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Bentley S, Exall E, Morgan L, Roche N, Khunti K, Rossom R, Piercy J, Arbuckle R, Higgins VS. Improving Assessment of Adherence Behaviors and Drivers: Targeted Literature Review and Concept Elicitation Interviews in Multiple Countries and Disease Populations. Patient Prefer Adherence 2024; 18:1231-1242. [PMID: 38911591 PMCID: PMC11192640 DOI: 10.2147/ppa.s433662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Medication adherence is crucial for achieving clinical goals. Medication adherence drivers and behaviors were explored across multiple conditions, countries, and medication schedules/modalities to develop a conceptual model of medication adherence, which could later be used to support development of a patient-reported outcome (PRO) measure of adherence. Patients and Methods Targeted review of qualitative literature identified important medication adherence concepts. Fifty-seven qualitative concept elicitation interviews were conducted (USA n=21, Spain n=18, Germany n=18). Participants were prescribed medication for: hypertension (n=9), asthma (n=8), multiple myeloma (n=8), psoriasis (n=8), diabetes (n=7), depression (n=7), multiple sclerosis (n=7), and/or schizophrenia (n=6). Thematic analysis of verbatim transcripts was performed. Expert clinicians (n=3) provided input throughout. Results Nine qualitative articles were selected for review from 2168 screened abstracts. Forty-two medication adherence concepts were reported and grouped into 10 domains. Eight forms of medication adherence were reported during interviews, along with 27 drivers of non-adherence, all of which were incorporated into a conceptual model. Participants reported skipping medication doses (n=36/57; 63.2%) or taking medication later in the day than prescribed (n=29/57; 50.9%). Common drivers of non-adherence included forgetfulness (n=35/57; 61.4%), being out of the usual routine (n=31/57; 54.4%) and being busy (n=22/57; 38.6%). US participants were more likely to report non-adherence due to low perceived efficacy (n=6/21, 28.6%) and cost (n=5/21, 23.8%) than German (n=1/18, 5.6%; n=0/18, 0.0%) or Spanish (n=2/18, 11.1%; n=1/18, 5.6%) participants. Conclusion Findings highlight the diverse forms and drivers of medication non-adherence, informing the development of a comprehensive conceptual model of medication adherence. The conceptual model builds on and advances previous models of medication adherence and can be used by healthcare professionals to understand and interpret barriers to medication adherence and how best to support patients in taking their medication as intended.
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Affiliation(s)
- Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | | | - Lucy Morgan
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre University of Paris, Institut Cochin (UMR1016), Paris, France
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester University, Leicester, UK
| | - Rebecca Rossom
- HealthPartners Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
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Southern KW, Addy C, Bell SC, Bevan A, Borawska U, Brown C, Burgel PR, Button B, Castellani C, Chansard A, Chilvers MA, Davies G, Davies JC, De Boeck K, Declercq D, Doumit M, Drevinek P, Fajac I, Gartner S, Georgiopoulos AM, Gursli S, Gramegna A, Hansen CM, Hug MJ, Lammertyn E, Landau EEC, Langley R, Mayer-Hamblett N, Middleton A, Middleton PG, Mielus M, Morrison L, Munck A, Plant B, Ploeger M, Bertrand DP, Pressler T, Quon BS, Radtke T, Saynor ZL, Shufer I, Smyth AR, Smith C, van Koningsbruggen-Rietschel S. Standards for the care of people with cystic fibrosis; establishing and maintaining health. J Cyst Fibros 2024; 23:12-28. [PMID: 38129255 DOI: 10.1016/j.jcf.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
This is the second in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on establishing and maintaining health. The guidance is produced using an evidence-based framework and with wide stakeholder engagement, including people from the CF community. Authors provided a narrative description of their topic and statements, which were more directive. These statements were reviewed by a Delphi exercise, achieving good levels of agreement from a wide group for all statements. This guidance reinforces the importance of a multi-disciplinary CF team, but also describes developing models of care including virtual consultations. The framework for health is reinforced, including the need for a physically active lifestyle and the strict avoidance of all recreational inhalations, including e-cigarettes. Progress with cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy is reviewed, including emerging adverse events and advice for dose reduction and interruption. This paper contains guidance that is pertinent to all people with CF regardless of age and eligibility for and access to modulator therapy.
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Affiliation(s)
- Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Scott C Bell
- Department of Thoracic Medicine and Faculty of Medicine, The University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Urzula Borawska
- Institute of Mother and Child in Warsaw, Cystic Fibrosis Department and Dziekanow Lesny Hospital, Cystic Fibrosis Center, Dziekanow Lesny, Poland
| | - Catherine Brown
- West Midlands Adult CF Centre, Heartlands Hospital Birmingham, UK
| | - Pierre-Régis Burgel
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP) and Université Paris-Cité, Institut Cochin, Inserm U1016, Paris, France
| | - Brenda Button
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia 3181, and Department of Respiratory Medicine, Alfred Health, Melbourne 3004, Australia
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Audrey Chansard
- Epigenetics and Cell Fate Centre, UMR7216 CNRS, Université Paris Cité, Paris, France, and Cystic Fibrosis Europe, Brussels, Belgium
| | - Mark A Chilvers
- Divison of Pediatric Respiratroy Medicine, BC Childrens Hospital, Vancouver, Canada
| | - Gwyneth Davies
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London; Imperial Biomedical Research Centre; Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | | | - Dimitri Declercq
- Cystic Fibrosis Reference Center, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Center for children and adolescents with diabetes, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Isabelle Fajac
- Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sandra Gursli
- National Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carina Me Hansen
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Martin J Hug
- Medical Center - University of Freiburg, Pharmacy, Hugstetter St. 55, Freiburg, D-79106, Germany
| | - Elise Lammertyn
- Cystic Fibrosis Europe, Brussels, Belgium and the Belgian CF Association, Brussels, Belgium
| | - Edwina Eddie C Landau
- The Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ross Langley
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Nicole Mayer-Hamblett
- Seattle Children's Research Institute, Seattle, WA and Department of Pediatrics, University of Washington, Seattle, Wa, USA
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney and CITRICA, Dept Respiratory & Sleep Medicine, Westmead Hospital, Westmead, Australia
| | - Monika Mielus
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland; Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Lisa Morrison
- West of Scotland Adult CF Centre, Queen Elizabeth University Hospital, Glasgow, UK
| | - Anne Munck
- Hospital Necker Enfants-Malades, AP-HP, CF centre, Université Paris Descartes, Paris, France
| | - Barry Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
| | | | - Dominique Pougheon Bertrand
- Laboratoire Educations et Promotion de la santé, LEPS, UR 3412, University of Sorbonne Paris Nord, F-93430, Villetaneuse, France
| | | | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine. St. Paul's Hospital and the University of British Columbia. Vancouver, British Columbia, Canada
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, UK and Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, UK
| | - Ilan Shufer
- CF Patient, Head of Access, Off label and Trials, Computer Science Architecture, Research and Innovation, Cystic Fibrosis Foundation of Israel, Israel
| | - Alan R Smyth
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Chris Smith
- Department of Nutrition and Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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Dwyer TJ, Elkins MR, Dentice R, Forbes S, Cooper P, Jaffe A, Bishop J, Middleton PG, Wark P, Bye PTP. Saline at lower tonicity in cystic fibrosis (SALTI-CF) trial comparing 0.9% versus 3% versus 6% nebulised saline. Eur Respir J 2023; 62:2100960. [PMID: 37343977 DOI: 10.1183/13993003.00960-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND In people with cystic fibrosis (CF), regular nebulisation of 6% or 7% saline improves lung function; however, these concentrations are not always tolerable. Clinically, some CF patients report using lower concentrations of saline to improve tolerability, yet the effects of lower concentrations are unknown. This study therefore aimed to evaluate the relative effectiveness and tolerability of 0.9% versus 3% versus 6% saline nebulised twice daily with an eFlow rapid nebuliser. METHODS This was a randomised, blinded, placebo-controlled, parallel-group, multicentre study where subjects inhaled 4 mL of 0.9%, 3% or 6% saline twice daily for 16 weeks. The primary outcome was forced expiratory volume in 1 s. The secondary outcomes were: forced vital capacity (FVC) and forced expiratory flow at 25-75% of FVC; quality of life; exercise capacity; acquisition or loss of bacterial organisms in expectorated sputum; tolerability of nebulised saline; pulmonary exacerbations; and adverse events. RESULTS 140 participants were randomised to 0.9% (n=47), 3% (n=48) or 6% (n=45) saline. 134 participants (96%) contributed to the intention-to-treat analysis. 3% saline significantly improved lung function and increased the time to first pulmonary exacerbation compared with 0.9% saline but did not improve quality of life. 6% saline had similar benefits to 3% saline but also significantly improved quality of life compared with 3% saline. Only 6% saline delayed the time to intravenous antibiotics for pulmonary exacerbation. Tolerability and adherence were similar. CONCLUSIONS Dilution of 6% saline to 3% maintains the benefits for lung function and exacerbation prevention; however, the positive impacts of 6% saline on quality of life and time to i.v. antibiotics for pulmonary exacerbations are lost.
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Affiliation(s)
- Tiffany J Dwyer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark R Elkins
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ruth Dentice
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Samantha Forbes
- Department of Respiratory Medicine, Children's Hospital Westmead, Westmead, Australia
| | - Peter Cooper
- Department of Respiratory Medicine, Children's Hospital Westmead, Westmead, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, UNSW Medicine and Health, Randwick, Australia
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, Australia
| | - Jennifer Bishop
- Department of Respiratory Medicine, Westmead Hospital, Westmead, Australia
| | - Peter G Middleton
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Westmead Hospital, Westmead, Australia
| | - Peter Wark
- Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Peter T P Bye
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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García-Muñoz AM, Victoria-Montesinos D, Cerdá B, Ballester P, de Velasco EM, Zafrilla P. Self-Reported Medication Adherence Measured with Morisky Scales in Rare Disease Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11111609. [PMID: 37297749 DOI: 10.3390/healthcare11111609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The visibility of Rare Diseases is a new challenge for society. These diseases are numerous, heterogeneous in nature and distribution, characterized by a high mortality rate but low prevalence, and usually presenting a severe evolution. Adherence to medication studies in rare diseases are uncommon, due to treatment scarcity. OBJECTIVES The main purpose of this study is to do a meta-analysis, evaluating the level of adherence to medication in the most prevalent rare diseases. METHODS This work is a systematic review, and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42022372843) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Adherence to treatment in this systematic review and meta-analysis was collected from all studies included, based on the crude numerators and denominators reported, using either the Morisky Medication Adherence Scale 4 or -8. RESULTS A total of 54 records were identified through database searches, or after screening relevant manuscripts' references. Finally, 18 studies were included in this systematic review and meta-analysis. A total of 1559 participants (54.18% women) aged less than 84 years old were included. Twelve studies used the MMAS-8. In 8 of them, they established the level of adherence to treatment in three categories (low, medium, and high), with the mean prevalence in each of them being 41.4%, 30.4%, and 28.2%, respectively. CONCLUSIONS The results observed in adherence to treatment in patients with rare diseases show great variability, due to the different aspects involved in the greater or lesser applicability of the medication.
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Affiliation(s)
- Ana María García-Muñoz
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
| | - Desirée Victoria-Montesinos
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
| | - Begoña Cerdá
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
| | - Pura Ballester
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
| | - Eloisa María de Velasco
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
| | - Pilar Zafrilla
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia (UCAM), Campus de los Jerónimos, 30107 Murcia, Spain
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5
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Volpi S, Carnovale V, Colombo C, Raia V, Blasi F, Pappagallo G. Use of mucoactive agents in cystic fibrosis: A consensus survey of Italian specialists. Health Sci Rep 2022; 5:e604. [PMID: 35677472 PMCID: PMC9169509 DOI: 10.1002/hsr2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background The goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients. Method A consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF. Results Full or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice. Conclusions The consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient.
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Affiliation(s)
- Sonia Volpi
- Cystic Fibrosis Center Azienda Ospedialiera Universitaria Integrata Verona Italy
| | - Vincenzo Carnovale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Cystic Fibrosis Center Milan Italy
| | - Carla Colombo
- Department of Translational Medical Science, Cystic Fibrosis Centre, Adult Unit University “Federico II” Naples Italy
| | - Valeria Raia
- Section of Pediatrics, Department of Translational Medical Sciences “University Federico II” Naples Italy
| | - Francesco Blasi
- Department of Internal Medicine Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
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Bentley S, Morgan L, Exall E, Arbuckle R, Rossom RC, Roche N, Khunti K, Higgins V, Piercy J. Qualitative Interviews to Support Development and Cognitive Debriefing of the Adelphi Adherence Questionnaire (ADAQ©): A Patient-Reported Measure of Medication Adherence Developed for Use in a Range of Diseases, Treatment Modalities, and Countries. Patient Prefer Adherence 2022; 16:2579-2592. [PMID: 36133076 PMCID: PMC9484566 DOI: 10.2147/ppa.s358046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Adelphi Adherence Questionnaire (ADAQ©) is a newly developed generic patient-reported outcome (PRO) assessment of medication adherence. The aim was to assess its content validity by conducting cognitive debriefing (CD) interviews with patients prescribed medication(s) of various treatment modalities in a range of therapy areas. MATERIALS AND METHODS Targeted literature/instrument review and concept elicitation interviews informed development of the ADAQ©. CD interviews were conducted with 57 adults from the United States of America (USA; n = 21), Spain (n = 18), and Germany (n = 18) who prescribed medication for hypertension, diabetes, depression, schizophrenia, asthma, multiple myeloma, psoriasis, and/or multiple sclerosis. Interviews were conducted in two rounds to explore the relevance and understanding of the item wording, instructions, recall period and response options. Verbatim transcripts were analysed in ATLAS.Ti using thematic analysis. Three expert clinicians provided guidance throughout the study. RESULTS ADAQ© items/instructions were well understood and relevant to participants. Key modifications following round 1 included revising instructions to refer to current medication(s) for one condition to reduce cognitive burden, removing two items with lower relevance (specifically those assessing running out of medication and social discouragement), and adding a response option for participants to indicate if they had stopped taking a medication. Minor wording modifications were made following round 2. Subgroup differences in item relevance were explored based on clinical characteristics. Cost of medication was more relevant amongst US participants. CONCLUSION Content validity of the ADAQ© was confirmed in demographically and clinically diverse participants. Psychometric properties of the ADAQ© will be explored in future studies.
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Affiliation(s)
- Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Lucy Morgan
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Elizabeth Exall
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
- Correspondence: Rob Arbuckle, Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK, Tel +44 7720 880884, Email
| | - Rebecca C Rossom
- HealthPartners Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre University Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester University, Leicester, UK
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Lumley E, Drabble SJ, Scott A, Wildman MJ, O’Cathain A. Objective Nebuliser Adherence Data as "Proof" of Adherence in the Management of Cystic Fibrosis: A Qualitative Interview Study. Patient Prefer Adherence 2022; 16:771-780. [PMID: 35370406 PMCID: PMC8965329 DOI: 10.2147/ppa.s353434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Low adherence to medication via nebulisers is linked to poor clinical outcomes for people with Cystic Fibrosis (PWCF). Advances in technology allow electronic monitoring of nebuliser usage and feedback of objective adherence data to PWCF and clinical teams caring for them. CFHealthHub is a new intervention that collects and displays objective adherence data in easy-to-read formats with the aim of improving nebuliser adherence and health. There is little understanding of how objective adherence data is perceived by PWCF and healthcare professionals (HCPs). PATIENTS AND METHODS A qualitative study using semi-structured interviews with 22 PWCF and 31 HCPs who had used the CFHealthHub intervention. RESULTS Objective adherence data was welcomed by the majority of PWCF in the sample, and HCP delivering the intervention, because the data allowed PWCF to reflect on patterns of adherence or non-adherence. Ease of use and characteristics of data display were important, particularly the use of a "traffic light" system to allow PWCF to easily see if they were meeting their adherence targets. For PWCF objective adherence data was used as "proof to self", offering reassurance to high adherers, and a wake-up call to those with lower levels of adherence. It could also provide 'proof to others' where PWCF had higher levels of adherence than HCP or family members believed. The data could sometimes change HCP perceptions of PWCF's identities as poor adherers. Where adherence was not high, data was used to facilitate honest discussions between PWCF and HCPs about how to increase adherence. HCPs perceived that it was important to use the data positively to motivate, rather than criticise, PWCF. CONCLUSION Objective nebuliser adherence data in CFHealthHub can offer proof of adherence to PWCF and HCPs. It is important to use it constructively to facilitate discussions on how to improve adherence.
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Affiliation(s)
- Elizabeth Lumley
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
- Correspondence: Elizabeth Lumley, Health and Care Research Unit, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK, Tel +44 114 2224294, Email
| | - Sarah J Drabble
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Scott
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alicia O’Cathain
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Abraham O, LeMay S, Nixon G, Braun A, Decker C, Szela L. Characterizing medication management and the role of pharmacists in caring for people living with cystic fibrosis: A work system approach. J Am Pharm Assoc (2003) 2021; 61:547-554.e2. [PMID: 33931354 DOI: 10.1016/j.japh.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive genetic disease requiring complex, lifelong medication regimens. Given the importance of medication in CF treatment, pharmacists are vital CF care team members in the care of people living with CF (PwCF). OBJECTIVES This study aimed to (1) define patients' CF medication experiences and educational needs and (2) investigate the CF outpatient clinic and community pharmacist's role in addressing patient challenges. METHODS A work system approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model was used to characterize knowledge and perception of CF medication regimens, educational modalities, and pharmacist interactions for PwCF. Semistructured interviews were conducted with adults living with CF at a CF center clinic. Data analyses identified relationships between the themes in the data and 4 SEIPS work system domains: tasks, tools and technology, person, and environment. RESULTS Thirty PwCF interviews highlighted 4 themes regarding health care experiences: (1) medication use experience, (2) medication education needs, (3) disease experience, and (4) pharmacist and pharmacy interactions. Patients reported complex medication regimens leading to challenges with medication adherence, although the benefit of treatment was recognized. Although a high level of disease-state knowledge was identified among the participants, PwCF desired to learn about CF medication benefits and adverse effects through credible sources using multiple modalities. Many reported a benefit of pharmacist involvement in their care. CONCLUSION Pharmacists are well-positioned to support PwCF in adherence, medication regimen management, and medication education. Opportunities exist for growth in these supportive roles of a pharmacist in both community and outpatient clinic settings.
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Drabble SJ, O’Cathain A, Arden MA, Hutchings M, Beever D, Wildman M. When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments. QUALITATIVE HEALTH RESEARCH 2019; 29:2119-2131. [PMID: 31303116 PMCID: PMC7322938 DOI: 10.1177/1049732319856580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.
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Affiliation(s)
| | | | | | | | - Daniel Beever
- The University of Sheffield, Sheffield,
United Kingdom
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10
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Arden MA, Drabble S, O'Cathain A, Hutchings M, Wildman M. Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework. Br J Health Psychol 2019; 24:357-380. [PMID: 30825258 PMCID: PMC6519271 DOI: 10.1111/bjhp.12357] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 02/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. DESIGN Data-prompted interviews using the TDF. METHODS Eighteen semi-structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. RESULTS Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision-making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. CONCLUSIONS This study is the first to use objectively measured adherence data in a data-prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem-solving may be particularly useful for adults with CF. Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self-reported adherence and objectively measured adherence. What this study adds A data-prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one-size fits all intervention for adherence to medication in cystic fibrosis.
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Affiliation(s)
- Madelynne A. Arden
- Centre for Behavioural Science and Applied Psychology (CeBSAP)Sheffield Hallam UniversityUK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | - Alicia O'Cathain
- School of Health and Related Research (ScHARR)University of SheffieldUK
| | | | - Martin Wildman
- School of Health and Related Research (ScHARR)University of SheffieldUK
- Sheffield Adult CF CentreNorthern General HospitalSheffieldUK
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Cordeiro SM, Jesus MCPD, Tavares RE, Oliveira DMD, Merighi MAB. Experience of adults with cystic fibrosis: a perspective based on social phenomenology. Rev Bras Enferm 2018; 71:2891-2898. [PMID: 30517390 DOI: 10.1590/0034-7167-2017-0749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 08/01/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the experience of adults living with cystic fibrosis. METHOD A qualitative study based on the social phenomenology by Alfred Schütz, carried out with 12 adults interviewed in 2016. The statements were analyzed and organized into concrete categories. RESULTS The following categories were evidenced: "The biopsychosocial impact of the disease on daily life", "Social prejudice as a generator of embarrassment", "Coping strategies" and "Fear, uncertainties and the desire to carry out life projects". FINAL CONSIDERATIONS The understanding of the experience lived by adults with cystic fibrosis allowed unveiling intersubjective aspects experienced by this public that should be considered by health professionals in the care of this group. It is up to the professionals involved in assisting these people to develop care strategies aimed at completeness, respect for the world of meanings of each individual, their life history, and intersubjectivity that is specially built in the relationship between professionals and people with cystic fibrosis.
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