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Dahal P, Kahana E. Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status. Patient Prefer Adherence 2024; 18:217-226. [PMID: 38269209 PMCID: PMC10807281 DOI: 10.2147/ppa.s409023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
Objective This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults. Methods A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used. Results Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence. Conclusion This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.
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Affiliation(s)
- Poshan Dahal
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
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Treciokiene I, Peceliuniene J, Wettermark B, Gulbinovic J, Taxis K. Hypertension management and drug-related problems. A case report of the 23-year history of Mr. Jonas. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100313. [PMID: 37601158 PMCID: PMC10433230 DOI: 10.1016/j.rcsop.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Arterial hypertension is a lifelong disease, which management is recognized as the most effective way to reduce cardiovascular mortality. Even though there is extensive evidence on the benefits of lifestyle modification and antihypertensive treatment, many patients with hypertension do not reach blood pressure targets. This paper aims to review the history of antihypertensive treatment of one patient and identify the drug related problems that occurred over the study period. In this case report, the patient's health record was studied, guidelines checked and a semi-structured interview conducted. Drug related problems were identified and possible pharmacist interventions were introduced. Drug related problems that could have contributed to the lack of hypertension control were adherence, side effects and disease-drug interaction. Identified pharmacists' interventions ranged from managing self-medication, to collaboration with general practitioner to change prescribing, and counselling the patient on medication use, including adherence. Even though the drug related problems were not that serious in the studied case, the patient could have valued from pharmacist intervention.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Jurate Peceliuniene
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy and Pharmacology center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, M. K. Ciurlionio str.21, 03101 Vilnius, Lithuania
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, Netherlands
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Chiu N, Chiu L, Aggarwal R, Raber I, Bhatt DL, Mukamal KJ. Trends in Blood Pressure Treatment Intensification in Older Adults With Hypertension in the United States, 2008 to 2018. Hypertension 2023; 80:553-562. [PMID: 36111537 DOI: 10.1161/hypertensionaha.122.19882] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hypertension control has worsened nationally, and treatment intensification is important for control. National trends for appropriate blood pressure intensification for older adults are unknown. We determine the proportion of ambulatory visits where older adults with hypertension were appropriately intensified on antihypertensives from 2008 to 2018. METHODS Data from National Ambulatory Medical Care Survey were used. National Ambulatory Medical Care Survey is a nationally representative sample of ambulatory visits. Adults 60 years or older were included. Appropriate antihypertensive intensification was defined as addition of an antihypertensive for a blood pressure reading above target. We examined appropriate intensification by blood pressure targets set by the American College of Cardiology-American Heart Association, the European Society of Cardiology, and the American College of Physicians-American Academy of Family Physicians guidelines for older adults. Further, we defined an additional all-inclusive criterion meeting all 3 guidelines. RESULTS From 2008 to 2018, appropriate intensification by American College of Cardiology/American Heart Association occurred at 11.1% (95% CI, 9.8%-12.5%) of visits, decreasing from 13.6% (95% CI, 15.6%-28.7%) of visits in 2008 to 2009 to 10.4% (95% CI, 10.9%-26.4%) in 2015 to 2018. Appropriate intensification by European Society of Cardiology occurred at 14.2% (12.1%-16.6%) of visits over 2008 to 2018, decreasing from 16.9% (95% CI, 13.5%-21.0%) in 2008 to 2009 to 12.5% (95% CI, 7.4%-20.3%) from 2015 to 2018. Appropriate intensification by American Academy of Family Physicians/American College of Physicians occurred at 18.9% (16.2%-22.0%) of visits over 2008 to 2018, decreasing from 24.7% (95% CI, 20.2%-29.0%) in 2008 to 2009 to 14.9% (95% CI, 9.0%-23.7%) from 2015 to 2018. By all-inclusive criteria, intensification trended toward worsening with time: odds ratio: 0.93 ([95% CI, 0.87-1.00]; P=0.07). CONCLUSIONS Appropriate treatment intensification for older adults with hypertension in the United States was suboptimal over the past decade.
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Affiliation(s)
- Nicholas Chiu
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.C., I.R., K.J.M.)
| | - Leonard Chiu
- Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN (L.C.)
| | - Rahul Aggarwal
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (R.A., D.L.B.)
| | - Inbar Raber
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.C., I.R., K.J.M.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (R.A., D.L.B.)
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.C., I.R., K.J.M.)
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Mullan B, Liddelow C, Haywood D, Breare H. Behavior Change Training for Health Professionals: Evaluation of a 2-Hour Workshop. JMIR Form Res 2022; 6:e42010. [DOI: 10.2196/42010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the “active ingredients” in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors.
Objective
We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables.
Methods
A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees.
Results
A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=–5.27, P<.001), subjective norms (t40=–3.49, P=.001), descriptive norms (t40=–3.65, P<.001), perceived behavioral control (t40=–3.30, P=.002), and intention (t36=–3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable.
Conclusions
A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals’ practices.
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Shin J, Jang J, Afaya A. Effectiveness of eHealth interventions targeted to improve medication adherence among older adults with mild cognitive impairment: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060590. [PMID: 36323471 PMCID: PMC9639072 DOI: 10.1136/bmjopen-2021-060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Medication adherence is a vital component of successful healthcare, yet poor adherence exists, especially in older adults with mild cognitive impairment. Therefore, this study seeks to conduct a systematic review of eHealth-based interventions aimed at improving medication adherence among older adults with mild cognitive impairment. METHODS AND ANALYSIS An open electronic database search will be conducted in PubMed, CINAHL, PsycINFO, EMBASE and Cochrane library to identify potential studies till 2022. Two authors will independently screen the titles and abstracts, after which studies that will be eligible for full-text review will be independently assessed by two reviewers for inclusion. Studies will be selected if they evaluate eHealth interventions aiming to improve medication adherence among older adults with mild cognitive impairment. Data will be analysed by using the Comprehensive Meta-Analysis software V.3 and Review Manager (RevMan) software V.5. The authors will separately analyse each outcome measure, compute intervention effects and present them as relative risks with 95% CIs for dichotomous data. Continuous data will be presented as mean differences and standardised mean differences (if required) with 95% CIs. If substantive statistical heterogeneity is identified, we will consider the use of random-effects models that can be incorporated into the statistical analysis. We envisage that this review will adduce evidence on eHealth interventions that will improve medication adherence among older adults with mild cognitive impairment. The findings can also inform health professionals and other relevant stakeholders on current eHealth-based interventions that are used to improve medication adherence among older adults with mild cognitive impairment. ETHICS AND DISSEMINATION Ethical approval is not required for systematic reviews. Findings will be disseminated widely through peer-reviewed publication and at conferences. PROSPERO REGISTRATION NUMBER CRD42021268665.
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Affiliation(s)
- Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-do, South Korea
| | - Jiyoon Jang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Agani Afaya
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Whittington M, Goggin K, Noel-MacDonnell J, Hathaway D, Remy L, Aholt D, Clark D, Miller C, Ashbaugh C, Wakefield M, Ellis RB, Russell C. Cost-Effectiveness Analysis: Personal Systems Approach in Improving Medication Adherence in Adult Kidney Transplant Patients. J Healthc Qual 2022; 44:240-252. [PMID: 35759613 PMCID: PMC9245085 DOI: 10.1097/jhq.0000000000000327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Interventions to improve medication nonadherence in transplantation have recently moved from a focus on motivation and intention, to a focus on person-level quality improvement strategies. These strategies link adherence to established daily routines, environmental cues, and supportive people. The objective of this evaluation was to estimate the cost of implementation and the cost-effectiveness of a person-level intervention shown to increase medication adherence. To estimate the intervention costs, a direct measure microcosting approach was used after key informant interviews with project champions and a review of implementation expenditures. Cost-effectiveness was calculated by comparing the incremental implementation costs and healthcare costs associated with nonadherence to the incremental percent adherent, defined as the percent of patients who took greater or equal to 85% of their medication doses, for each pairwise comparison. The intervention was low-resource to implement, costing approximately $520 to implement per patient, and was associated with significant improvements in medication adherence. These implementation costs were more than outweighed by the expected healthcare savings associated with improvements in adherence. This person-level intervention is a low-cost, efficacious intervention associated with significant statistical and clinical improvements in medication adherence in adult kidney transplant recipients.
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Ping Y, Visaria A, Suppiah SD, Tan YW, Malhotra R. Prevalence and correlates of medication reminder app ‘use and use intention’ among older adults. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100150. [PMID: 35755719 PMCID: PMC9218158 DOI: 10.1016/j.rcsop.2022.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Medication adherence is relatively poor among older adults. Although there exist medication reminder apps, data on the prevalence and correlates of their ‘use and use intention’ by older adults are limited. Objective To examine the prevalence, and socio-demographic and health correlates of medication reminder app use and use intention among older adults in Singapore. Methods Data from a nationally representative survey of 2228 adults aged 62 years and above, who were taking at least one prescription medication, were analysed. Medication reminder app use (in the past one month) and use intention (in the next one month) were self-reported. Bivariate and multivariable logistic regression models were used to identify the correlates of medication reminder app use and use intention. Results The prevalence of medication reminder app use and use intention was low at 2.6% (comprising 0.5% for use and 2.1% for use intention). Age, ethnicity, education level, previous participation in information technology/computer-related courses, comorbidity, health literacy, medication adherence and polypharmacy were correlated with app use and use intention in multivariable analyses. Conclusion The very low prevalence of medication reminder app use and use intention among older adults in Singapore and identified correlates point to opportunities to increase the use of such apps.
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Affiliation(s)
- Yongjing Ping
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | | | - Yi Wen Tan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Corresponding author at: Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, 8 College Road, Level 4, 169857, Singapore.
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Yang C, Zhu S, Lee DTF, Chair SY. Interventions for improving medication adherence in community-dwelling older people with multimorbidity: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104154. [PMID: 34953373 DOI: 10.1016/j.ijnurstu.2021.104154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multimorbidity is highly prevalent amongst older people. Compared with those with a single disease, older people with multimorbidity are more susceptible to medication nonadherence, which causes adverse health outcomes and increased health care costs. The effectiveness of interventions for improving medication adherence in this population is still unclear. OBJECTIVE To evaluate the effectiveness of interventions to improve medication adherence for community-dwelling older people with multimorbidity. DESIGN Systematic review and meta-analysis. DATA SOURCES Ten databases: Airiti Library, China National Knowledge Infrastructure, Cochrane CENTRAL, EBSCO CINAHL, OVID EMBASE, OVID MEDLINE, Proquest Central, PsycINFO, Wanfang Database and Web of Science Core Collection. REVIEW METHODS Studies evaluating the effects of interventions on medication adherence in community-dwelling older people with multimorbidity were included. Two researchers independently performed the study selection, data extraction and risk assessment. Intervention effects were pooled by random-effects meta-analysis. RESULTS A total of nine studies with 3,292 participants were included. Studies on self-management interventions revealed a significant and modest improvement in medication adherence (n = 3 studies; SMD 0.52; 95% CI 0.04 to 0.99; p = 0.03, I2 = 43%). Studies using electronic health interventions demonstrated a small yet significant benefit for medication adherence (n = 2 studies; SMD 0.22; 95% CI 0.02 to 0.42; p = 0.03, I2 = 0%). There was no pooled significant effect of medication review on medication adherence (n = 4 studies; SMD -0.03; 95% CI -0.21 to 0.15; p = 0.74, I2 = 68%). Most of the studies failed to yield a significant improvement in patients' health outcomes. CONCLUSIONS Self-management interventions and electronic health interventions might be effective in improving medication adherence for older people with multimorbidity. Future adherence interventions are needed to demonstrate improvements in medication adherence and health outcomes. PROSPERO REGISTRATION NUMBER CRD42020150500.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Song Zhu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Krousel-Wood M, Craig LS, Peacock E, Zlotnick E, O’Connell S, Bradford D, Shi L, Petty R. Medication Adherence: Expanding the Conceptual Framework. Am J Hypertens 2021; 34:895-909. [PMID: 33693474 DOI: 10.1093/ajh/hpab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022] Open
Abstract
Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.
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Affiliation(s)
- Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Leslie S Craig
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emily Zlotnick
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O’Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - David Bradford
- Department of Public Administration and Policy, University of Georgia, Athens, Georgia, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Richard Petty
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Campbell PJ, Axon DR, Taylor AM, Smith K, Pickering M, Black H, Warholak T, Chinthammit C. Hypertension, cholesterol and diabetes medication adherence, health care utilization and expenditure in a Medicare Supplemental sample. Medicine (Baltimore) 2021; 100:e27143. [PMID: 34477169 PMCID: PMC8416010 DOI: 10.1097/md.0000000000027143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Limited evidence exists regarding the relationships between adherence, as defined in Pharmacy Quality Alliance (PQA) medication adherence measures, health care utilization, and economic outcomes. PQA adherence measures for hypertension, cholesterol, and diabetes are of particular interest given their use in Medicare Star Ratings to evaluate health plan performance.The objective of this study was to assess the relationship between adherence and utilization and cost among Medicare Supplemental beneficiaries included in the aforementioned PQA measures over a 1-year period.Retrospective cohort study.Three cohorts (hypertension, cholesterol, and diabetes) of eligible individuals from the Truven Health MarketScan Commercial Claims and Encounters Research Databases (2009-2015) were used to assess associations between adherence and health care expenditure and utilization for Medicare Supplemental beneficiaries.Generalized linear models with log link and negative binomial (utilization) or gamma (expenditure) distributions assessed relationships between adherence (≥80% proportion of days covered) and health care utilization and expenditure (in 2015 US dollars) while adjusting for confounding variables. Beta coefficients were used to compute cost ratios and rate ratios.Adherence for all 3 disease cohorts was associated with lower outpatient and inpatient visits. During the 1-year study period, adherence was associated with lower outpatient, inpatient, and total expenditures across the cohorts, ranging from 9% lower outpatient costs (diabetes cohort) to 41.9% lower inpatient costs (hypertension cohort). Savings of up to $324.53 per member per month in total expenditure were observed for the hypertension cohort.Our findings indicate adherence is associated with lower health care utilization and expenditures within 1 year.
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Affiliation(s)
| | - David R. Axon
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
| | - Ann M. Taylor
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
| | - Karen Smith
- Regis University School of Pharmacy, 3333 Regis Boulevard, Denver, CO
| | - Matthew Pickering
- Pharmacy Quality Alliance, Inc., 5911 Kingstowne Village Parkway, Suite 130, Alexandria, VA
| | - Heather Black
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ
| | - Terri Warholak
- University of Arizona College of Pharmacy, 1295N Martin Avenue, Tucson, AZ
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Marcum ZA, Jiang S, Bacci JL, Ruppar TM. Pharmacist-led interventions to improve medication adherence in older adults: A meta-analysis. J Am Geriatr Soc 2021; 69:3301-3311. [PMID: 34287846 DOI: 10.1111/jgs.17373] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/26/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVE As pharmacists work to ensure reimbursement for chronic disease management services on the national level, evidence of their impact on important health metrics, such as medication adherence, is needed. However, summative evidence is lacking on the effectiveness of pharmacists to improve medication adherence in older adults. The objective was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults (65+ years). DESIGN/SETTING/PARTICIPANTS Using a systematic review and meta-analytic approach, a comprehensive search of publications in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar was conducted through April 2, 2020 for randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. A standardized mean difference effect size (Cohen's d) was calculated for medication adherence in each study. Study effect sizes were pooled using a random-effects model, with effect sizes weighted by inverse of its total variance. MEASUREMENTS Medication adherence using any method of measurement. RESULTS Among 40 unique randomized trials of pharmacist-led interventions with data from 8822 unique patients (mean age, range: 65-85 years), the mean effect size was 0.57 (k = 40; 95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size reduced to 0.41 (k = 38; 95% CI: 0.27-0.54). A sensitivity analysis of medication adherence outcome by time point resulted in a mean effect size of 0.64 at 3 months (k = 12; 95% CI: 0.32-0.97), 0.30 at 6 months (k = 13; 95% CI: 0.11-0.48), 0.22 at 12 months (k = 12; 95% CI: 0.08-0.37), and 0.36 for outcome time points beyond 12 months (k = 5; 95% CI: 0.02-0.70). CONCLUSION This meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions. Implementation of pharmacist-led interventions supported by Medicare reimbursement could ensure older adults' access to effective medication adherence support.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Shangqing Jiang
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jennifer L Bacci
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Todd M Ruppar
- College of Nursing, Rush University, Chicago, Illinois, USA
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Lanca M, Abrams DN, Crittenden P, Jones KM. Cognitive Stabilization Intervention during the Era of COVID-19. Dev Neuropsychol 2021; 46:298-313. [PMID: 34225510 DOI: 10.1080/87565641.2021.1943398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As COVID-19 halted traditional neuropsychological assessment due to infection risk, neuropsychologists considered alternative practice models. Cognitive stabilization intervention (CSI) via telehealth, was developed to stabilize cognition in advance of neuropsychological assessment. It incorporates elements of evidence-based treatments, including cognitive training, sleep training, and medication adherence training within a motivational interview framework. Two case vignettes are described. One vignette describes an elder man who received CSI to manage sleep difficulties, forgetfulness, and mood symptoms. Another vignette describes a woman who completed CSI following an autoimmune disorder episode to improve sleep, organization, and attention. The benefits and limitations of CSI are discussed.
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Affiliation(s)
- Margaret Lanca
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Danielle N Abrams
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Persephone Crittenden
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Kelly M Jones
- Private Practice, Boston & Woburn, Massachusetts, USA
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13
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Bogart LM, Barreras JL, Gonzalez A, Klein DJ, Marsh T, Agniel D, Pantalone DW. Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men. AIDS Behav 2021; 25:1647-1660. [PMID: 33231847 PMCID: PMC8084890 DOI: 10.1007/s10461-020-03081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Joanna L Barreras
- Bienestar Human Services Inc, Los Angeles, CA, USA
- California State University Long Beach, Long Beach, CA, USA
| | - Ana Gonzalez
- Bienestar Human Services Inc, Los Angeles, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Terry Marsh
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - David W Pantalone
- University of Massachusetts Boston, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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14
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Alcántara C, Diaz SV, Cosenzo LG, Loucks EB, Penedo FJ, Williams NJ. Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities. Health Psychol Rev 2021; 14:132-144. [PMID: 31957557 DOI: 10.1080/17437199.2020.1718527] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.
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Affiliation(s)
| | | | | | - Eric B Loucks
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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15
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Majd Z, Mohan A, Paranjpe R, Abughosh SM. Identifying adherent patients to newly initiated statins using previous adherence to chronic medications. J Manag Care Spec Pharm 2021; 27:186-197. [PMID: 33506725 PMCID: PMC10390965 DOI: 10.18553/jmcp.2021.27.2.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Statins are one of the most frequently prescribed medications in the United States. Despite well-documented benefits in managing hyperlipidemia and reducing cardiovascular risks, statin adherence remains suboptimal. Several effective interventions have been implemented to improve adherence to statins. However, identifying patients who are at risk for developing poor medication adherence at the time of treatment initiation could assist in planning early targeted interventions. Studies have suggested that previous adherence to chronic medications is a strong predictor of future adherence to newly initiated medications. OBJECTIVE: To investigate patients' adherence to newly initiated statins by measuring previous adherence to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and oral antidiabetic drugs (OADs). METHODS: A retrospective cohort study was conducted using administrative claims data from January 2016 to May 2018. New statin initiators were identified and included in the study if they were continuously enrolled in the health plan and had at least 1 prescription for ACEIs, ARBs, or OADs 1 year before statin initiation (pre-index period). Baseline adherence to ACEIs/ARBs, OADs, or both was calculated during a 1-year pre-index period using proportion of days covered (PDC) and defined as PDC ≥ 0.80. Adherence to statins was assessed 1 year after statin initiation and was the primary outcome, with a PDC ≥ 0.80 considered as adherent. Patient demographics were measured during the pre-index period. Multivariable logistic regression was conducted for each cohort separately to determine an association between baseline adherence and future statin adherence controlling for various demographic and clinical characteristics. RESULTS: 1,223 ACEI/ARB users, 714 OAD users, and 452 concomitant ACEI/ARB and OAD users were identified. In the regression model, adherence to baseline medications was significantly associated with 1-year adherence to statins (ACEI/ARB users: OR = 1.75, 95% CI = 1.37-2.25; OAD users: OR = 2.02, 95% CI = 1.46-2.79; concomitant ACEI/ARB and OAD users: OR = 1.73, 95% CI = 1.16-2.58). CONCLUSIONS: Past adherence to baseline medications may predict future adherence to newly initiated statins. Identifying patients likely to become nonadherent during treatment initiation could enable health care providers in recognizing individuals at risk of nonadherence and intervene earlier to enhance future adherence. DISCLOSURES: No funding was received for this study. Abughosh reports grants from Regeneron-Sanofi, BMS-Pfizer, and Valeant, unrelated to this work. Majd, Mohan, and Paranjpe have nothing to disclose.
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Affiliation(s)
- Zahra Majd
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
| | - Anjana Mohan
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
| | - Rutugandha Paranjpe
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
| | - Susan M Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
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16
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Gruszczyńska M, Wyszomirska J, Daniel‐Sielańczyk A, Bąk‐Sosnowska M. Selected psychological predictors of medication adherence in the older adults with chronic diseases. Nurs Open 2021; 8:317-326. [PMID: 33318839 PMCID: PMC7729554 DOI: 10.1002/nop2.632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Aim The main goal of the study was to assess the significance of selected psychological factors related to the adherence to medication recommendations among the older adults with chronic diseases. Design It was designed as a cross-sectional study, aimed at assessing the importance of selected psychological factors in complying with medication recommendations among older adults. Methods The study involved 345 older adults with chronic diseases, assessed the importance of selected psychological factors, such as: health locus of control, stress coping and mindfulness in adhering to medication recommendations older persons. To answer the research questions, we performed frequency analyses, basic descriptive statistics analyses together with the Kolmogorov-Smirnov test, Student's t tests for independent samples, monofactorial analysis of variance in the intergroup diagram, analysis correlation with the Pearson correlation coefficient, Spearman's rank correlation ρ analysis and stepwise linear regression analysis. Results The study identified psychological predictors of medication adherence, which explained 12% of the variability. An emotion-oriented coping proved to be the most important factor. Additionally, powerful other health locus of control and mindful attention were shown to have a positive effect.
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Affiliation(s)
- Magdalena Gruszczyńska
- Department of Psychology, Chair of Social Sciences and Humanities, School of Health Sciences in KatowiceMedical University of Silesia in KatowiceKatowicePoland
| | - Julia Wyszomirska
- Department of Psychology, Chair of Social Sciences and Humanities, School of Health Sciences in KatowiceMedical University of Silesia in KatowiceKatowicePoland
| | - Anna Daniel‐Sielańczyk
- Department of Psychology, Chair of Social Sciences and Humanities, School of Health Sciences in KatowiceMedical University of Silesia in KatowiceKatowicePoland
| | - Monika Bąk‐Sosnowska
- Department of Psychology, Chair of Social Sciences and Humanities, School of Health Sciences in KatowiceMedical University of Silesia in KatowiceKatowicePoland
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17
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Kojima T, Mizokami F, Akishita M. Geriatric management of older patients with multimorbidity. Geriatr Gerontol Int 2020; 20:1105-1111. [PMID: 33084212 DOI: 10.1111/ggi.14065] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023]
Abstract
Older patients tend to have multimorbidity represented by multiple chronic diseases or geriatric conditions due to aging changes of organs, which require a variety of medical management. Currently, there are no sufficient disease treatment guidelines for older people with multimorbidity, therefore physicians have difficulty managing multimorbidity, such as which diseases should be treated intensively or to what extent the conditions should be improved. Furthermore, there are other points to be considered when initiating the treatment of diseases. For example, physicians must assess physical function. Some people have no difficulty with ambulation, but some are bedridden and have difficulty getting up on their own. As there are differences in disease severity, comorbid conditions and life expectancy, there should be differences in deciding treatment and prescribing drugs. It may be necessary to change the option for treatment depending on cognitive function, the living environment and the care environment, using comprehensive geriatric assessments. In addition, when treating multimorbidity, patients tend to have polypharmacy, which is a risk for adverse drug events. Because of this, it is necessary to consider dose reduction and drug discontinuation in patients with polypharmacy. Because of the global increase in older patients with multimorbidity, developing an essential method for managing multimorbidity is an urgent issue. More research and practices are necessary to achieve high-quality care in patients with multimorbidity. Geriatr Gerontol Int 2020; 20: 1105-1111.
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Affiliation(s)
- Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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18
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Kelly A, Tymms K, Wit M, Bartlett SJ, Cross M, Dawson T, De Vera M, Evans V, Gill M, Hassett G, Lim I, Manera K, Major G, March L, O’Neill S, Scholte-Voshaar M, Sinnathurai P, Sumpton D, Teixeira‐Pinto A, Tugwell P, Bemt B, Tong A. Patient and Caregiver Priorities for Medication Adherence in Gout, Osteoporosis, and Rheumatoid Arthritis: Nominal Group Technique. Arthritis Care Res (Hoboken) 2020; 72:1410-1419. [DOI: 10.1002/acr.24032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Ayano Kelly
- Australian National University and Canberra Rheumatology, Canberra, Australian Capital Territory, Australia, and Children’s Hospital at Westmead Sydney New South Wales Australia
| | - Kathleen Tymms
- Australian National University, Canberra Rheumatology, and Canberra Hospital Canberra Australian Capital Territory Australia
| | - Maarten Wit
- Amsterdam University Medical Centre Amsterdam The Netherlands
| | - Susan J. Bartlett
- McGill University, Montreal, Quebec, Canada, and Johns Hopkins School of Medicine Baltimore Maryland
| | - Marita Cross
- Institute of Bone and Joint Research Kolling Institute of Medical Research Sydney New South Wales Australia
| | - Therese Dawson
- Lord Street Specialist Centre, Port Macquarie, New South Wales, Australia, and Mayo Hospital Specialist Centre Taree New South Wales Australia
| | - Mary De Vera
- University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada Richmond British Columbia Canada
| | - Vicki Evans
- Clear Vision Consulting and University of Canberra, Canberra, Australian Capital Territory, Australia, and Outcome Measures in Rheumatology
| | - Michael Gill
- Dragon Claw, Sydney, New South Wales, Australia, and Outcome Measures in Rheumatology
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Irwin Lim
- BJC Health Sydney New South Wales Australia
| | - Karine Manera
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | - Gabor Major
- John Hunter Hospital and University of Newcastle Newcastle New South Wales Australia
| | - Lyn March
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Sean O’Neill
- Liverpool Hospital and Ingham Institute of Applied Medical Research Sydney New South Wales Australia
| | - Marieke Scholte-Voshaar
- University of Twente, Enschede, The Netherlands, and Outcome Measures in Rheumatology Netherlands
| | - Premarani Sinnathurai
- Institute of Bone and Joint Research Kolling Institute of Medical Research Royal North Shore Hospital, and Northern Clinical School Sydney University Sydney New South Wales Australia
| | - Daniel Sumpton
- Children’s Hospital at Westmead University of Sydney, and Concord Hospital Sydney New South Wales Australia
| | - Armando Teixeira‐Pinto
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
| | | | - Bart Bemt
- Sint Maartenskliniek, Ubbergen, The Netherlands, and Radboud University Medical Centre Nijmegen The Netherlands
| | - Allison Tong
- Children’s Hospital at Westmead and University of Sydney Sydney New South Wales Australia
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19
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Podzolkov VI, Bragina AE, Vasil’eva LV, Grintsevich YP, Rodionova YN. Adherence to statin therapy in patients with high and very high cardiovascular risk in real clinical practice. SECHENOV MEDICAL JOURNAL 2020. [DOI: 10.47093/2218-7332.2020.11.1.38-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the proven efficacy of lipid-lowering therapy, adherence to long-term statin therapy in patients with cardiovascular disease remains low.Aim. To study adherence to long-term statin therapy and factors associated with adherence in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Materials and methods. The single-center cohort study included 53 patients (mean age 68.1 ± 10.2 years) with high or very high CVR on the SCORE scale and have been taking statins for at least 3 months prior to inclusion in the study. The level of low-density lipoprotein cholesterol (LDL-C), cognitive impairment (MoCA test), anxiety and depression (HADS scale), presence of senile asthenia (FRAIL scale), M. Charlson comorbidity index were assessed. Adherence to statin therapy was assessed using the original questionnaire. The correlation between patient adherence and ordinal variables for the scores of the studied scales was studied.Results. Completely adherent to statin therapy were only 12 (22%) patients, 14 (26%) were insufficiently adherent, 27 (51%) were non-adherent. The target level of LDL-С was achieved in 13 (25%) patients. 38 (72%) patients showed a decrease in cognitive functions; a positive correlation was found between adherence and the MoCA test (r = 0.44, p = 0.04). Clinical and subclinical depression and anxiety were noted in 12 (23%) and 14 (26%) patients, respectively. A statistically significant negative correlation was found between adherence and depression (r = –0.32; p = 0.04) and a positive correlation between adherence and anxiety (r = 0.44; p = 0.04). There was no statistically significant correlation between adherence and the FRAIL fragility scale, as well as the M. Charlson comorbidity index.Conclusions. Depression and cognitive decline are associated with decreased adherence to statin therapy.
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Affiliation(s)
- V. I. Podzolkov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. E. Bragina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L. V. Vasil’eva
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - Yu. N. Rodionova
- Sechenov First Moscow State Medical University (Sechenov University)
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20
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Raj JP, Mathews B. Effect of behavioral intervention on medication adherence among elderly with select non-communicable diseases (ENDORSE): Pilot randomized controlled trial. Geriatr Gerontol Int 2020; 20:1079-1084. [PMID: 32896089 DOI: 10.1111/ggi.14032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
AIM Adherence to medication is important in older patients with non-communicable diseases, and there is a need to investigate various interventions to enhance adherence in our Indian setting. This pilot randomized controlled trial aimed at testing the effectiveness of systematic education and behavioral intervention in enhancing medication adherence among older adults. METHODS It was a single center, open label, parallel arm, randomized controlled trial carried out among older (age >60 years) inpatients of general medicine wards diagnosed with select non-communicable diseases, such as diabetes, hypertension, dyslipidemia and coronary artery disease. Participants were randomized either to receive the usual standard of care or the intervention that comprises of systematic education, patient diary to mark daily medicine intake and periodic telephone reminders. Barriers to medication adherence were identified and interventions were tailored according to the identified barriers over a 6-month follow-up period. The primary end-points were change in the reported pill count (RPC) within groups and between groups at the third and sixth month. RESULTS The RPC in control and intervention arms at the thrid month were 78.20% and 91.88% (P = 0.007), whereas at 6 months they were 68.64% and 83.08% (P = 0.003), respectively. Similarly, change in RPC in intervention arm between baseline and the third month (mean difference 24.08%, P = 0.001), and between baseline and the sixth month (mean difference 15.280%, P = 0.006) were statistically significant. However, the RPC between the third and sixth month showed a significant decline (mean difference 8.8%, P = 0.016). CONCLUSION In this pilot study, we prove that behavioral interventions have improved medication adherence among older adults, and it is feasible to carry out such studies among older adults in India. Geriatr Gerontol Int 2020; 20: 1079-1084.
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Affiliation(s)
- Jeffrey P Raj
- Department of Pharmacology, St. John's Medical College, Bengaluru, India
| | - Betsy Mathews
- Division of Geriatrics, Department of Medicine, St. John's Medical College, Bengaluru, India
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21
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Wilson JR, Tickle-Degnen L, Scheutz M. Challenges in Designing a Fully Autonomous Socially Assistive Robot for People with Parkinson’s Disease. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2020. [DOI: 10.1145/3379179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Assistive robots are becoming an increasingly important application platform for research in robotics, AI, and HRI, as there is a pressing need to develop systems that support the elderly and people with disabilities, with a clear path to market. Yet, what remains unclear is whether current autonomous systems are already up to the task or whether additional HRI work is needed to make these systems acceptable and useful.
In this article, we report our efforts of developing and evaluating an architecture for a fully autonomous robot designed to assist older adults with Parkinson’s disease (PD) in sorting their medications. The main goal for the robot is to aid users in a manner that maintains the autonomy of the user by providing cognitive and social support with varying levels of assistance. We first evaluated the robot with subjects drawn from a pool of university students, which is common practice in experimental work in psychology and HRI. As the results were very positive, we followed up with an evaluation using people with Parkinson’s disease, who surprisingly had mostly negative outcomes. We thus report our analysis of the differences in the evaluations and discuss the challenges for HRI posed by the sources of the negative evaluations: (1) designing a robot to adapt to the many routines the participants use at home, (2) unique needs of participants with PD not present in student participants, and (3) the role of familiar technologies in designing and evaluating a new technology. While it is unlikely, given the current state of technology, that fully autonomous assistive robots for older adults will be available in the near term, we believe that our work exposes a critical need in HRI to involve the target population as early as possible in the design process.
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Affiliation(s)
- Jason R. Wilson
- Department of Computer Science, Northwestern University, Evanston, IL
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22
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Linkens AEMJH, Milosevic V, van der Kuy PHM, Damen-Hendriks VH, Mestres Gonzalvo C, Hurkens KPGM. Medication-related hospital admissions and readmissions in older patients: an overview of literature. Int J Clin Pharm 2020; 42:1243-1251. [PMID: 32472324 PMCID: PMC7522062 DOI: 10.1007/s11096-020-01040-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Abstract
Background The number of medication related hospital admissions and readmissions are increasing over the years due to the ageing population. Medication related hospital admissions and readmissions lead to decreased quality of life and high healthcare costs. Aim of the review To assess what is currently known about medication related hospital admissions, medication related hospital readmissions, their risk factors, and possible interventions which reduce medication related hospital readmissions. Method We searched PubMed for articles about the topic medication related hospital admissions and readmissions. Overall 54 studies were selected for the overview of literature. Results Between the different selected studies there was much heterogeneity in definitions for medication related admission and readmissions, in study population and the way studies were performed. Multiple risk factors are found in the studies for example: polypharmacy, comorbidities, therapy non adherence, cognitive impairment, depending living situation, high risk medications and higher age. Different interventions are studied to reduce the number of medication related readmission, some of these interventions may reduce the readmissions like the participation of a pharmacist, education programmes and transition-of-care interventions and the use of digital assistance in the form of Clinical Decision Support Systems. However the methods and the results of these interventions show heterogeneity in the different researches. Conclusion There is much heterogeneity in incidence and definitions for both medication related hospital admissions and readmissions. Some risk factors are known for medication related admissions and readmissions such as polypharmacy, older age and additional diseases. Known interventions that could possibly lead to a decrease in medication related hospital readmissions are spare being the involvement of a pharmacist, education programs and transition-care interventions the most mentioned ones although controversial results have been reported. More research is needed to gather more information on this topic.
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Affiliation(s)
- A E M J H Linkens
- Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - V Milosevic
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, The Netherlands
| | - P H M van der Kuy
- Department of Clinical Pharmacy, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - V H Damen-Hendriks
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
| | - C Mestres Gonzalvo
- Department of Clinical Pharmacy, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - K P G M Hurkens
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
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23
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Morita F, Wajngarten M, Katz M, Fernandes-Silva MM, Caixeta A, Franken M, Lemos PA, Pesaro AE. Short- and Midterm Adherence to Platelet P2Y12 Receptor Inhibitors After Percutaneous Coronary Intervention With Drug-Eluting Stents. J Cardiovasc Pharmacol Ther 2020; 25:466-471. [PMID: 32419491 DOI: 10.1177/1074248420926667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION/OBJECTIVES In patients who have undergone recent percutaneous coronary intervention (PCI), poor adhesion to antiplatelet agents may increase the risk of stent thrombosis and death. We aimed to investigate the adherence to different P2Y12 receptor inhibitors after PCI with drug-eluting stent in stable and unstable patients and to evaluate the factors associated with low adherence. METHOD In a prospective study conducted between 2014 and 2018, the 8-item Morisky scale was applied at 30 days and 6 months post-PCI to measure P2Y12 receptor inhibitors adherence. Also, we describe the characteristics of patients using different platelet receptor P2Y12 inhibitors. Regression models were used to identify predictors of poor adherence. RESULTS A total of 214 patients were included (65 ± 12 years, 81% man, 61% acute coronary syndromes). Patients in the clopidogrel group were older than those in the prasugrel (68 ± 12 vs 59 ± 11 years, P < .01, respectively) or ticagrelor group (68 ± 12 vs 62 ± 12 years, P < .01). Patients with low/moderate adherence at 30 days and 6 months represented, respectively, 19.8% and 27.5% of our sample. Current smokers and preexisting cardiovascular disease at presentation were associated with lower adherence at 30 days. CONCLUSIONS We found substantial rates of moderate and low adherence to P2Y12 receptor inhibitors early after PCI. Current smokers and preexisting cardiovascular disease at presentation were associated with a lower likelihood of adherence. These results highlight the need of monitoring adherence to medical treatment after PCI.
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Affiliation(s)
- Fernando Morita
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mauricio Wajngarten
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antonio E Pesaro
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Peng Y, Wang H, Fang Q, Xie L, Shu L, Sun W, Liu Q. Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis. J Manag Care Spec Pharm 2020; 26:550-561. [PMID: 32223596 PMCID: PMC10391210 DOI: 10.18553/jmcp.2020.26.4.550] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication adherence is frequently suboptimal in adults with chronic diseases, resulting in negative consequences. Traditional interventions to improve adherence are complex and not widely effective. Mobile applications may be a scalable means to support medication adherence. OBJECTIVE To investigate the effect of mobile apps on medication adherence in adults with chronic diseases. METHODS MEDLINE, EMBASE, CINAHL Plus, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials evaluating the effectiveness of any mobile application (app) intervention directed at patients with chronic disease to improve medication adherence in comparison with usual care. A random-effects model was used to pool the outcome data. Risk of bias and quality of study were assessed per Cochrane guidelines. RESULTS Fourteen studies were included in this systematic review involving 1,785 participants, 940 of whom were randomized to a mobile app intervention group and 845 to the usual care group. The meta-analysis showed that the use of mobile apps was associated with a significant improvement in patient adherence to medication (Cohen's d = 0.40, 95% CI = 0.27-0.52; P < 0.001), with a low quality of GRADE evidence. There was no evidence of publication bias (Egger's test; P = 0.81) or substantial heterogeneity (I2 = 29%). In the sensitivity analysis, our findings remained robust to change in inclusion criteria based on study quality (Cohen's d = 0.43, 95% CI = 0.33-0.54; P < 0.001). The included apps incorporated 9 features, sorted from high to low based on relative weights (RW): documentation (RW = 0.254), medication reminder (RW = 0.204), data sharing (RW = 0.148), feedback message (RW = 0.104), clinical decision support (RW = 0.097), education (RW = 0.081), customization (RW = 0.049), data statistics (RW = 0.041), and appointment reminder (RW = 0.041). In the subgroup analysis, the effect was not sensitive to study characteristics or app features (0.37 ≤ P ≤ 0.95). App acceptability was reported by participants in the intervention group in 8 studies: 144 of 156 participants (91.7%) were satisfied with all aspects of the apps. CONCLUSIONS Compared with conventional care, mobile apps are effective interventions to help improve medication adherence in adults with chronic diseases. Although promising, these results should be interpreted with caution given the low level of evidence and short intervention duration. Future research will not only need to identify ideal app features and the costs to providers but also need to improve the apps to make them user friendly, secure, and effective based on patient-centered theory. DISCLOSURES Funding for this study was provided by Chongqing Science and Technology Bureau (No. cstc2017shmsA130115). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no conflicts of interest to disclose.
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Affiliation(s)
- Yihang Peng
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Wang
- Department of Joint Surgery, Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiovasology, Chongqing Medical University, Chongqing, China
| | - Liling Xie
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingzhi Shu
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjing Sun
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Liu
- School of Public Health & Management, Chongqing Medical University, Chongqing, China
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Hennessy EA, Johnson BT, Acabchuk RL, McCloskey K, Stewart-James J. Self-regulation mechanisms in health behavior change: a systematic meta-review of meta-analyses, 2006-2017. Health Psychol Rev 2020; 14:6-42. [PMID: 31662031 PMCID: PMC7571594 DOI: 10.1080/17437199.2019.1679654] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022]
Abstract
Self-regulation is one primary mechanism in interventions for health behavior change and has been examined in numerous recent meta-analyses. This pre-registered meta-review (PROSPERO CRD42017074018) examined Mmeta-analyses of any intervention and health behavior/outcome were eligible if they quantitatively assessed self-regulation and appeared between January 2006 and August 2017. In total, 66 meta-analyses were ultimately eligible; 27% reported a protocol, 11% used GRADE; 58% focused on RCTs. Reviews satisfied only a moderate number of items on the AMSTAR 2 (M = 45.45%, SD = 29.57%). Only 6% of meta-analyses directly examined whether changes in self-regulation predicted the behavior change (i.e., self-efficacy and physical activity, l = 2; frequency of self-monitoring and goal attainment, l = 1; cognitive bias modification and addiction, l = 1). Meta-analyses more routinely assessed self-regulation by comparing the efficacy of intervention components (97%), such as those from behavior change taxonomies. Meta-analyses that focused on intervention components identified several as successful, including personalized feedback, goal setting, and self-monitoring; however, none were consistently successful in that each worked only for some health behaviors and with particular populations. Some components had inconclusive evidence, given that they were only examined in low- quality reviews. Future reviewers should utilize advanced methods to assess mechanisms, and study authors should report hypothesized mechanisms to facilitate synthesis.
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Affiliation(s)
- Emily A Hennessy
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Blair T Johnson
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Rebecca L Acabchuk
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Kiran McCloskey
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jania Stewart-James
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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Wilson TE, Hennessy EA, Falzon L, Boyd R, Kronish IM, Birk JL. Effectiveness of interventions targeting self-regulation to improve adherence to chronic disease medications: a meta-review of meta-analyses. Health Psychol Rev 2020; 14:66-85. [PMID: 31856664 DOI: 10.1080/17437199.2019.1706615] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adherence to chronic disease medication regimens depends in part on successful self-regulation. However, the overall benefit of interventions targeting self-regulatory mechanisms is not well-understood. Accordingly, we conducted a meta-review of meta-analyses assessing the effect of interventions targeting self-regulation on medication adherence. For this meta-review, meta-analyses appearing between January 2006 and March 2019 were eligible if they included experimental trials that assessed the effect of an intervention targeting self-regulation on adherence to chronic disease medication. A systematic literature search of multiple databases for published and unpublished literature identified 16,001 abstracts. Twelve meta-analyses met eligibility criteria and had variable quality according to AMSTAR 2 item completion (M = 50%; range: 31-66%). Overall, meta-reviews showed small to medium effect sizes for interventions that targeted self-monitoring, provided personalised feedback on adherence, or involved complete self-management. Other interventions, such as goal setting, barrier identification and problem solving, and stress management showed little evidence of improving adherence. Only a limited number of self-regulation intervention components were able to be evaluated. Additional research is needed to advance the understanding of the efficacy of adherence interventions focussed on self-regulation by expanding the scope of self-regulation elements targeted (e.g., emotion regulation).
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Affiliation(s)
- Tracey E Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, USA
| | - Emily A Hennessy
- Department of Psychological Sciences, University of Connecticut, Storrs, USA
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, USA
| | - Rebekah Boyd
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, NY, USA
| | - Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, NY, USA
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Russell CL, Hathaway D, Remy LM, Aholt D, Clark D, Miller C, Ashbaugh C, Wakefield M, Ye S, Staggs VS, Ellis RJ, Goggin K. Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial. Am J Transplant 2020; 20:125-136. [PMID: 31291507 PMCID: PMC7179766 DOI: 10.1111/ajt.15528] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and subsequent 6-month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person-level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty-nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6-month intervention phase. Using an intent-to-treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR 0.76-0.96) and attention control (median 0.67, IQR 0.52-0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13-0.30, P < .001). At the conclusion of the subsequent 6-month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR 0.56-0.94) and attention control (median 0.60, IQR 0.44-0.73) patients remained large (difference in medians 0.17, 95% CI 0.06-0.33, P = .004). SystemCHANGE™ patients evidenced lower mean creatinine and BUN at 12 months and more infections at 6 and 12 months. This first fully powered RCT testing SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT02416479.
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Affiliation(s)
- Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Donna Hathaway
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Laura M. Remy
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Dana Aholt
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Debra Clark
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Courtney Miller
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Catherine Ashbaugh
- University of Missouri Renal Transplant Program, University of Missouri Health Care, Columbia, Missouri
| | - Mark Wakefield
- University of Missouri Renal Transplant Program, University of Missouri Health Care, Columbia, Missouri
| | - Sangbeak Ye
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Vincent S. Staggs
- Health Services & Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Rebecca J. Ellis
- Indiana University School of Nursing, Indiana University-Purdue University, Indianapolis, Indiana
| | - Kathy Goggin
- Health Services & Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
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Ganjali R, Taherzadeh Z, Ghorban Sabbagh M, Nazemiyan F, Mamdouhi F, Tabesh H, Badiee Aval S, Golmakani R, Mostafavi SM, Eslami S. Effect of an interactive voice response system on self-management in kidney transplant recipients: Protocol for a randomized controlled trial. Medicine (Baltimore) 2019; 98:e14291. [PMID: 30732143 PMCID: PMC6380874 DOI: 10.1097/md.0000000000014291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adherence to a complex and ongoing set of therapeutic recommendations significantly determines short and long-term outcomes after kidney transplantation (KT). Interactive voice response system (IVRS) is a novel phone-based platform which is potentially useful to deliver health behavior interventions. OBJECTIVE The aims of the study is to describe the development of a theory-driven and educational IVRS investigate the effect of an IVRS on the self-management outcomes in KT recipients as compared with the control group. METHODS This study has been designed as a randomized, 2 parallel groups controlled trial. The KT recipients' older than18 years of age with access to a cellphone will be included. A total of 120 patients will be randomly assigned to the control and intervention groups. The participants in the intervention group will receive completely automatic calls in 3 categories: educational, medication adherence, and reminders by the IVRS, whereas those in the control group will receive usual care. The follow up will be performed within 6 months. The primary outcome will be the medication adherence while patients' transplant knowledge, health-related quality of life, and rehospitalization rates will be considered as secondary outcomes. RESULTS Thus far, recruitment of participants has not been completed and results will be published in 2019. DISCUSSION The IVRS is potentially useful to help KT recipients improve the self-management outcomes. The hypothesis is using an IVRS intervention makes a significant difference between basel assessment of adherence to immunosuppressive medications scale, 12-item short form survey, second version, kidney transplant understanding tool baseline scores, and those obtained at the end of study. TRIAL REGISTRATION NUMBER This trial is registered with the Iran Trial Registrar under registration number IRCT20180124038492N1 and registration date 30 January 2018. https://irct.ir/trial/29215.
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Affiliation(s)
| | - Zhila Taherzadeh
- Neurogenic Inflammation Research Center
- Targeted Drug Delivery Research Center
| | - Mahin Ghorban Sabbagh
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Fatemeh Nazemiyan
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Fereshteh Mamdouhi
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine
| | | | - Reza Golmakani
- Department of Emergency Medicine, Doctor Shariati Hospital
| | | | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands
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29
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Long H, Bartlett YK, Farmer AJ, French DP. Identifying Brief Message Content for Interventions Delivered via Mobile Devices to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A Rapid Systematic Review. J Med Internet Res 2019; 21:e10421. [PMID: 30626562 PMCID: PMC6329430 DOI: 10.2196/10421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023] Open
Abstract
Background Current interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions. Objective This review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions. Methods A rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy. Results A total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences). Conclusions We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs.
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Affiliation(s)
- Hannah Long
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne K Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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30
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Matsumura S, Watanabe K, Fukuhara S. The association between physician's affiliation and patients' adherence to their antihypertensive medication and pharmaceutical knowledge. J Gen Fam Med 2019; 20:19-24. [PMID: 30631655 PMCID: PMC6321828 DOI: 10.1002/jgf2.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/03/2018] [Accepted: 10/27/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study was to examine whether or not the type of physician is associated with the knowledge of and adherence to hypertensive medication among patients. METHODS The study was a self-administered questionnaire survey among patients who submitted their prescriptions for antihypertensive drugs to 13 pharmacies in Japan in 2006. We compared patients' knowledge of their medications and the self-reported adherence according to the type of physician. RESULTS A total of 736 patients were surveyed, and 687 (362 from clinics and 325 from hospitals) were analyzed. In total, 51.8% of the patients correctly named their antihypertensive medicine, with no significant differences observed between clinics and hospitals (51.4% in clinics vs 52.3% in hospitals; P = 0.81, adjusted odds ratio (OR) to the hospital: 0.736, 95% confidence interval [CI]: 0.50-1.08). Significant differences were not observed in the knowledge of the frequency with which hypertensive medication was supposed to be taken (47.2% in clinics vs 46.5% in hospitals; P = 0.84, adjusted OR: 0.80, 95% CI: 0.55-1.16), nor observed in the knowledge of the side effects of the medication (53.2% in clinics vs 51.0% in hospitals; P = 0.57, adjusted OR: 1.14, 95% CI: 0.78-1.68). No significant difference was observed in self-reported adherence (75.1% in clinics vs 77.7% in hospitals; P = 0.42, adjusted OR: 0.73, 95% CI: 0.46-1.16). CONCLUSIONS About 75% answered that they were taking their medication as instructed. No significant differences were observed in responses based on the physician's affiliation. Further studies are needed to achieve better patient's adherence and pharmaceutical knowledge.
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Affiliation(s)
- Shinji Matsumura
- Matsumura ClinicTokyoJapan
- Department of Clinical EpidemiologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
| | - Kazuhiro Watanabe
- Center for Education & Research on Clinical PharmacyShowa Pharmaceutical UniversityTokyoJapan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public HealthKyoto UniversityKyotoJapan
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Shen Y, Wang T, Gao M, Zhu X, Zhang X, He C, Li Y, Sun X. Effectiveness of low-cost reminder package combined with case-based health education to improve hypertensive patients' medication adherence: a clustered randomized controlled trial. Patient Prefer Adherence 2019; 13:1083-1092. [PMID: 31371926 PMCID: PMC6628963 DOI: 10.2147/ppa.s194667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Medication adherence (MA) is a key factor for hypertensive patients' blood pressure control and forgetfulness is one of the main reasons that cause medication non-adherence. If effective, low-cost reminder package (LCRP) has great potentials for large-scale promotion. Therefore, this study aims to evaluate the effectiveness of combining LCRP and health education to improve MA among hypertensive patients. PATIENTS AND METHODS A clustered randomized controlled trial was performed in Beijing. A total of 518 hypertensive patients recruited from 8 community health care centers were randomized to receive LCRP combined with case-based health education or usual care. Randomization was performed at community level. Multilevel modeling was used to evaluate the study effect. RESULTS MA scores did not differ significantly at baseline between the intervention group and the control group. The results of multilevel modeling indicated that MA scores increased more in the intervention group, and the intervention effect on MA was 0.287 (95% CI: [0.103, 0.471], P=0.002). Patients' systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not improved (SBP: difference=0.536, 95% CI [-3.207, 4.278]; DBP: difference=-0.927, 95% CI [-3.283, 1.428]). CONCLUSION LCRP combined with case-based health education could significantly improve hypertensive patients' MA.
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Affiliation(s)
- Ying Shen
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Taotao Wang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Min Gao
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaorou Zhu
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xing Zhang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
- Yindong Li Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China Email
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, People’s Republic of China
- Correspondence: Xinying Sun School of Public Health, Peking University, Beijing, People’s Republic of ChinaTel +86 1 369 121 2050Fax +86 108 280 1743 Email
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Gnjidic D, Husband A, Todd A. Challenges and innovations of delivering medicines to older adults. Adv Drug Deliv Rev 2018; 135:97-105. [PMID: 30118723 DOI: 10.1016/j.addr.2018.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 12/17/2022]
Abstract
Older adults with multimorbidity, polypharmacy, and complex health needs are the major consumer of health care. Ensuring that medicines are used safely, effectively, and delivered efficiently in this population is challenging. In this context, the approach to medicines delivery should seek to overcome some of the difficulties of delivering medicines to older people, and ensure each medication is delivered by the optimal and most convenient route for the patient in question. However, this poses significant obstacles, as the development of medicines suitable for use in older populations does not often account for complex health needs, potential challenges in relation to drug disposition, safety of excipients and limitations with practical usability of dosage forms. The objective of this review is to summarise and discuss current challenges and novel approaches to delivering medications to older adults.
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Affiliation(s)
- Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Andy Husband
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK
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Zullig LL, Deschodt M, Liska J, Bosworth HB, De Geest S. Moving from the Trial to the Real World: Improving Medication Adherence Using Insights of Implementation Science. Annu Rev Pharmacol Toxicol 2018; 59:423-445. [PMID: 30125127 DOI: 10.1146/annurev-pharmtox-010818-021348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential by reviewing published, high-quality medication adherence studies that could potentially be translated into clinical practice yet lack essential implementation science building blocks. We further illustrate this point by describing an adherence study that demonstrates how implementation science creates a junction between research and real-world settings. This article is a call to action for researchers, clinicians, policy makers, pharmaceutical companies, and others involved in the delivery of care to adopt the implementation science paradigm in the scale-up of adherence (research) programs.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Mieke Deschodt
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Division of Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Jan Liska
- Patient Solutions Unit, Medical Evidence Generation Team, Sanofi, 75008 Paris, France
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management. J Clin Rheumatol 2018; 23:317-323. [PMID: 28816767 DOI: 10.1097/rhu.0000000000000561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. OBJECTIVES The aim of this study was to examine associations of patient and provider factors with optimal gout management. METHODS Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. RESULTS A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). CONCLUSIONS Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.
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Xu R, Xie X, Li S, Chen X, Wang S, Hu C, Lv X. Interventions to improve medication adherence among Chinese patients with hypertension: a systematic review and meta-analysis of randomized controlled trails. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:291-301. [PMID: 29693291 DOI: 10.1111/ijpp.12452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to understand the effectiveness of medication adherence (MA) interventions among Chinese patients with hypertension. METHODS A literature search was conducted with three English databases (PubMed, Web of Science and Embase) and three Chinese databases (China National Knowledge Infrastructure, Wanfang and VIP Database for Chinese Technical Periodicals) for the period from 1970 to October 2017. Only both RCTs with a minimum of 10 participants in each intervention group and Chinese patients with hypertension as participants were included. A random-effects model was applied to calculate pooled effect sizes with 95% CI. Subgroup analysis was conducted to identify potential sources of heterogeneity from duration of intervention, type of intervener, methods of intervention and sites of intervention. Funnel plots and Egger's test were used to evaluate for publication bias. KEY FINDINGS A total of 48 studies met criteria for the meta-analysis, including 14 568 participants, testing 57 independent comparisons. Overall, the effect size revealed that interventions significantly improved MA (pooled relative risk = 1.59, 95% CI: 1.43 to 1.78; pooled Cohen's d = 1.42, 95% CI: 0.976 to 1.876). Interventions were found to significantly reduce blood pressure (BP) (systolic BP: Cohen's d = -0.85, 95% CI: -1.11 to -0.60 and diastolic BP: Cohen's d = -0.73, 95% CI: -1.00 to -0.46). Longer duration of intervention gave better effectiveness. Physician as interventionist, regular follow-up visits and interventions conducted at a hospital were associated with better effectiveness. CONCLUSION Adherence interventions improve MA and reduce uncontrolled BP among Chinese patients with hypertension. In the future, investigators should adopt a skill set to address the problem of poor MA.
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Affiliation(s)
- Rixiang Xu
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Xuefeng Xie
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Shuting Li
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Xiaoyu Chen
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Sheng Wang
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China
| | - Xiongwen Lv
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
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Ouchi M, Kitta T, Kanno Y, Moriya K, Suzuki S, Shinohara N, Kato K. Medium-term follow-up after supervised pelvic floor muscle training for patients with anterior vaginal wall prolapse. Eur J Obstet Gynecol Reprod Biol 2018; 225:95-100. [PMID: 29702450 DOI: 10.1016/j.ejogrb.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/01/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to determine changes in quality of life, urogenital symptoms, and adherence to pelvic floor muscle training (PFMT) for pelvic organ prolapse (POP) in the medium term. STUDY DESIGN The present study conducted a pretest-posttest quasi-experimental study design. Of 29 participants in 4-month supervised PFMT, 27 completed all assessments in a follow-up study. Twenty subjects were included in final analysis except 7 participants who underwent surgery during follow-up. To evaluate urogenital symptoms, they completed a prolapse-quality of life (P-QOL) questionnaire and POP-specific QOL. A urologist evaluated the prolapse status of all participants with POP-Q. In addition, the participants were asked about their adherence to PFMT, PFMT obstacles, and where PFMT was performed. All outcome measures were assessed at the following three time points: before PFMT, immediately after PFMT with one-on-one session, and at follow-up via a phone call. Values of p < 0.05 were considered significant. RESULTS Of the 29 participants in the 4-month supervised PFMT, 27 completed all assessments in a follow-up study (response rate: 93.1%). The percentages of patients who continued PFMT at least 4 times declined substantially in non-operated at follow-up compared with supervised PFMT period. POP-specific QOL such as general health, prolapse impact, and role limitation were significantly worse at follow-up compared with immediately after PFMT despite initial improvement in the short term (p < 0.05). CONCLUSION POP-specific QOL gradually worsened compared with patients immediately after supervised PFMT in mild to moderate POP women who were followed up without surgery at a 2-year follow-up. Adherence to home-based PFMT might decline without further supervision. It might indicate that to PFMT would be required to maintain symptoms and QOL in medium term. Further study will be needed to clarify if PFMT is effective to improve urogenital symptoms and QOL in long term among the patients with POP.
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Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeyuki Suzuki
- Department of Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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Russell CL, Miller C, Remy LM, Wessol JL, Andrews AM, Aholt D, Clark D, Hardinger K, O'Brien T, Hathaway D, Goggin K. Improvement of Immunosuppressive Medication Adherence Using a SystemCHANGE Intervention: Case Study of an Older Adult Kidney Transplant Recipient. Nephrol Nurs J 2018; 45:171-223. [PMID: 30303638 PMCID: PMC6456040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article reports a case study of an older adult kidney transplant recipient with poor medication adherence enrolled in an innovative six-month SystemCHANGE intervention that seeks to systematically improve medication adherence by identifying and shaping routines, involving others in routines, and using medication-taking feedback through small, patient-led experiments. Medication adherence increased immediately and was sustained throughout the intervention and maintenance phases. This is the first case study to demonstrate effectiveness of the SystemCHANGE intervention for promoting medication adherence in a kidney transplant recipient. The intervention improved the timing of doses by linking them to a regularly occurring behavior and providing feedback. The SystemCHANGE intervention represents a systems-thinking approach for both provider and patients, and gives healthcare providers the tools needed to assist patients in using habits and routines, and feedback to improve medication taking and timing.
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Affiliation(s)
- Cynthia L Russell
- Professor, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
| | - Courtney Miller
- Research Assistant, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
| | - Laura M Remy
- Research Assistant, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
| | - Jennifer L Wessol
- PhD Student and Jonas Nurse Leader Scholar 2016-2018, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
| | - Angela M Andrews
- PhD Student, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
| | - Dana Aholt
- Research Assistant, University of Missouri - Kansas City, School of Nursing and Health Studies, Kansas City, MO
- Member of ANNA's Central Missouri Chapter
| | - Debra Clark
- Research Nurse Coordinator, University of Tennessee Health Science Center, College of Nursing, Memphis, TN
| | - Karen Hardinger
- Assistant Professor, Ohio State University, Columbus, OH
- Member of ANNA's Bluff city Chapter
| | - Tara O'Brien
- Assistant Professor, Ohio State University, Columbus, OH
- Member of ANNA's Bluff city Chapter
| | - Donna Hathaway
- University Distinguished Professor, University of Tennessee Health Science Center, College of Nursing, Memphis, TN
- member of ANNA's Bluff City Chapter
| | - Kathy Goggin
- Ernest L. Glasscock Chair of Pediatric Education and Research, Associate Chair for Research, Department of Pediatrics, Deputy Director, Children's Research Institute, Director, Health Services and Outcomes Research, Children's Mercy Hospital
- Professor of Medicine and Pharmacy, University of Missouri - Kansas City, School of Medicine Pharmacy, Kansas City, MO
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Ali EE, Teo AKS, Goh SXL, Chew L, Yap KYL. MedAd-AppQ: A quality assessment tool for medication adherence apps on iOS and android platforms. Res Social Adm Pharm 2018; 14:1125-1133. [PMID: 29402755 DOI: 10.1016/j.sapharm.2018.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the recent proliferation of smartphone medication adherence applications (apps), it is increasingly more difficult for patients and clinicians to identify the most useful app. OBJECTIVE To develop a quality assessment tool for medication adherence apps, and evaluate the quality of such apps from the major app stores. METHODS In this study, a Medication Adherence App Quality assessment tool (MedAd-AppQ) was developed and two evaluators independently assessed apps that fulfilled the following criteria: availability in English, had at least a medication reminder feature, non-specific to certain disease conditions (generic apps), free of technical malfunctions and availability on both the iPhone Operating System (iOS) and Android platforms. Descriptive statistics, Mann-Whitney U test, Pearson product moment correlation and Spearman rank-order correlation were used for statistical analysis. RESULTS MedAd-AppQ was designed to have 24 items (total 43 points) categorized under three sections: content reliability (11 points), feature usefulness (29 points) and feature convenience (3 points). The three sections of MedAd-AppQ were found to have inter-rater correlation coefficients of 0.801 (p-value < .001) or higher. Based on analysis of 52 apps (27 iOS and 25 Android), quality scores ranged between 7/43 (16.3%) and 28/43 (65.1%). There was no significant difference between the quality scores of the Android and iOS versions. None of the apps had features for self-management of side effects. Only two apps in each platform provided disease-related and/or medication information. CONCLUSIONS MedAd-AppQ can be used to reliably assess the quality of adherence apps. Clinicians can use the tool in selecting apps for use by patients. Developers of adherence apps should consider features that provide therapy-related information and help patients in medications and side-effects management.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore.
| | - Amanda Kai Sin Teo
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Republic of Singapore.
| | - Sherlyn Xue Lin Goh
- Department of Economics, Faculty of Arts and Social Sciences, National University of Singapore, Republic of Singapore.
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore; Department of Pharmacy, National Cancer Centre Singapore, Republic of Singapore.
| | - Kevin Yi-Lwern Yap
- National Pharmacy Programme Management Office, Office of Director of Medical Services, Ministry of Health, Republic of Singapore.
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Patton DE, Cadogan CA, Ryan C, Francis JJ, Gormley GJ, Passmore P, Kerse N, Hughes CM. Improving adherence to multiple medications in older people in primary care: Selecting intervention components to address patient-reported barriers and facilitators. Health Expect 2018; 21:138-148. [PMID: 28766816 PMCID: PMC5750691 DOI: 10.1111/hex.12595] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst multimorbid older people prescribed multiple medications. Interventions targeting adherence often lack a theoretical underpinning and this may impact on effectiveness. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence. OBJECTIVES This study aimed to (i) identify determinants (barriers, facilitators) of adherence to multiple medications from older people's perspectives; (ii) identify key domains to target for behaviour change; and (iii) map key domains to intervention components [behaviour change techniques (BCTs)] that could be delivered in an intervention by community pharmacists. METHOD Focus groups were conducted with older people (>65 years) receiving ≥4 medications. Questions explored the 12 domains of the TDF (eg "Knowledge," "Emotion"). Data were analysed using the framework method and content analysis. Identification of key domains and mapping to intervention components (BCTs) followed established methods. RESULTS Seven focus groups were convened (50 participants). A wide range of determinants were identified as barriers (eg forgetfulness, prioritization of medications) and facilitators (eg social support, personalized routines) of adherence to multiple medications. Eight domains were identified as key targets for behaviour change (eg "Social influences," "Memory, attention and decision processes," "Motivation and goals") and mapped to 11 intervention components (BCTs) to include in an intervention [eg "Social support or encouragement (general)," "Self-monitoring of the behaviour," "Goal-setting (behaviour)"]. CONCLUSION This study used a theoretical underpinning to identify potential intervention components (BCTs). Future work will incorporate the selected BCTs into an intervention that will undergo feasibility testing in community pharmacies.
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Affiliation(s)
| | - Cathal A. Cadogan
- School of PharmacyQueen's University BelfastBelfastUK
- School of PharmacyRoyal College of Surgeons in IrelandDublinIreland
| | - Cristín Ryan
- School of PharmacyQueen's University BelfastBelfastUK
- School of PharmacyRoyal College of Surgeons in IrelandDublinIreland
| | | | | | - Peter Passmore
- Centre for Public HealthQueen's University BelfastBelfastUK
| | - Ngaire Kerse
- School of Population HealthUniversity of AucklandAucklandNew Zealand
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Pérez-San-Gregorio MÁ, Martín-Rodríguez A, Sánchez-Martín M, Borda-Mas M, Avargues-Navarro ML, Gómez-Bravo MÁ, Conrad R. Spanish Adaptation and Validation of the Transplant Effects Questionnaire (TxEQ-Spanish) in Liver Transplant Recipients and Its Relationship to Posttraumatic Growth and Quality of Life. Front Psychiatry 2018; 9:148. [PMID: 29720952 PMCID: PMC5915644 DOI: 10.3389/fpsyt.2018.00148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/03/2018] [Indexed: 12/21/2022] Open
Abstract
The valid assessment of the impact of transplantation on psychological well-being is highly relevant to optimize treatment. However, to date there is no standardized instrument available in Spain. The Transplant Effects Questionnaire (TxEQ) evaluates the specific problems associated with organ transplantation, such as worry about transplant, guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment and responsibility toward the donor, family, friends, or medical staff. Against this backdrop the English original version of the TxEQ was translated into Spanish and validated in a sample of 240 liver transplant recipients. Participants also filled in the Posttraumatic Growth Inventory (PTGI), and the 12-Item Short Form Health Survey (SF-12v.2). Confirmatory factor analysis of the TxEQ-Spanish revealed a five-factor structure equivalent to the English original version, and satisfactory internal consistency (Cronbach's alpha: worry α = 0.82, guilt α = 0.77, disclosure α = 0.91, adherence α = 0.82, responsibility α = 0.83). Results showed that better mental quality of life was associated with higher adherence and disclosure, as well as less worry and guilt. Higher posttraumatic growth was significantly associated with worry, guilt, and responsibility. Interestingly, the most powerful predictor of posttraumatic growth was worry. Analysis of variance showed an interaction effect of PTG and mental quality of life on adherence, with medium PTG being associated with significantly stronger adherence in participants with better mental quality of life. In conclusion our study could successfully adapt and validate the Spanish version of the TxEQ in a large sample of liver transplant recipients. Our findings show a complex relationship between emotional reactions to transplantation, mental quality of life, and posttraumatic growth, which give further insight into inner processes supporting psychological well-being and adherence after liver transplantation.
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Affiliation(s)
- María Á Pérez-San-Gregorio
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | | | - Mercedes Borda-Mas
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - María L Avargues-Navarro
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Miguel Á Gómez-Bravo
- Hepatic-Biliary-Pancreatic Surgery and Liver Transplant Unit, University Hospital Virgen del Rocío of Seville, Seville, Spain
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
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Senft Y, Kirsch M, Denhaerynck K, Dobbels F, Helmy R, Russell CL, Berben L, De Geest S. Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study. Eur J Cardiovasc Nurs 2017; 17:356-367. [PMID: 29231747 DOI: 10.1177/1474515117747577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians' responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level. RESULTS The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75-88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7-28.6%), the number of strategies decreased. CONCLUSIONS Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.
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Affiliation(s)
- Yuliya Senft
- 1 Department of Haematology, University Hospital of Basel, Switzerland
| | - Monika Kirsch
- 2 Department of Anesthesiology, University Hospital of Basel, Switzerland
| | - Kris Denhaerynck
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | | | - Remon Helmy
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Cynthia L Russell
- 5 School of Nursing and Health Studies, University of Missouri-Kansas City, USA
| | - Lut Berben
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Sabina De Geest
- 3 Institute of Nursing Science, University of Basel, Switzerland.,4 Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
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Unni EJ, Sharp LK. Giving adherence intervention programs their due. Curr Med Res Opin 2017; 33:2263-2264. [PMID: 28799429 DOI: 10.1080/03007995.2017.1356709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth J Unni
- a Roseman University of Health Sciences College of Pharmacy , South Jordan , UT , USA
| | - Lisa K Sharp
- b Outcomes and Policy , University of Illinois at Chicago , Chicago , IL , USA
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Malhotra R, Bautista MAC, Tan NC, Tang WE, Tay S, Tan ASL, Pouliot A, Saffari SE, Chei CL, Vaillancourt R. Bilingual Text With or Without Pictograms Improves Elderly Singaporeans’ Understanding of Prescription Medication Labels. THE GERONTOLOGIST 2017; 59:378-390. [DOI: 10.1093/geront/gnx169] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | | | | | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore
| | - Sarah Tay
- Clinic Pharmacy, SingHealth Polyclinics, Singapore
| | | | - Annie Pouliot
- Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
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Kassianos AP, Georgiou G, Papaconstantinou EP, Detzortzi A, Horne R. Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning. Front Psychol 2017; 8:1769. [PMID: 29075216 PMCID: PMC5641822 DOI: 10.3389/fpsyg.2017.01769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/25/2017] [Indexed: 01/29/2023] Open
Abstract
Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.
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Affiliation(s)
- Angelos P. Kassianos
- Department of Applied Health Research, University College London, London, United Kingdom
| | | | | | | | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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Andrews AM, Russell CL, Cheng AL. Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review. J Gerontol Nurs 2017; 43:37-45. [DOI: 10.3928/00989134-20170523-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/18/2017] [Indexed: 11/20/2022]
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Lin CY, Yaseri M, Pakpour AH, Malm D, Broström A, Fridlund B, Burri A, Webb TL. Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter, Randomized Controlled Trial with 18-Month Follow-Up. Drugs Aging 2017; 34:143-156. [PMID: 28004259 DOI: 10.1007/s40266-016-0429-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important. OBJECTIVE The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery. METHODS Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses. RESULTS Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04). CONCLUSION The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran. .,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Dan Malm
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Internal Medicine, Country Hospital Ryhov, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Andrea Burri
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Anaesthesia and Perioperative Medicine, Waitemata Pain Service, North Shore Hospital, Auckland, New Zealand
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Marcum ZA, Hanlon JT, Murray MD. Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs Aging 2017; 34:191-201. [PMID: 28074410 DOI: 10.1007/s40266-016-0433-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. OBJECTIVE The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adherence also improve the health outcomes of older adults residing in community-based settings. METHODS Articles that assessed medication adherence interventions and related health outcomes in elderly individuals were identified through searches of MEDLINE (1970-June 2016), the Cochrane Database of Systematic Reviews (through to June 2016), and Google Scholar. Across the 12 included studies, interventions were grouped into three main categories: behavioral/educational (n = 3), pharmacist-led (n = 7), and reminder/simplification (n = 2). RESULTS Among the behavioral/educational intervention studies, two showed improvements in both adherence and related health outcomes, whereas one found no changes in adherence or health outcomes. Among the pharmacist-led studies, three showed improvements in both adherence and related health outcomes, while three reported no changes in adherence or health outcomes. One found an improvement in adherence but not health outcomes. Among the reminder/simplification studies, both studies reported improvements in adherence without a significant impact on related health outcomes. CONCLUSION This evidence-based review of medication adherence interventions in older adults revealed promising strategies in the larger context of a largely mixed body of literature. Future patient-centered and multidisciplinary interventions should be developed and tested using evidence-based principles to improve medication adherence and health outcomes in older adults.
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Affiliation(s)
| | - Joseph T Hanlon
- Schools of Medicine (Geriatrics), Pharmacy, and Public Health, University of Pittsburgh, 3471 Fifth Avenue, Suite #500, Pittsburgh, PA, 15213, USA. .,Center for Health Equity Research and Promotion and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Michael D Murray
- Purdue University College of Pharmacy and Regenstrief Institute, Indianapolis, IN, USA
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Bazargan M, Smith J, Yazdanshenas H, Movassaghi M, Martins D, Orum G. Non-adherence to medication regimens among older African-American adults. BMC Geriatr 2017; 17:163. [PMID: 28743244 PMCID: PMC5526276 DOI: 10.1186/s12877-017-0558-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/17/2017] [Indexed: 01/13/2023] Open
Abstract
Background Despite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use. Methods Four-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants’ medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use. Results Participants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2–10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1–3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index. Conclusions While other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration.
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Affiliation(s)
- Mohsen Bazargan
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA. .,University of California, Los Angeles, CA, USA. .,Department of Family Medicine, Los Angeles, CA, USA. .,Public Health Program, Los Angeles, CA, USA.
| | - James Smith
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA
| | - Hamed Yazdanshenas
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, CA, USA
| | | | - David Martins
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, CA, USA
| | - Gail Orum
- Keck Graduate Institutes, School of Pharmacy, Claremont, CA, USA
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Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis. Prev Med 2017; 99:269-276. [PMID: 28315760 PMCID: PMC5467216 DOI: 10.1016/j.ypmed.2017.03.008] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/22/2017] [Accepted: 03/12/2017] [Indexed: 11/20/2022]
Abstract
Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.
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Ruppar TM, Dunbar-Jacob JM, Mehr DR, Lewis L, Conn VS. Medication adherence interventions among hypertensive black adults. J Hypertens 2017; 35:1145-1154. [DOI: 10.1097/hjh.0000000000001260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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