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Li H, Wu X, Shen J, Lou S. Perspective and Experience of Patients with Aplastic Anemia on Medication Adherence. Patient Prefer Adherence 2023; 17:2215-2225. [PMID: 37701429 PMCID: PMC10493145 DOI: 10.2147/ppa.s390409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
Background Drug treatment is critical for patients with aplastic anemia, and medication adherence directly impacts the therapeutic effect. Poor medication adherence is common among patients with chronic diseases. However, knowledge of the perceptions and experiences of patients with aplastic anemia regarding taking prescribed medicines is limited. Objective To gain insights into the perceptions and experiences of patients with aplastic anemia regarding taking prescribed medicines. Methods A descriptive qualitative design was used. Fifteen patients with aplastic anemia were recruited from the hematology department. Individual semi-structured interviews were conducted. The data were analyzed using the thematic analysis method and conceptualized using the Health Belief Model. Results Five themes emerged: the perceived threat of aplastic anemia, perceived benefits and barriers of taking prescribed medicines, cues to action, self-efficacy, and modifying factors. While patients' knowledge was limited, they acknowledged the threat of aplastic anemia and the necessity of drug treatments, but they also encountered some barriers in practice. The desire for health and healthcare providers' opinions were the main clues to medication adherence. The expectation of the future and the sense of self-competency made participants adopt good behavior. Discussions This study provided new perspectives on the medication adherence of patients with aplastic anemia, which may be valuable in clinical work and research. Further interventions should be developed for intentional and unintentional non-compliance. Future research can start with developing professional assessment tools addressing the influence of cognition and emotion on compliance.
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Affiliation(s)
- Hangting Li
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China
| | - Xiaolian Wu
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China
| | - Jiaoni Shen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Shuhui Lou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Quinlivan A, Lester S, Barrett C, Whittle S, Rowett D, Black R, Chand V, Marine F, March L, Sinnathurai P, Buchbinder R, Hill C. Attitudes of Australians with inflammatory arthritis to biologic therapy and biosimilars. Rheumatol Adv Pract 2022; 6:rkac099. [PMID: 36424984 PMCID: PMC9682816 DOI: 10.1093/rap/rkac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To investigate the knowledge and beliefs of Australian patients with inflammatory arthritis regarding biologic/targeted synthetic DMARDs (b/tsDMARDs) and biosimilars and their sources of information. METHODS Participants enrolled in the Australian Rheumatology Association Database (ARAD) with RA, PsA and axial SpA were sent an online survey. They were asked about information sources for b/tsDMARDs and how positive or negative this information was. The Beliefs about Medicine Questionnaire (BMQ) was used to measure beliefs about b/tsDMARDs with scores ranging from 1 (strongly disagree) to 5 (strongly agree). Participants were asked about their knowledge of biosimilars and willingness to switch to biosimilar. RESULTS There was a response rate of 66% (994/1498; 67% female, median age 62 years). Participants currently taking b/tsDMARDs (n = 794) had a high b/tsDMARD-specific BMQ 'necessity' score {median 4.2 [interquartile range (IQR) 3.6-4.8]}, with a lower specific 'concerns' score [median 2.4 (IQR 2.0- 3.0)]. Participants consulted multiple information sources [median 3 (IQR 2-5)]. Positive sources were rheumatologists and educational websites and negative were chat rooms and social media. Only 18% were familiar with biosimilars, with half knowing of availability in Australia. Following a short paragraph describing biosimilars, 75% (744) of participants indicated they would consider switching if recommended by their rheumatologist, with nearly half identifying safety and efficacy of biosimilars as an important concern. CONCLUSION Australian patients have positive attitudes towards b/tsDMARDs overall, although little knowledge of biosimilars specifically. They have a high degree of trust in their rheumatologist regarding treatment decisions, even if they are unfamiliar with the medication recommended.
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Affiliation(s)
- Alannah Quinlivan
- Correspondence to: Alannah Quinlivan, Rheumatology Department, St Vincent’s Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, VIC 3065, Australia. E-mail:
| | - Susan Lester
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia
| | - Claire Barrett
- Redcliffe Hospital, Redcliffe, QLD, Australia,Discipline of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Samuel Whittle
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | - Debra Rowett
- UniSA Clinical and Health Science, University of South Australia, Adelaide, SA, Australia,Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Daw Park, SA, Australia
| | - Rachel Black
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vibhasha Chand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | | | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia,Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Premarani Sinnathurai
- Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia,Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia,NPS MedicineWise, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Brisbane, VIC, Australia,Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
| | - Catherine Hill
- Rheumatology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia,University of Adelaide, Adelaide, SA, Australia,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
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3
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Sun H, Li J, Cheng Y, Pan X, Shen L, Hua W. Developing a framework for understanding health information behavior change from avoidance to acquisition: a grounded theory exploration. BMC Public Health 2022; 22:1115. [PMID: 35658937 PMCID: PMC9166210 DOI: 10.1186/s12889-022-13522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health information avoidance is common in real life, but because it is not always conducive to health promotion and maintenance, people often actively switch to health information acquisition. Understanding this process of active change can facilitate intervention in unreasonable avoidance behaviors. However, studies so far have mostly focused on why and how avoidance takes place, little is known about the process of active change from avoidance to acquisition. We thus use a grounded theory approach (GT) to explore how the active change takes place, and to generate a grounded theoretical framework capable of illustrating stages and influencing factors involved in the active change process. METHODS Straussian grounded theory (Corbin & Strauss, 2015) was used to analyze data collected through semi-structured interviews with 30 adults (14 in good health, 11 with disease, 5 in other health status) who had experienced health information behavior change from avoidance to acquisition. These interviews focused on how the change occurred and what effected the change. RESULTS The core category of Health Information Avoidance Change and 12 categories were identified and integrated to form a theoretical framework termed the Health Information Avoidance Change Model (HIACM). This model describes the process using five non-linear stage variables (initiation, preparation, action, maintenance, and abandonment) and seven moderating factor variables (cognitive change, social stimulus, beliefs and attitudes, intrapsychic literacy, social resources, information source, time and material resources). CONCLUSIONS HIACM can be used to explain the process of active change from health information avoidance to health information acquisition. HIAC is a non-linear and holistic process, and it is necessary to dynamically analyze the impact of relevant factors and take targeted intervention measures in stages. HIAC is usually not only an individual behavior, but also a socialized behavior requiring the collaboration of individuals, families, health information providers, healthcare providers, and governments.
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Affiliation(s)
- Haixia Sun
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Ying Cheng
- School of Information Management, Nanjing University, Nanjing, China
| | - Xuelian Pan
- School of Information Management, Nanjing University, Nanjing, China
| | - Liu Shen
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Weina Hua
- School of Information Management, Nanjing University, Nanjing, China
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Sherbini AA, Gwinnutt JM, Hyrich KL, Verstappen SMM. Rates and predictors of methotrexate-related adverse events in patients with early rheumatoid arthritis: results from a nationwide UK study. Rheumatology (Oxford) 2022; 61:3930-3938. [PMID: 35078225 PMCID: PMC9536779 DOI: 10.1093/rheumatology/keab917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To estimate prevalence rates and identify baseline predictors of adverse events (AEs) over the first year of treatment in patients with rheumatoid arthritis (RA) starting methotrexate (MTX). METHODS Data came from the UK Rheumatoid Arthritis Medication Study (RAMS), a prospective cohort of patients with RA starting MTX. This analysis included patients aged ≥ 18 years with physician diagnosed RA and symptom duration ≤ two years, who were commencing MTX for the first time. AEs were recorded by interviewing patients at six- and twelve-month follow-up visits. The period prevalence rates of AEs are reported for 0-6 months, 6-12 months, and 0-12 months of follow-up. The associations between baseline characteristics and AEs were assessed using multivariable logistic regression. RESULTS A total of 1069 patients were included in the analysis. Overall, 77.5% experienced at least one AE. The most commonly reported AEs were: gastrointestinal (42.0%), neurological (28.6%), mucocutaneous (26.0%), pulmonary (20.9%), elevated alanine transaminase (18.0%) and haematologic AEs (5.6%).Factors associated with increased odds of AEs were: women vs men (gastrointestinal, mucocutaneous, neurological), and alcohol consumption (nausea, alopecia, mucocutaneous). Older age, higher estimated Glomerular Filtration Rate (eGFR), and alcohol consumption were associated with less reporting of haematologic AEs. CONCLUSIONS AEs were common among patients over the first year of MTX, although most were not serious. Knowledge of the rates and factors associated with AEs occurrence are valuable when communicating risks prior to commencing MTX. This can help patients make informed decisions whether to start MTX, potentially increasing adherence to treatment.
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Affiliation(s)
- Ahmad A Sherbini
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Manchester, UK
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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5
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Abstract
An estimated 11%-33% of persons taking methotrexate for rheumatoid arthritis (RA) are intolerant to this medication. Medications for RA are often discontinued or changed because of patient intolerance. Yet, intolerance is a poorly defined perspective, specifically the patient's perspective. This study used descriptive qualitative methodologies to describe methotrexate intolerance from the perspective of adult patients with RA. Semistructured, audio-recorded individual interviews were conducted with 14 adult English-speaking patients with RA who had been prescribed, were taking, or had ever taken methotrexate. Methotrexate intolerance involves a complex belief system involving 3 themes: beliefs about the risk of methotrexate, beliefs about the benefits of methotrexate, and beliefs about the threat of RA. Participants reported a threshold by which perceived risks and benefits of methotrexate were weighed against perceived risks of RA. The critical underpinnings of the largely undefined and unique patient perspective of methotrexate intolerance are described.
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Affiliation(s)
- Elizabeth Salt
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
| | - Kristine Lohr
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
| | - Jean Edward
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
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Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management. J Clin Med 2021; 10:jcm10163566. [PMID: 34441861 PMCID: PMC8396818 DOI: 10.3390/jcm10163566] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Fatigue is a common constitutional feature of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). While the two diseases share a common mechanism of autoimmunity, they differ in their clinical manifestations and treatment. Fatigue is one of the most commonly reported symptoms in both groups, associated with pain, depression and anxiety, and affecting function, work and quality of life. Fatigue is not easy to assess or conceptualise. It can be linked to disease activity, although it is not always, and is challenging to treat. Several measures have been trialled in RA and SLE; however, none have been adopted into mainstream practice. Despite being a common symptom, fatigue remains poorly managed in both RA and SLE—more so in the latter, where there have been relatively fewer studies. Additionally, comorbidities contribute to fatigue, further complicating its management. Pain, depression and anxiety also need to be addressed, not as separate entities, but together with fatigue in a holistic manner. Here, we describe the similarities and differences between fatigue in patients with RA and SLE, discuss concepts and practices applicable to both conditions and identify areas for further research. Through this review, we aim to highlight the importance of the holistic management of fatigue in SLE.
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7
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Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics 2021; 13:pharmaceutics13071100. [PMID: 34371791 PMCID: PMC8309154 DOI: 10.3390/pharmaceutics13071100] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medication adherence continues to be a significant challenge in healthcare, and there is a shortage of effective interventions in this area. This scoping review studied the patient-related factors of medication adherence. Methods: We searched Medline Ovid, Scopus, and Cochrane Library from January 2009 to June 2021 to find the most recent original qualitative studies or systematic reviews that addressed the patient-related factors of medication adherence in treating chronic conditions. We used the PRISMA-ScR checklist to ensure the quality of the study. Results: The initial search revealed 4404 studies, of which we included 89 qualitative studies in the scoping review. We inductively organized the patient-related factors causing barriers, as well as the facilitators to medication adherence. The studies more often dealt with barriers than facilitators. We classified the factors as patient-specific, illness-specific, medication-related, healthcare and system-related, sociocultural, as well as logistical and financial factors. Information and knowledge of diseases and their treatment, communication, trust in patient-provider relationships, support, and adequate resources appeared to be the critical facilitators in medication adherence from the patient perspective. Discussion and conclusions: Patients are willing to discuss their concerns about medications. Better communication and better information on medicines appear to be among the critical factors for patients. The findings of this scoping review may help those who plan further interventions to improve medication adherence.
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Affiliation(s)
- Kirsi Kvarnström
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
- Correspondence:
| | - Aleksi Westerholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (A.W.); (M.A.)
| | - Helena Liira
- Department of General Practice, University of Helsinki, 00290 Helsinki, Finland;
- Unit of Primary Health Care, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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Tong V, Krass I, Robson S, Aslani P. Opt-in or opt-out health-care communication? A cross-sectional study. Health Expect 2021; 24:776-789. [PMID: 33761176 PMCID: PMC8235885 DOI: 10.1111/hex.13198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/19/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients need medication and medical condition-related information to better self-manage their health. Health-care professionals (HCPs) should be able to actively provide information outside of one-on-one consultations; however, patient consent may be required. OBJECTIVE To investigate the Australian public's preferences, and factors that may influence their preferences, towards an opt-in versus an opt-out approach to health communication. DESIGN A cross-sectional study using a structured questionnaire administered via Computer-Assisted Telephone Interviewing. SETTING AND PARTICIPANTS Participants across Australia who were adults, English-speaking and had a long-term medical condition. MAIN OUTCOME MEASURES Preferences for opt-in vs opt-out approach to receiving follow-up tailored information. RESULTS A total of 8683 calls were made to achieve the required sample size of 589 completed surveys. Many (346/589; 58.7%) indicated that they were interested in receiving tailored, ongoing follow-up information from their HCP. Nearly half (n = 281; 47.7%) preferred an opt-in service and 293/589 (49.7%) an opt-out service for receiving follow-up information. Reasons for preferring an opt-in service were being in control of the information received (n = 254); able to make a decision that is best for them (n = 245); opt-in service would save time for HCPs (n = 217); they may not want or need the information (n = 240). Many (n = 255) felt that an opt-out service should be part of the normal duty of care of their HCP and believed (n = 267) that this approach would ensure that everyone has access to information. CONCLUSIONS Respondents were interested in receiving tailored information outside of consultation times. However, preferences for an opt-in or opt-out approach were divided.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
| | | | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
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Leonardo N, Lester S, Graham M, Barrett C, Whittle S, Rowett D, Buchbinder R, Hill CL. Selection and perception of methotrexate treatment information in people with rheumatoid arthritis. Int J Rheum Dis 2020; 23:805-812. [DOI: 10.1111/1756-185x.13833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Susan Lester
- The Queen Elizabeth Hospital Adelaide SA Australia
- Discipline of Medicine University of Adelaide Adelaide SA Australia
| | | | - Claire Barrett
- Redcliffe Hospital Redcliffe Qld Australia
- Discipline of Medicine University of Queensland Brisbane Qld Australia
| | | | - Debra Rowett
- School of Pharmacy and Medical Sciences University of South Australia Adelaide SA Australia
- Drug and Therapeutics Information Service SALHN Adelaide SA Australia
| | - Rachelle Buchbinder
- Cabrini Institute Melbourne Vic. Australia
- Monash University Melbourne Vic. Australia
| | - Catherine L. Hill
- The Queen Elizabeth Hospital Adelaide SA Australia
- Discipline of Medicine University of Adelaide Adelaide SA Australia
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Jager M, de Zeeuw J, Tullius J, Papa R, Giammarchi C, Whittal A, de Winter AF. Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4300. [PMID: 31694299 PMCID: PMC6862529 DOI: 10.3390/ijerph16214300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 01/22/2023]
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
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Affiliation(s)
- Margot Jager
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Janine de Zeeuw
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
- Department of Medical Sciences, Educational Institute, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Janne Tullius
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Roberta Papa
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Cinzia Giammarchi
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Amanda Whittal
- Department of Psychology & Methods, Jacobs University, 28759 Bremen, Germany;
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
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11
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de Toro J, Cea-Calvo L, Battle E, Carmona L, Arteaga MJ, Fernández S, González CM. Perceptions of patients with rheumatic diseases treated with subcutaneous biologicals on their level of information: RHEU-LIFE Survey. REUMATOLOGIA CLINICA 2019; 15:343-349. [PMID: 29277578 DOI: 10.1016/j.reuma.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate, in Spanish patients with rheumatic diseases treated with subcutaneous biological drugs, their sources of information, which sources they consider most relevant, and their satisfaction with the information received in the hospital. METHODS Rheumatologists from 50 hospitals handed out an anonymous survey to 20 consecutive patients with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis treated with subcutaneous biologicals. The survey was developed ad hoc by 4 rheumatologists and 3 patients, and included questions with closed-ended responses on sources of information and satisfaction. RESULTS The survey was handed-out to 1,000 patients, 592 of whom completed it (response rate: 59.2%). The rheumatologist was mentioned as the most important source of information (75%), followed by the primary care physician, nurses, and electronic resources; 45.2% received oral and written information about the biological, 46.1% oral only, and 6.0% written only; 8.7% stated that they had not been taught to inject the biological. The percentage of patients satisfied with the information received was high (87.2%), although the satisfaction was lower in relation to safety. If the information came from the rheumatologist, the satisfaction was higher (89.6%) than when coming from other sources (59.6%; P<.001). Satisfaction was also higher if the information was provided orally and written (92.8%) than if provided only orally (86.1%; P=.013); 45.2% reported having sought information from sources outside the hospital. CONCLUSIONS The rheumatologist is key in transmitting satisfactory information on biological treatment to patients. He or she must also act as a guide, since a high percentage of patients seeks information in other different sources.
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Affiliation(s)
- Javier de Toro
- Departamento de Reumatología, Hospital Universitario A Coruña, A Coruña, España
| | - Luis Cea-Calvo
- Departamento de Medical Affairs, Merck Sharp & Dohme de España
| | - Enrique Battle
- Departamento de Reumatología, Hospital Universitario de Sant Joan d'Alacant, Alicante, España
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, España.
| | - María J Arteaga
- Departamento de Medical Affairs, Merck Sharp & Dohme de España
| | | | - Carlos M González
- Departamento de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
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Albaqami J, Alshalhoub R, Almalag H, Dessougi M, Al Harthi A, Bedaiwi MK, Omair MA. Prevalence of methotrexate intolerance among patients with rheumatoid arthritis using the Arabic version of the methotrexate intolerance severity score. Int J Rheum Dis 2019; 22:1572-1577. [DOI: 10.1111/1756-185x.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 02/19/2019] [Accepted: 05/15/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jawza Albaqami
- Department of Clinical Pharmacy, College of Pharmacy; King Saud University; Riyadh Saudi Arabia
- Department of Clinical Pharmacy; Security Force Hospital; Riyadh Saudi Arabia
| | - Rawan Alshalhoub
- Department of Clinical Pharmacy, College of Pharmacy; King Saud University; Riyadh Saudi Arabia
| | - Haya Almalag
- Department of Clinical Pharmacy, College of Pharmacy; King Saud University; Riyadh Saudi Arabia
| | - Maha Dessougi
- Rheumatology Unit, Department of Medicine; Security Forces Hospital; Riyadh Saudi Arabia
| | - Amal Al Harthi
- Rheumatology Unit, Department of Medicine; Security Forces Hospital; Riyadh Saudi Arabia
| | - Mohamed K. Bedaiwi
- Rheumatology Unit, Department of Medicine, College of Medicine; King Saud University; Riyadh Saudi Arabia
| | - Mohammed A. Omair
- Rheumatology Unit, Department of Medicine, College of Medicine; King Saud University; Riyadh Saudi Arabia
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Abstract
PURPOSE OF REVIEW Inflammation has been shown to be central to the development and progression of atherosclerosis. Despite detailed understanding of its central role and the cellular dynamics, which contribute to atherosclerotic inflammation, there has been slow progress in finding suitable agents to treat it. The recent CANTOS trial showed that the interleukin-1β inhibitor canakinumab can improve outcomes after acute coronary syndromes. Being a monoclonal antibody, it is expensive and inconvenient to administer for long-term treatment. This review summarizes recent work in finding effective, affordable alternatives to canakinumab. RECENT FINDINGS Statin drugs have anti-inflammatory properties but separating their LDL lowering effect from their anti-inflammatory effect has been difficult. Drugs acting on targets outside of the interleukin-1β (IL-1β) pathway have been tested without finding a suitable candidate. Following the proof of principle provided by the success of canakinumab, other candidates targeting the IL-1β pathway are undergoing detailed evaluation. The most likely candidates are low-dose methotrexate and low-dose colchicine. The potential mechanisms and ongoing clinical trials are described. SUMMARY Targeting the IL-1β pathway has already been successful with canakinumab but its expense and inconvenience of administration may limit its widespread uptake for controlling inflammation in atherosclerosis. Low-dose methotrexate and low-dose colchicine are affordable and more accessible alternatives, currently undergoing detailed evaluation for safety and efficacy in large randomized controlled trials.
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Affiliation(s)
- Peter L Thompson
- Heart Research Institute, Sir Charles Gairdner Hospital
- Harry Perkins Institute of Medical Research
- School of Medicine and Pharmacology, University of Western Australia
- GenesisCare, Perth, Australia
| | - S Mark Nidorf
- Harry Perkins Institute of Medical Research
- GenesisCare, Perth, Australia
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14
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Connelly K, Segan J, Lu A, Saini M, Cicuttini FM, Chou L, Briggs AM, Sullivan K, Seneviwickrama M, Wluka AE. Patients' perceived health information needs in inflammatory arthritis: A systematic review. Semin Arthritis Rheum 2018; 48:900-910. [PMID: 30185378 DOI: 10.1016/j.semarthrit.2018.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/21/2018] [Accepted: 07/26/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify the breadth of the literature regarding patients' perceived health information needs related to inflammatory arthritis care. METHODS A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO was performed to identify relevant articles (1990 -2016) examining patients' perceived needs relating to health information in inflammatory arthritis. Data and themes were identified and categorised and risk of bias assessed. RESULTS Twenty nine studies (11 quantitative, 14 qualitative and 4 mixed methods) from 4121 identified articles were relevant for inclusion. Most focussed on rheumatoid arthritis. Key findings included: (1) Reasons for seeking health information often focussed on gaining ownership over their condition and facilitating self-management. (2) Demographic differences in information needs were inconsistent, but women and younger patients generally reported more needs. (3) Desired information content was broad, and included targeted and practical information covering disease treatment and psychosocial wellbeing. (4) Preferred information delivery method was consultation with a Rheumatologist; however group sessions had advantages for psychosocial issues while written information provided useful supplementation. (5) Barriers to meeting health information needs were around timely access. CONCLUSIONS Patients with inflammatory arthritis have high information needs, desiring practical and individualised information. When developing strategies to meet patients' information needs, aligning patient expectations with delivery methods that are accessible, cost-effective and flexible may help to optimize patient outcomes.
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Affiliation(s)
- Kathryn Connelly
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Julian Segan
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Alicia Lu
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Meher Saini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Louisa Chou
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; MOVE: Muscle, Bone & Joint Health, Victoria, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
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15
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Palominos PE, Gasparin AA, de Andrade NPB, Xavier RM, da Silva Chakr RM, Igansi F, Gossec L. Fears and beliefs of people living with rheumatoid arthritis: a systematic literature review. Adv Rheumatol 2018; 58:1. [DOI: 10.1186/s42358-018-0001-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022] Open
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16
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Shaw Y, Metes ID, Michaud K, Donohue JM, Roberts MS, Levesque MC, Chang JC. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. Arthritis Care Res (Hoboken) 2018; 70:533-541. [PMID: 28575542 DOI: 10.1002/acr.23301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. METHODS A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. RESULTS In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. CONCLUSION Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process.
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Affiliation(s)
- Yomei Shaw
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ilinca D Metes
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark S Roberts
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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Patient and Physician Perceptions of Drug Safety Information for Sleep Aids: A Qualitative Study. Drug Saf 2018; 40:531-542. [PMID: 28247279 DOI: 10.1007/s40264-017-0516-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The US Food and Drug Administration uses drug safety communications (DSCs) to release emerging information regarding post-market safety issues, but it is unclear the extent of awareness by patients and providers of these communications and their specific recommendations. OBJECTIVE We conducted semi-structured interviews with patients and physicians to evaluate their awareness and understanding of emerging drug safety information related to two sleep aids: zolpidem or eszopiclone. METHODS We conducted interviews with 40 patients and ten physicians recruited from a combination of insurer claims databases and online sources. We evaluated (1) sources of drug safety information; (2) discussions between patients and physicians about the two medications; (3) their knowledge of the DSC; and (4) preferences for learning about future drug safety information. Interviews were transcribed and analyzed thematically. RESULTS Patients cited their physicians, pharmacy inserts, and the Internet as sources of drug safety information. Physicians often referred to medical journals and online medical sources. Most patients reported being aware of information contained in the DSC summaries they were read. Almost all patients and physicians reported discussing side effects during patient-provider conversations, but almost no patients mentioned that physicians had communicated with them key messaging from the DSCs at issue: the risk of next-morning impairment with zolpidem and the lower recommended initial dose for women. CONCLUSIONS Some risks of medications are effectively communicated to patients and physicians; however, there is still a noticeable gap between information issued by the Food and Drug Administration and patient and physician awareness of this knowledge, as well as patients' decisions to act on this information. Disseminators of emerging drug safety information should explore ways of providing user-friendly resources to patients and healthcare professionals that can update them on new risks in a timely manner.
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Choy E, Aletaha D, Behrens F, Finckh A, Gomez-Reino J, Gottenberg JE, Schuch F, Rubbert-Roth A. Monotherapy with biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:689-697. [PMID: 27550301 DOI: 10.1093/rheumatology/kew271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Indexed: 01/10/2023] Open
Abstract
Current EULAR guidelines state that biologic DMARD (bDMARD) therapy should be administered in combination with MTX or other conventional synthetic (cs) DMARD in RA. Nonetheless, a third of patients for whom a bDMARD agent is prescribed take it in the absence of concurrent csDMARD therapy. While the reasons underlying the low uptake of bDMARD-csDMARD combination therapy in clinical practice have not been well delineated, they may include poor adherence, contraindication to csDMARD therapy and adverse effects, as well as csDMARD withdrawal following remission. The challenges surrounding bDMARD therapy and the benefit/risk ratio of biologic monotherapy when compared with combination with a csDMARD will be discussed. We will provide insights into these important issues, as well as reviewing the evidence base differentiating biologic agents and exploring therapeutic options for patients with rheumatoid arthritis for whom csDMARD therapy is contraindicated or discontinued.
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Affiliation(s)
- Ernest Choy
- CREATE Centre, Institute of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Daniel Aletaha
- Department of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Frank Behrens
- CIRI/Division of Rheumatology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Juan Gomez-Reino
- Hospital Clinico, University of Santiago de Compostela, Santiago de Compostela, Spain
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Heller MK, Chapman SCE, Horne R. No blank slates: Pre-existing schemas about pharmaceuticals predict memory for side effects. Psychol Health 2017; 32:402-421. [PMID: 28219295 DOI: 10.1080/08870446.2016.1273355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Attribution of symptoms as medication side effects is informed by pre-existing beliefs about medicines and perceptions of personal sensitivity to their effects (pharmaceutical schemas). We tested whether (1) pharmaceutical schemas were associated with memory (recall/recognition) for side effect information (2) memory explained the attribution of a common unrelated symptom as a side effect. DESIGN In this analogue study participants saw the patient leaflet of a fictitious asthma drug listing eight side effects. MAIN OUTCOME MEASURES We measured recall and recognition memory for side effects and used a vignette to test whether participants attributed an unlisted common symptom (headache) as a side effect. RESULTS Participants who perceived pharmaceuticals as more harmful in general recalled fewer side effects correctly (rCorrect Recall = -.273), were less able to differentiate between listed and unlisted side effects (rRecognition Sensitivity = -.256) and were more likely to attribute the unlisted headache symptom as a side effect (rside effect attribution = .381, ps < .01). The effect of harm beliefs on side effect attribution was partially mediated by correct recall of side effects. CONCLUSION Pharmaceutical schemas are associated with memory for side effect information. Memory may explain part of the association between pharmaceutical schemas and the attribution of unrelated symptoms as side effects.
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Affiliation(s)
- Monika K Heller
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
| | - Sarah C E Chapman
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
| | - Rob Horne
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
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Blalock SJ. Medication Risk Communication in Rheumatology: Where Are We and Where Do We Go from Here? Curr Rheumatol Rep 2017; 19:7. [PMID: 28164248 DOI: 10.1007/s11926-017-0631-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reviews findings from recent research examining issues related to the risk communication process within the context of rheumatologic conditions. Five specific questions are addressed. First, to what extent do patients with rheumatic disorders exhibit adequate knowledge relevant to disease and medication risks and risk management? Second, what sources do patients use when attempting to find information about disease and medication risks and risk management? Third, what types of information about disease and medication risks and risk management do rheumatologists provide during routine office visits. Fourth, what governmental regulations attempt to increase consumer access to information about medication risks and risk management? Finally, what other educational resources are available to facilitate patient-provider communication concerning disease and medication risks and risk management? The findings reported identify gaps in patient knowledge concerning medication risks and risk management, highlight areas for improvement, and identify resources that may enhance medication risk communication.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7573, USA.
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21
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Farinha F, Freitas F, Águeda A, Cunha I, Barcelos A. Concerns of patients with systemic lupus erythematosus and adherence to therapy - a qualitative study. Patient Prefer Adherence 2017; 11:1213-1219. [PMID: 28761334 PMCID: PMC5522825 DOI: 10.2147/ppa.s137544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The objectives of this study were 1) to identify the impact of systemic lupus erythematosus (SLE) on patients' lives and their reactions to this, as well as their main concerns and expectations regarding their disease and treatments; and 2) to assess the relationship between these concerns and the adherence to treatments, medical visits, and diagnostic tests. PATIENTS AND METHODS Qualitative study, using a convenient sample of SLE patients attending an outpatient rheumatology clinic. Semistructured interviews were conducted and audiotaped. The full transcripts were analyzed by two different coders using content analysis methodology. RESULTS Fifteen participants were included. SLE had a major impact on these patients' lives. Their main concerns were fear of disease worsening and becoming dependent on other people, fear of not being able to take care of their children or provide for the family, and the possibility of transmitting SLE to their offspring. The main reasons for adherence to therapy were the wish to avoid manifestations of SLE and trust in the rheumatologist and routine. Nonadherence was more common in the beginning of the treatment because of the difficulty in accepting a chronic disease that requires lifelong therapy. CONCLUSION Our data underlined the important interplay between adherence to medication and the possibility to gather accurate information and proper support during the treatment process. Good communication and efficient patient education strategies, focused on improving their knowledge about the disease and its treatments, may be important to improve adherence to therapy in SLE.
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Affiliation(s)
- Filipa Farinha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
- Correspondence: Filipa Farinha, Serviço de Reumatologia – Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810–501 Aveiro, Portugal, Tel +351 234 378 300, Fax +351 234 378 395, Email
| | - Francisco Freitas
- Centre for Social Studies, Universidade de Coimbra, Coimbra, Portugal
| | - Ana Águeda
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Inês Cunha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
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22
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Brandstetter S, Hertig S, Loss J, Ehrenstein B, Apfelbacher C. 'The lesser of two evils…' - views of persons with rheumatoid arthritis on medication adherence: a qualitative study. Psychol Health 2016; 31:675-92. [PMID: 26832226 DOI: 10.1080/08870446.2016.1139111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors. DESIGN A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis. RESULTS Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants' current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits 'openness' and 'conscientiousness', belief in medical progress, characteristics of the medication, level of trust in one's physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events. CONCLUSION The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants' ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers.
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Affiliation(s)
- Susanne Brandstetter
- a Medical Sociology, Institute of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany
| | - Simone Hertig
- a Medical Sociology, Institute of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany
| | - Julika Loss
- a Medical Sociology, Institute of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany
| | - Boris Ehrenstein
- b Department of Rheumatology and Clinical Immunology , Asklepios Clinic , Bad Abbach , Germany
| | - Christian Apfelbacher
- a Medical Sociology, Institute of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany
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