medication adherence as measured by MEMS cap openings in pharmacologic trials, which corroborates prior research. These findings may suggest that medication adherence support in pharmacologic trials among methamphetamine users may be needed to improve study compliance and could be targeted towards periods of time when there are more likely to not open their study medication pill bottles.
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Affiliation(s)
- Keith A. Hermanstyne
- University of California – Los Angeles Robert Wood Johnson Foundation Clinical Scholars Program, 10920 Wilshire Boulevard, Suite 710, Los Angeles, CA 90024
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Eric Vittinghoff
- University of California-San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762, USA.
| | - Deirdre Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Grant Colfax
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Phillip Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
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Adams WG, Phillips BD, Bacic JD, Walsh KE, Shanahan CW, Paasche-Orlow MK. Automated conversation system before pediatric primary care visits: a randomized trial. Pediatrics 2014; 134:e691-9. [PMID: 25092938 DOI: 10.1542/peds.2013-3759] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians. METHODS English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction. RESULTS PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P < .01) and prescription medication use (85.7% vs 72.6%; P = .04) and to report being better prepared for visits. One hundred percent of clinicians reported that PHP improved the quality of their care. CONCLUSIONS Systems like PHP have the potential to improve clinical screening, counseling, and medication management.
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Affiliation(s)
| | - Barrett D Phillips
- Research Department, VA Central Western Massachusetts, Leeds, Massachusetts; and
| | | | - Kathleen E Walsh
- Anderson Center and General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher W Shanahan
- General Internal Medicine, Boston University/Boston Medical Center, Boston, Massachusetts
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