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Baéz-Gutiérrez N, Rodríguez-Ramallo H, Sánchez-Fidalgo S. Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00117-X. [PMID: 39142941 DOI: 10.1016/j.farma.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE To study medication adherence and persistence among heart failure patients, assess the methods utilised for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes. METHODS A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalisation, emergency visits, and mortality. The I2 statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews CRD42024509542. DISCUSSION This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.
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Affiliation(s)
- Nerea Baéz-Gutiérrez
- Pharmacy Department, University Hospital Nuestra Señora de Valme, Seville, Spain; Preventive Medicine and Public Health Department, University of Seville, Seville, Spain
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Oliveira CJ, José HMG, da Costa EIMT. Medication Adherence in Adults with Chronic Diseases in Primary Healthcare: A Quality Improvement Project. NURSING REPORTS 2024; 14:1735-1749. [PMID: 39051365 PMCID: PMC11270278 DOI: 10.3390/nursrep14030129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
(1) Background: Medication adherence is influenced by a variety of intricate factors, presenting hurdles for nurses working to improve it among adults with chronic conditions. Pinpointing the reasons for non-adherence is crucial for customizing interventions. The objective of this quality improvement project was to improve medication adherence among adults with chronic diseases in primary healthcare by promoting evidence-based practices, identifying barriers and facilitators to compliance, and developing strategies to ensure optimal adherence through engaging the nursing team, enhancing knowledge, and evaluating the effectiveness of the implemented strategies. (2) Methods: This study was a quality improvement project that utilized the JBI Evidence Implementation framework, the Practical Application of Clinical Evidence System, and the Getting Research into Practice audit tool across three phases: (i) forming a project team and conducting a baseline audit, (ii) offering feedback via the GRiP tool, and (iii) conducting a follow-up audit to assess best practice outcomes. The study was conducted between September 2021 and March 2022 in the community care unit of Algarve Regional Health Administration, targeting adults with chronic illnesses. (3) Results: A total of 148 individuals were audited, including 8 nurses, 70 baseline patients, and 70 post-implementation patients. Initial compliance with key best practices was low, with several criteria at 0% compliance at baseline. Post-intervention, we observed significant improvements; compliance with key best practices improved dramatically, with many reaching 100%. Notable improvements included enhanced patient education on medication management, regular medication adherence assessments, and increased engagement of healthcare professionals in adherence activities. (4) Conclusions: This quality improvement project demonstrated that structured, evidence-based interventions could significantly enhance medication adherence among adults with chronic diseases. The success of the project highlights the potential of similar strategies to be applied broadly in primary healthcare settings to improve health outcomes.
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Affiliation(s)
- Claúdia Jorge Oliveira
- Health School, Polytechnic Institute of Beja, 7800 Beja, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046 Coimbra, Portugal; (H.M.G.J.); (E.I.M.T.d.C.)
| | - Helena Maria Guerreiro José
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046 Coimbra, Portugal; (H.M.G.J.); (E.I.M.T.d.C.)
- School of Health, University Institute Atlântica, 2730 Barcarena, Portugal
| | - Emília Isabel Martins Teixeira da Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046 Coimbra, Portugal; (H.M.G.J.); (E.I.M.T.d.C.)
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal
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Temeloglu Sen E, Sertel Berk HO, Rezvani A. Serial mediation of illness perception and beliefs about medicines in the relationship between patient satisfaction and medication adherence: An evaluation of self-regulatory model in rheumatoid arthritis and ankylosing spondylitis patients. J Health Psychol 2024; 29:836-847. [PMID: 38014636 DOI: 10.1177/13591053231213306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
This study examined the effect of patient satisfaction on medication adherence through serial mediation of Self Regulatory Model (SRM) components which are illness perception and beliefs about medicines in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The 222 outpatients (nRA = 112; nAS = 110) were administered a sociodemographic form, the Medication Adherence Report Scale, the Brief Illness Perception Questionnaire, the Short Assessment of Patient Satisfaction, and the Beliefs about Medicines Questionnaire. The results showed that SRM components fully mediated the relationship between patient satisfaction and medication adherence. This proposed model had acceptable and better fit indices than the alternative model where patient satisfaction was introduced as a direct predictor. Furthermore, patient satisfaction, illness perception, and beliefs about medicines had an extremely good relationship, so these may be interpreted as variables of a latent construct of the illness experience which deserves further research in these group of patients.
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Carrillo A, Belnap BH, Rothenberger SD, Feldman R, Rollman BL, Celano CM. Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial. BMC Psychol 2024; 12:328. [PMID: 38835104 PMCID: PMC11151478 DOI: 10.1186/s40359-024-01816-4] [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: 07/10/2023] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs. METHODS Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments. RESULTS In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes. CONCLUSIONS These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.
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Affiliation(s)
- Alba Carrillo
- Instituto Polibienestar, University of Valencia, Valencia, Spain
- Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Scott D Rothenberger
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert Feldman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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Huber M, Busch AK, Stalder-Ochsner I, Flammer AJ, Schmid-Mohler G. Medication adherence in adults after hospitalization for heart failure: A cross-sectional study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200234. [PMID: 38299126 PMCID: PMC10828571 DOI: 10.1016/j.ijcrp.2023.200234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
Background Medication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients' post-hospitalization medication non-adherence in Switzerland. Objectives Our primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF. A secondary objective was to identify differences between fully and partially adherent patients regarding selected unplanned therapy-related inpatient/outpatient cardiology visits. Methods A non-experimental cross-sectional study was applied. The prevalence of medication adherence was assessed with a German-translated version of the Medication Adherence Report Scale (MARS-5) and analyzed descriptively. Differences between adherent and partially adherent patients' numbers of medications, dosing per day and 180-day unplanned inpatient stays or cardiology outpatient visits were explored. Results Of 153 recruited patients, 72 participated in the survey. Of these, 26.4 % were not fully adherent. Their most common reason was forgetfulness (23.7 %). There were no significant group differences regarding therapy-related variables or 180-day unplanned cardiology stays/visits. Conclusions Considering that over one-quarter of surveyed HF patients were not fully medication adherent, Swiss cardiology nurses need to be sensitized to this issue and trained in adherence-enhancing interventions. Reaching acceptable adherence levels in patients with HF will require further research and action.
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Affiliation(s)
- Manuela Huber
- Educational Center for Health and Social, Weinfelden, Switzerland
- Clinic for General, Visceral, Transplant, Vascular and Thoracic Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Ada Katrin Busch
- Institute of Nursing, ZHAW School of Health Science, Winterthur, Switzerland
| | - Irene Stalder-Ochsner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Andreas J. Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Gabriela Schmid-Mohler
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Switzerland
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Ichihara YK, Shiraishi Y, Kohsaka S, Nakano S, Nagatomo Y, Ono T, Takei M, Sakamoto M, Mizuno A, Kitamura M, Niimi N, Kohno T, Yoshikawa T. Association of pre-hospital precipitating factors with short- and long-term outcomes of acute heart failure patients: A report from the WET-HF2 registry. Int J Cardiol 2023; 389:131161. [PMID: 37437664 DOI: 10.1016/j.ijcard.2023.131161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited. METHODS We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018-2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed. RESULTS Median patient age was 78 years (interquartile range: 68-85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93-1.51]) and the no-PF group (HR 1.28 [95%CI 1.00-1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07-1.83] and HR 1.39 [95%CI 1.06-1.83], respectively). CONCLUSION Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization.
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Affiliation(s)
- Yumiko Kawakubo Ichihara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Tomohiko Ono
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Munehisa Sakamoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Nozomi Niimi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
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Meraz R, McGee J, Caldwell EP, Ke W, Osteen K. The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure. J Cardiovasc Nurs 2023; 38:415-424. [PMID: 36103430 DOI: 10.1097/jcn.0000000000000948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. OBJECTIVE The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. METHODS This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. RESULTS Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. CONCLUSION Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.
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Purcell C, Dibben G, Hilton Boon M, Matthews L, Palmer VJ, Thomson M, Smillie S, Simpson SA, Taylor RS. Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. Cochrane Database Syst Rev 2023; 6:CD013820. [PMID: 37378598 PMCID: PMC10305790 DOI: 10.1002/14651858.cd013820.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Globally, cardiovascular diseases (CVD, that is, coronary heart (CHD) and circulatory diseases combined) contribute to 31% of all deaths, more than any other cause. In line with guidance in the UK and globally, cardiac rehabilitation programmes are widely offered to people with heart disease, and include psychosocial, educational, health behaviour change, and risk management components. Social support and social network interventions have potential to improve outcomes of these programmes, but whether and how these interventions work is poorly understood. OBJECTIVES: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. The comparator was usual care with no element of social support (i.e. secondary prevention alone or with cardiac rehabilitation). SEARCH METHODS: We undertook a systematic search of the following databases on 9 August 2022: CENTRAL, MEDLINE, Embase, and the Web of Science. We also searched ClinicalTrials.gov and the WHO ICTRP. We reviewed the reference lists of relevant systematic reviews and included primary studies, and we contacted experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of social network or social support interventions for people with heart disease. We included studies regardless of their duration of follow-up, and included those reported as full text, published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS Using Covidence, two review authors independently screened all identified titles. We retrieved full-text study reports and publications marked 'included', and two review authors independently screened these, and conducted data extraction. Two authors independently assessed risk of bias, and assessed the certainty of the evidence using GRADE. Primary outcomes were all-cause mortality, cardiovascular-related mortality, all-cause hospital admission, cardiovascular-related hospital admission, and health-related quality of life (HRQoL) measured at > 12 months follow-up. MAIN RESULTS: We included 54 RCTs (126 publications) reporting data for a total of 11,445 people with heart disease. The median follow-up was seven months and median sample size was 96 participants. Of included study participants, 6414 (56%) were male, and the mean age ranged from 48.6 to 76.3 years. Studies included heart failure (41%), mixed cardiac disease (31%), post-myocardial infarction (13%), post-revascularisation (7%), CHD (7%), and cardiac X syndrome (1%) patients. The median intervention duration was 12 weeks. We identified notable diversity in social network and social support interventions, across what was delivered, how, and by whom. We assessed risk of bias (RoB) in primary outcomes at > 12 months follow-up as either 'low' (2/15 studies), 'some concerns' (11/15), or 'high' (2/15). 'Some concerns' or 'high' RoB resulted from insufficient detail on blinding of outcome assessors, data missingness, and absence of pre-agreed statistical analysis plans. In particular, HRQoL outcomes were at high RoB. Using the GRADE method, we assessed the certainty of evidence as low or very low across outcomes. Social network or social support interventions had no clear effect on all-cause mortality (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.49 to 1.13, I2 = 40%) or cardiovascular-related mortality (RR 0.85, 95% CI 0.66 to 1.10, I2 = 0%) at > 12 months follow-up. The evidence suggests that social network or social support interventions for heart disease may result in little to no difference in all-cause hospital admission (RR 1.03, 95% CI 0.86 to 1.22, I2 = 0%), or cardiovascular-related hospital admission (RR 0.92, 95% CI 0.77 to 1.10, I2 = 16%), with a low level of certainty. The evidence was very uncertain regarding the impact of social network interventions on HRQoL at > 12 months follow-up (SF-36 physical component score: mean difference (MD) 31.53, 95% CI -28.65 to 91.71, I2 = 100%, 2 trials/comparisons, 166 participants; mental component score MD 30.62, 95% CI -33.88 to 95.13, I2 = 100%, 2 trials/comparisons, 166 participants). Regarding secondary outcomes, there may be a decrease in both systolic and diastolic blood pressure with social network or social support interventions. There was no evidence of impact found on psychological well-being, smoking, cholesterol, myocardial infarction, revascularisation, return to work/education, social isolation or connectedness, patient satisfaction, or adverse events. Results of meta-regression did not suggest that the intervention effect was related to risk of bias, intervention type, duration, setting, and delivery mode, population type, study location, participant age, or percentage of male participants. AUTHORS' CONCLUSIONS: We found no strong evidence for the effectiveness of such interventions, although modest effects were identified in relation to blood pressure. While the data presented in this review are indicative of potential for positive effects, the review also highlights the lack of sufficient evidence to conclusively support such interventions for people with heart disease. Further high-quality, well-reported RCTs are required to fully explore the potential of social support interventions in this context. Future reporting of social network and social support interventions for people with heart disease needs to be significantly clearer, and more effectively theorised, in order to ascertain causal pathways and effect on outcomes.
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Affiliation(s)
- Carrie Purcell
- Faculty of Wellbeing, Education and Language Studies, The Open University in Scotland, Edinburgh, UK
| | - Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michele Hilton Boon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lynsay Matthews
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Victoria J Palmer
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Meigan Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Susie Smillie
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Jarrah M, Khader Y, Alkouri O, Al-Bashaireh A, Alhalaiqa F, Al Marzouqi A, Qaladi OA, Alharbi A, Alshahrani YM, Alqarni AS, Oweis A. Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050960. [PMID: 37241192 DOI: 10.3390/medicina59050960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.
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Affiliation(s)
- Mohamad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Yousef Khader
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk Univerity, P.O. Box 566, Irbid 21163, Jordan
| | - Ahmad Al-Bashaireh
- Higher Colleges of Technology, Abu Dhabi P.O. Box 25026, United Arab Emirates
| | | | - Ameena Al Marzouqi
- College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Omar Awadh Qaladi
- College of Nursing, King Saud University, P.O. Box 11451, Riyadh 11451, Saudi Arabia
| | - Abdulhafith Alharbi
- College of Nursing, University of Hail, P.O. Box 2440, Hail 81451, Saudi Arabia
| | | | | | - Arwa Oweis
- Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
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10
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Gheiasi SF, Cheraghi MA, Dastjerdi M, Navid H, Khoshavi M, Peyrovi H, Khachian A, Seylani K, Esmaeili M, Navab E. Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure. Clin Nurs Res 2023; 32:648-659. [PMID: 36788432 DOI: 10.1177/10547738221147402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.
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11
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Dietrich F, Zeller A, Allemann S, Arnet I. Development and acceptance of a new adherence monitoring package to identify non-adherent patients with polypharmacy in primary care: a feasibility study. BMJ Open Qual 2023; 12:bmjoq-2022-002155. [PMID: 36849193 PMCID: PMC9972443 DOI: 10.1136/bmjoq-2022-002155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Adherence to pharmacotherapy is crucial to prevent symptom deterioration in chronic diseases. However, non-adherence to chronic treatments is prevalent, especially in polypharmacy. Practical tools to assess adherence to polypharmacy in primary care are missing. AIMS We aimed to develop an Adherence Monitoring Package (AMoPac) for general practitioners (GPs) to identify patient non-adherence. We tested the feasibility and acceptance of AMoPac in the primary healthcare setting. METHODS AMoPac was developed based on peer-reviewed literature. It consists in (1) electronic monitoring of patients' medication intakes for 4 weeks, (2) receiving feedback on intake behaviour by the pharmacist and (3) generating an adherence report to communicate to the GPs. A feasibility study was conducted with heart failure patients. GPs' acceptance of AMoPac was explored with semistructured interviews. Electronic transmission of the reports into the GP's electronic health record along with laboratory reports stating N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was analysed. RESULTS We developed AMoPac and tested its feasibility with six GPs and seven heart failure patients. GPs were satisfied with the adherence report including the pharmaceutical-clinical recommendations. Integrated transmission of adherence reports to GPs was not feasible due to technical incompatibilities. Mean taking adherence was 86.4%±12.8% and three patients had low correct dosing-days (69%, 38% and 36%, respectively). NT-proBNP ranged from 102 to 8561 pg/mL and four patients had elevated values (>1000 pg/mL). CONCLUSION AMoPac is feasible in the primary healthcare setting, excluding the integrated transmission of adherence reports to GPs. The procedure was highly accepted by GPs and patients. AMoPac fills a gap by combining clinical values with adherence data, and therefore, delivers a multifaceted picture of the patient's behaviour. In case of unmet adherence, our tool might facilitate the selection of patient-centred approaches to optimise pharmacological therapies in chronic heart failure patients. TRIAL REGISTRATION NUMBER NCT04326101.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University Hospital Basel, Liestal, Switzerland
| | - Samuel Allemann
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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12
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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13
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Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial. BMC Nurs 2022; 21:346. [PMID: 36476375 PMCID: PMC9727875 DOI: 10.1186/s12912-022-01130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Comorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities. METHODS In this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge. RESULTS Both groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P < 0.001) at other time points. A significant increase in medication adherence (P < 0.001) and a significant reduction in the burden of all symptoms were observed in the intervention group compared to the control group from Time 1 to Time 3. CONCLUSIONS The MMP (targeting comorbidity) is a promising strategy for managing symptoms and medication adherence in HF patients with comorbidities.
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14
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Mirzadeh SI, Arefeen A, Ardo J, Fallahzadeh R, Minor B, Lee JA, Hildebrand JA, Cook D, Ghasemzadeh H, Evangelista LS. Use of machine learning to predict medication adherence in individuals at risk for atherosclerotic cardiovascular disease. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 26:100328. [PMID: 37169026 PMCID: PMC10168531 DOI: 10.1016/j.smhl.2022.100328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Medication nonadherence is a critical problem with severe implications in individuals at risk for atherosclerotic cardiovascular disease. Many studies have attempted to predict medication adherence in this population, but few, if any, have been effective in prediction, sug-gesting that essential risk factors remain unidentified. Objective This study's objective was to (1) establish an accurate prediction model of medi-cation adherence in individuals at risk for atherosclerotic cardiovascular disease and (2) identify significant contributing factors to the predictive accuracy of medication adherence. In particular, we aimed to use only the baseline questionnaire data to assess medication adherence prediction feasibility. Methods A sample of 40 individuals at risk for atherosclerotic cardiovascular disease was recruited for an eight-week feasibility study. After collecting baseline data, we recorded data from a pillbox that sent events to a cloud-based server. Health measures and medication use events were analyzed using machine learning algorithms to identify variables that best predict medication adherence. Results Our adherence prediction model, based on only the ten most relevant variables, achieved an average error rate of 12.9%. Medication adherence was closely correlated with being encouraged to play an active role in their treatment, having confidence about what to do in an emergency, knowledge about their medications, and having a special person in their life. Conclusions Our results showed the significance of clinical and psychosocial factors for predicting medication adherence in people at risk for atherosclerotic cardiovascular diseases. Clini-cians and researchers can use these factors to stratify individuals to make evidence-based decisions to reduce the risks.
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Affiliation(s)
- Seyed Iman Mirzadeh
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Asiful Arefeen
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
- Corresponding author: (A. Arefeen)
| | - Jessica Ardo
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Ramin Fallahzadeh
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Bryan Minor
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Janett A. Hildebrand
- Department of Nursing at the School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - Diane Cook
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Hassan Ghasemzadeh
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
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15
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Garland R, Gagnon M, Lewis KB. Time to Revisit Heart Failure Self-Care: A Concept Analysis. ANS Adv Nurs Sci 2022; 45:371-386. [PMID: 35704424 DOI: 10.1097/ans.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self .
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Affiliation(s)
- Rachel Garland
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada (Ms Garland and Dr Gagnon); School of Nursing, University of Ottawa, Ottawa, Ontario, Canada (Dr Lewis); and University of Ottawa Heart Institute, Ottawa, Ontario, Canada (Dr Lewis)
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16
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Felker GM, Buttrick P, Rosenzweig A, Abel ED, Allen LA, Bristow M, Das S, DeVore AD, Drakos SG, Fang JC, Freedman JE, Hernandez AF, Li DY, McKinsey TA, Newton-Cheh C, Rogers JG, Shah RV, Shah SH, Stehlik J, Selzman CH. Heart Failure Strategically Focused Research Network: Summary of Results and Future Directions. J Am Heart Assoc 2022; 11:e025517. [PMID: 36073647 DOI: 10.1161/jaha.122.025517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure remains among the most common and morbid health conditions. The Heart Failure Strategically Focused Research Network (HF SFRN) was funded by the American Heart Association to facilitate collaborative, high-impact research in the field of heart failure across the domains of basic, clinical, and population research. The Network was also charged with developing training opportunities for young investigators. Four centers were funded in 2016: Duke University, University of Colorado, University of Utah, and Massachusetts General Hospital-University of Massachusetts. This report summarizes the aims of each center and major research accomplishments, as well as training outcomes from the HF SFRN.
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Affiliation(s)
- G Michael Felker
- Division of Cardiology Duke University School of Medicine and Duke Clinical Research Institute Durham NC
| | - Peter Buttrick
- Division of Cardiology University of Colorado School of Medicine Aurora CO
| | | | - E Dale Abel
- Department of Medicine UCLA School of Medicine Los Angeles CA
| | - Larry A Allen
- Division of Cardiology University of Colorado School of Medicine Aurora CO
| | - Michael Bristow
- Division of Cardiology University of Colorado School of Medicine Aurora CO
| | - Saumya Das
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Adam D DeVore
- Division of Cardiology Duke University School of Medicine and Duke Clinical Research Institute Durham NC
| | - Stavros G Drakos
- Division of Cardiology University of Utah School of Medicine Salt Lake City UT
| | - James C Fang
- Division of Cardiology University of Utah School of Medicine Salt Lake City UT
| | - Jane E Freedman
- Division of Cardiology Vanderbilt University School of Medicine Nashville TN
| | - Adrian F Hernandez
- Division of Cardiology Duke University School of Medicine and Duke Clinical Research Institute Durham NC
| | - Dean Y Li
- Merck Research Laboratories Rahway NJ
| | - Timothy A McKinsey
- Division of Cardiology University of Colorado School of Medicine Aurora CO
| | | | | | - Ravi V Shah
- Division of Cardiology Vanderbilt University School of Medicine Nashville TN
| | - Svati H Shah
- Division of Cardiology Duke University School of Medicine and Duke Clinical Research Institute Durham NC
| | - Josef Stehlik
- Division of Cardiology University of Utah School of Medicine Salt Lake City UT
| | - Craig H Selzman
- Division of Cardiology University of Utah School of Medicine Salt Lake City UT
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17
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Orrego C, Ballester M, Heymans M, Camus E, Groene O, Niño de Guzman E, Pardo-Hernandez H, Sunol R. Talking the same language on patient empowerment: Development and content validation of a taxonomy of self-management interventions for chronic conditions. Health Expect 2021; 24:1626-1638. [PMID: 34252259 PMCID: PMC8483213 DOI: 10.1111/hex.13303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022] Open
Abstract
CONTEXT The literature on self-management interventions (SMIs) is growing exponentially, but it is characterized by heterogeneous reporting that limits comparability across studies and interventions. Building an SMI taxonomy is the first step towards creating a common language for stakeholders to drive research in this area and promote patient self-management and empowerment. OBJECTIVE To develop and validate the content of a comprehensive taxonomy of SMIs for long-term conditions that will help identify key characteristics and facilitate design, reporting and comparisons of SMIs. METHODS We employed a mixed-methods approach incorporating a literature review, an iterative consultation process and mapping of key domains, concepts and elements to develop an initial SMI taxonomy that was subsequently reviewed in a two-round online Delphi survey with a purposive sample of international experts. RESULTS The final SMI taxonomy has 132 components classified into four domains: intervention characteristics, expected patient/caregiver self-management behaviours, outcomes for measuring SMIs and target population characteristics. The two-round Delphi exercise involving 27 international experts demonstrated overall high agreement with the proposed items, with a mean score (on a scale of 1-9) per component of 8.0 (range 6.1-8.8) in round 1 and 8.1 (range 7.0-8.9) in round 2. CONCLUSIONS The SMI taxonomy contributes to building a common framework for the patient self-management field and can help implement and improve patient empowerment and facilitate comparative effectiveness research of SMIs. Patient or public contribution. Patients' representatives contributed as experts in the Delphi process and as partners of the consortium.
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Affiliation(s)
- Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC)
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC)
| | | | - Estela Camus
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oliver Groene
- OPTIMEDIS.,London School of Hygiene and Tropical Medicine, London, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC)
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18
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Kumar SR, Mehta CH, Nayak UY. Long-Acting Formulations: A Promising Approach for the Treatment of Chronic Diseases. Curr Pharm Des 2021; 27:876-889. [PMID: 32634073 DOI: 10.2174/1381612826666200707122012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022]
Abstract
Medication and patient adherence are the two main aspects of any successful treatment of chronic disease. Even though diseases and its treatment existed for several hundred years, the treatment optimization for a given patient is still a researcher question for scientists. There are differences in treatment duration, prognostic signs and symptoms between patient to patient. Hence, designing ideal formulation to suit individual patient is a challenging task. The conventional formulations like oral solids and liquids gives a partial or incomplete treatment because the patient needs to follow the daily pills for a longer time. In such cases, the long-acting formulations will have better patient compliances as drug will be released for a longer duration. Many such approaches are under the clinical investigation. The favorable pharmacokinetic and pharmacodynamic relationships, will be promising option for the treatment of chronic diseases. In this review, we have highlighted the importance of long-acting formulations in the treatment of chronic diseases and the advent of newer formulation technologies.
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Affiliation(s)
- Somaraju R Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Chetan H Mehta
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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19
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Hany A, Fadlila R, Lydia EP. The influence of reminder book to adherence of heart failure patients in Malang city. J Public Health Res 2021; 10:2158. [PMID: 33855392 PMCID: PMC8129757 DOI: 10.4081/jphr.2021.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Non-adherence to the recommended therapy causes patients with heart failure to experience recurrence of the disease. Reminder book on therapy adherence is very useful, because it assists in monitoring adherence to therapy carried out by patients while at home. Therefore, this study aims to determine the effect of the existence of a reminder book on adherence to therapy among patients with heart failure in a private hospital in Malang. DESIGN AND METHOD A pre-experiment design with one-group pre and posttest was used. The respondents were 18 patients that received counseling on the management of heart failure therapy while at home and were given a reminder book. Furthermore, the modified MMAS-8 scale was the study instrument used to measure adherence. RESULT The results showed that most respondents were above the age of 65 with a treatment duration of 1 to 5 years. It was discovered that most of the respondents had never received information about heart failure therapy. Data analysis which was carried out using the Wilcoxon test with a p-value of 0.001, showed that there was a significant difference between respondents' compliance before and after being given a reminder book. CONCLUSION From this study, it was concluded that providing a reminder book has an effect on therapeutic adherence in patients with heart failure. Researchers recommend that hospitals should make use of this reminder as a tool to control or supervise outpatient therapy.
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Affiliation(s)
- Alfrina Hany
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
| | - Rizqa Fadlila
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
| | - Endah Panca Lydia
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
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20
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Directly Measured Adherence to Treatment in Chronic Heart Failure: LEVEL-CHF Registry. Am J Med Sci 2021; 361:491-498. [PMID: 33781390 DOI: 10.1016/j.amjms.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/08/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing. METHODS We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years. RESULTS 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged <60 years were more likely to be non-adherent than older patients (OR 2.15). No other clinical or laboratory parameters predicted non-adherence. CONCLUSIONS A significant proportion of outpatients with chronic heart failure were non-adherent to treatment when assessed by a direct method of serum drug level testing. Non-adherence was more likely in younger patients.
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21
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Freedland KE, Skala JA, Steinmeyer BC, Carney RM, Rich MW. Effects of Depression on Heart Failure Self-Care. J Card Fail 2021; 27:522-532. [PMID: 33358958 DOI: 10.1016/j.cardfail.2020.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression has been identified as a barrier to effective heart failure self-care, but recent studies suggest that the relationship between depression and self-care is more complex than was previously believed. This study was designed to clarify the relationship between depression and self-care in hospitalized patients with HF. METHODS AND RESULTS During hospitalization with a confirmed clinical diagnosis of HF, 400 patients completed a structured interview to diagnose Diagnostic and Statistical Manual, 5th edition (DSM-5) depressive disorders, the Patient Health Questionnaire (PHQ-9) depression questionnaire, the Self-Care of Heart Failure Index (SCHFI), and several psychosocial questionnaires. Multivariable models were fitted to each SCHFI scale; separate models were run with DSM-5 disorders and PHQ-9 depression scores. Higher PHQ-9 depression scores were independently associated with lower (worse) scores on the SCHFI Maintenance (P < .05), Management (P < .01), and Confidence (P < .01) scales. No independent associations with DSM-5 depressive disorders were detected. Measures of perceived stress, anxiety, and low perceived social support were also significantly associated with poor HF self-care. CONCLUSIONS Patients with a combination of psychosocial problems, including symptoms of depression, stress, anxiety, and inadequate social support, may be more likely than other patients to display difficulties with HF self-care that can increase their risk for hospitalization. Research is needed on "broad-spectrum" psychosocial interventions for patients with HF self-care deficits.
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Affiliation(s)
| | - Judith A Skala
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Robert M Carney
- Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri
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22
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Makris E, Hu L, Jones GB, Wright JM. Moving the Dial on Heart Failure Patient Adherence Rates. Patient Prefer Adherence 2020; 14:2407-2418. [PMID: 33324042 PMCID: PMC7733338 DOI: 10.2147/ppa.s283277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Heart failure remains a substantive contributor to patient morbidity and mortality rates worldwide and represents a significant burden on the healthcare ecosystem. Faced with persistent physical symptoms and debilitating social consequences, patients follow complex treatment regimens and often have difficulty adhering to them. PURPOSE In this manuscript, we review factors which contribute to low adherence rates and advance potential single- and multi-factor-based interventions. It is hoped that these observations can lead to improvements in managed care of this vulnerable population of patients. METHODS A narrative review of the primary literature was performed on contributing factors with primary focus on the period 2015-2020 using available databases and search engines. Adherence pain points identified were mapped against a series of potential solutions which are presented. RESULTS Enhancement of treatment adherence relies on two approaches viz. single-factor and multi-factor solutions. Single factors identified include electronic reminders, enhanced health education, financial incentives, gamification strategies, community drivers, persona-based modeling, and burden relief of poly pharmacy. Multi-factor solutions combine two or more of the seven approaches offering the potential for flexible interventions tailored to the individual. DISCUSSION AND CONCLUSION Heart failure patients with poor adherence have increased mortality, hospitalization needs, and healthcare costs. This review highlights current single-factor and multi-factor adherence methods. Against a backdrop of diversity of approaches, multi-factor solutions cast the widest net for positively influencing adherent behaviors. A key enabler lies in the development and leveraging of patient personas in the synthesis of successful intervention methods. Deployable solutions can also be envisioned in clinical trials where adherence tracking represents an essential component.
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Affiliation(s)
- Eleanna Makris
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Lucy Hu
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Graham B Jones
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA02111, USA
| | - Justin M Wright
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
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Assessing Barriers to and Level of Adherence to Hypertension Therapy among Palestinians Living in the Gaza Strip: A Chance for Policy Innovation. Int J Hypertens 2020; 2020:7650915. [PMID: 33062318 PMCID: PMC7555458 DOI: 10.1155/2020/7650915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Hypertension is a major health concern, especially in low-income countries. Nonadherence and poor or no persistence in adhering to hypertension treatment regimens result in uncontrolled high blood pressure, increasing rates of mortality and morbidity, and preventable healthcare costs. The aim of this study was to assess the level of adherence and barriers to treatment regimens among hypertensive patients living in the Gaza Strip, Palestine. Methods A convenience sample of 648 participants completed the Hill-Bone Compliance to High Blood Pressure Therapy Scale. The great majority of participants (n = 521, 80.4%) was highly adherent to their treatment regimen, 123 participants (18.98%) were classified as moderately nonadherent, and 4 (0.62%) participants were classified as highly nonadherent to their hypertension treatment regimen. Participants of this study showed the highest adherence rate to the domain of medication adherence (mean of 1.42 out of 4) followed by appointment keeping (mean 1.8), while they were least adherent to diet (mean of 2.18). The greatest three barriers to adherence to the recommended treatment regimen reported by participants were inability to exercise, inability to resist fast and fried food, and inability to keep themselves away from salty foods. Conclusion Overall adherence to medication in Gaza was surprisingly good in patients with a diagnosis of hypertension for at least one year. However, adherence to lifestyle advice or dietary regimes remains poor. A combination of interventions using low-cost mobile technology, combined with face-to-face interventions by healthcare professionals, can be applied to improve adherence to hypertension treatment regimens in order to reduce the consequences of uncontrolled blood pressure.
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Myers SL, Siegel EO, Hyson DA, Bidwell JT. A qualitative study exploring the perceptions and motivations of patients with heart failure who transitioned from non-adherence to adherence. Heart Lung 2020; 49:817-823. [PMID: 33011459 DOI: 10.1016/j.hrtlng.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Management of heart failure (HF) involves complex self-care recommendations. Many patients have difficulty adhering to these recommendations, and mechanisms that support behavior change are poorly understood. OBJECTIVE The objective of this study was to explore the perceptions and motivations of individuals with HF who became adherent to HF treatment recommendations after being non-adherent. METHODS This was a qualitative descriptive study. Participants were recruited from cardiology clinics and completed a semi-structured interview on their experiences and motivations for self-care behavior change. Data was analyzed using thematic analysis. The sample size (n = 8) was sufficient to achieve saturation. RESULTS Five themes were identified: experiencing mortality, optimism and hope, making connections between behavior and health, self-efficacy, and the role of the clinician. The temporal chronological sequence of these themes across participants varied. CONCLUSIONS This study adds to our current understanding of HF self-care by suggesting mechanisms that may enhance existing self-care interventions, and demonstrating the important role of the clinician.
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Affiliation(s)
- Sharon L Myers
- Heart and Vascular Center, University of California, Davis, 2335 Stockton Blvd, Sacramento, CA, 95817, United States.
| | - Elena O Siegel
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
| | - Dianne A Hyson
- College of Social Sciences and Interdisciplinary Studies, California State University, Sacramento, 6000 J St, Sacramento, CA, 95819, United States.
| | - Julie T Bidwell
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
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Abstract
The number of systematic reviews and meta-analyses submitted to nursing and allied health journals continues to grow. Well-conducted and reported syntheses of research are valuable to advancing science. One of the common critiques identified in these manuscripts involves how the authors addressed heterogeneity among the studies in their meta-analyses. Methodologically inappropriate approaches regarding heterogeneity introduce error and bias into analyses and may lead to incorrect findings and conclusions. This article will discuss some of the approaches to take as well as avoid when addressing heterogeneity in meta-analyses, including suggestions for how to choose a fixed-effect or random-effects meta-analysis model and steps to follow to address heterogeneity in meta-analysis results.
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Affiliation(s)
- Todd Ruppar
- Department of Adult Health and Gerontological Nursing, Rush University, USA
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Larina VN, Leonova MV, Bondarenkova AA, Larin VG. Patient compliance and physicians’ adherence to guidelines on heart failure with reduced ejection fraction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- V. N. Larina
- N.I. Pirogov Russian National Research Medical University
| | | | | | - V. G. Larin
- N.I. Pirogov Russian National Research Medical University
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Pallangyo P, Millinga J, Bhalia S, Mkojera Z, Misidai N, Swai HJ, Hemed NR, Kaijage A, Janabi M. Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study. BMC Res Notes 2020; 13:89. [PMID: 32085803 PMCID: PMC7035643 DOI: 10.1186/s13104-020-04959-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population. Results We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7–16.0, p < 0.001). Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (adjusted RR 1.7, 95% CI 1.2–2.9, p = 0.04). Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3–4.6, p < 0.01). In conclusion, Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. .,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naairah R Hemed
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Alice Kaijage
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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You J, Wang S, Li J, Luo Y. Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure. Med Sci Monit 2020; 26:e920469. [PMID: 32068197 PMCID: PMC7047924 DOI: 10.12659/msm.920469] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aims of the present study were to determine whether a nurse-led program of care can improve medication adherence, quality of life (QoL), rates of rehospitalization, and all-cause mortality for chronic heart failure (CHF) patients. MATERIAL AND METHODS CHF patients were randomly assigned into either a control group or an intervention group. At 12 weeks, patients were followed up to evaluate the rate of medication adherence, QoL (as assessed by SF-12 physical and mental component score [PCS and MCS]), rehospitalization, and all-cause mortality. RESULTS We recruited 152 patients. No significant differences in demographics, comorbidities, CHF severity, or etiology at baseline were observed. At discharge, no significant differences in medications prescription, PCS (46 vs. 45), or MCS (55 vs. 56) were observed. However, at 12-week follow-up, compared to the control group, patients in the intervention group were more likely to keep on medications therapy, with a significantly higher use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker [73.8% vs. 59.7%], beta-blocker (62.5% vs. 51.4%), and aldosterone receptor antagonist (60% vs. 54.2%). Both PCS (35 vs. 40) and MCS (42 vs. 49) were also significantly lower in the control group versus the intervention groups (P<0.05). Patients in the control group had higher incident rate of rehospitalization (8.0% vs. 5.2% per person-week) than in the intervention group, with an incident rate ratio of 1.54 (95% confidence interval [CI]: 1.06-2.23). CONCLUSIONS A nurse-led discharge program of care can be a cost-effective and feasible approach for management of CHF patients in China.
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Affiliation(s)
- Jinyan You
- Department of Nursing, Hainan Western Central Hospital, Danzhou, Hainan, China (mainland)
| | - Suping Wang
- Department of Nursing, Cadre Sanatorium of Hainan and Geriatric Hospital of Hainan, Danzhou, Hainan, China (mainland)
| | - Jing Li
- Department of Nursing, Hainan Western Central Hospital, Danzhou, Hainan, China (mainland)
| | - Yuanping Luo
- Department of Cardiology, Chinese People's Liberation Army Logistic Support Hospital No. 928, Danzhou, Hainan, China (mainland)
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Russell CL, Hathaway D, Remy LM, Aholt D, Clark D, Miller C, Ashbaugh C, Wakefield M, Ye S, Staggs VS, Ellis RJ, Goggin K. Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial. Am J Transplant 2020; 20:125-136. [PMID: 31291507 PMCID: PMC7179766 DOI: 10.1111/ajt.15528] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and subsequent 6-month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person-level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty-nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6-month intervention phase. Using an intent-to-treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR 0.76-0.96) and attention control (median 0.67, IQR 0.52-0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13-0.30, P < .001). At the conclusion of the subsequent 6-month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR 0.56-0.94) and attention control (median 0.60, IQR 0.44-0.73) patients remained large (difference in medians 0.17, 95% CI 0.06-0.33, P = .004). SystemCHANGE™ patients evidenced lower mean creatinine and BUN at 12 months and more infections at 6 and 12 months. This first fully powered RCT testing SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT02416479.
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Affiliation(s)
- Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Donna Hathaway
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Laura M. Remy
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Dana Aholt
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Debra Clark
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Courtney Miller
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Catherine Ashbaugh
- University of Missouri Renal Transplant Program, University of Missouri Health Care, Columbia, Missouri
| | - Mark Wakefield
- University of Missouri Renal Transplant Program, University of Missouri Health Care, Columbia, Missouri
| | - Sangbeak Ye
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
| | - Vincent S. Staggs
- Health Services & Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Rebecca J. Ellis
- Indiana University School of Nursing, Indiana University-Purdue University, Indianapolis, Indiana
| | - Kathy Goggin
- Health Services & Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
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Alemán JF, Rueda B. [Influence of gender on protective and vulnerability factors, adherence and quality of life in patients with cardiovascular disease]. Aten Primaria 2019; 51:529-535. [PMID: 30348466 PMCID: PMC6945135 DOI: 10.1016/j.aprim.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/26/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine gender differences on specific protective factors (PF: acceptance and resilience), vulnerability factors (VF: anger, depression, and anxiety; adherence to treatment and quality of life (QoL) in cardiovascular patients, as well as to study separately the relationships of these factors with adherence and QoL in females and males. DESIGN Observational and cross-sectional. SETTING Two Primary Care Centres in Gran Canaria. PARTICIPANTS One hundred and ninety-eight cardiovascular patients (91 males and 107 females) participated. MAIN MEASUREMENTS Acceptance was assessed by the ICQ scale; resilience by the CD-RISC; depression by the PHQ-9; anxiety by the HADS; Anger-In and Anger-Out by the STAXI-2; QoL by the SF-36; and adherence by a self-reported scale. RESULTS Females exhibited higher anxiety (95% CI: 6.3-7.9) and adherence to reducing smoking (95% CI: 9.4-10.0) and drinking (95% CI: 9.6-10.1), and lower Anger-Out (95% CI: 8.9-10.0), mental QoL (95% CI: 47.0-51.3) and adherence to medication (95% CI: 22.2-23.3) compared to males. Acceptance was associated with better adherence only in women. There were more VF related to worse adherence in males. Anxiety had a negative impact on adherence, and QoL was positively associated with PF, and negatively with VF in both groups. CONCLUSIONS Gender differences in QoL, some VF, and adherence are observed, in addition to the beneficial role of Acceptance in women.
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Affiliation(s)
- Juan Francisco Alemán
- Departamento de Psicología de la Personalidad, Evaluación y Tratamiento Psicológicos, Universidad Nacional de Educación a Distancia, Madrid, España; Centro de Salud de Agaete, Agaete, Gran Canaria, Las Palmas, España.
| | - Beatriz Rueda
- Departamento de Psicología de la Personalidad, Evaluación y Tratamiento Psicológicos, Universidad Nacional de Educación a Distancia, Madrid, España
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Fetensa G, Yadecha B, Tolossa T, Bekuma TT. Medication Adherence and Associated Factors among Chronic Heart Failure Clients on Follow Up Oromia Region, West Ethiopia. Cardiovasc Hematol Agents Med Chem 2019; 17:104-114. [PMID: 31629399 DOI: 10.2174/1871525717666191019162254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. METHODS Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. RESULTS A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. CONCLUSION AND RECOMMENDATION Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.
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Affiliation(s)
- Getahun Fetensa
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Birhanu Yadecha
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- School of Nursing and Midwifery, health science Wollega University, Nekemte, Ethiopia
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Oscalices MIL, Okuno MFP, Lopes MCBT, Campanharo CRV, Batista REA. Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial. Rev Lat Am Enfermagem 2019; 27:e3159. [PMID: 31432915 PMCID: PMC6703101 DOI: 10.1590/1518-8345.2484.3159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/23/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure. METHOD randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%). RESULTS One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days. CONCLUSION discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859.
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Affiliation(s)
- Monica Isabelle Lopes Oscalices
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem,
São Paulo, SP, Brasil
- Instituto Dante Pazzanese de Cardiologia, Pronto Socorro, São Paulo,
SP, Brasil
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Bui QM, Allen LA, LeMond L, Brambatti M, Adler E. Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus. Circ Heart Fail 2019; 12:e006058. [DOI: 10.1161/circheartfailure.119.006058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools—including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale—were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (L.A.A.)
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Phoenix (L.L.)
| | - Michela Brambatti
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
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A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure-A randomized controlled trial. Heart Lung 2019; 48:507-514. [PMID: 31182217 DOI: 10.1016/j.hrtlng.2019.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication nonadherence is prevalent and links to serious outcomes (e.g., rehospitalization/death) in heart failure (HF) patients; therefore, an urgent need exists for an intervention to improve and sustain adherence after intervention completion. OBJECTIVES To test the efficacy of a multi-component, family-focused, literacy-sensitive (FamLit) intervention on medication adherence in HF patients. METHODS Forty-three HF patients and their care partners were enrolled and randomized to receive FamLit or attention-only intervention, including an in-person session at baseline and bi-weekly phone boosters for 3 months. We measured medication adherence from baseline to 3-month post-intervention using the Medication Event Monitoring System. RESULTS After 3-month intervention, intervention patients had significantly better medication adherence than control patients. At 6 months (3-months post-intervention), intervention effect on adherence was sustained in the FamLit intervention group, while adherence decreased in the control group. CONCLUSION Incorporating care partner support and providing an easy-to-understand intervention to patients-care partners may improve/sustain adherence.
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Forsyth P, Richardson J, Lowrie R. Patient-reported barriers to medication adherence in heart failure in Scotland. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:443-450. [PMID: 30675955 DOI: 10.1111/ijpp.12511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Medication adherence is the end result of a complex set of interwoven factors. Non-adherence with medication in heart failure patients is associated with excess mortality and morbidity. Studies describing interventions to improve adherence in heart failure are limited by a lack of robust methods and inconsistent outcomes. The aim of this evaluation was to explore the barriers to medication adherence in Scottish heart failure patients in order to inform the development of complex interventions. METHODS Qualitative patient interviews. Participants were aged ≥18 years with current or previous signs or symptoms of clinical heart failure, reduced left ventricular ejection fraction ≤45% and confirmed adherence of <80% in tablet counts of heart failure therapy. Thematic analysis was employed. KEY FINDINGS Eleven patients were recruited. The median age was 79 years old, and participants were typically from socially deprived communities. Participants were prescribed a mean 9.9 different medications per day. Seven distinct themes emerged around barriers to medication adherence: co-morbidity; treatment burden; health literacy; trust in NHS; socioeconomic factors; autonomy and health expectations. CONCLUSIONS The factors affecting medication adherence in heart failure are multi-factorial and are unlikely to be improved by one single-faceted intervention. Future interventions need to treat patients holistically, build their trust as partners, simplify complex treatment regimens where possible and involve educational and social elements. The skill set and opportunities afforded to pharmacists may be well placed to deliver many of these aspects but this would need tested in the context of the development of complex interventions.
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Affiliation(s)
| | - Janice Richardson
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Long H, Bartlett YK, Farmer AJ, French DP. Identifying Brief Message Content for Interventions Delivered via Mobile Devices to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A Rapid Systematic Review. J Med Internet Res 2019; 21:e10421. [PMID: 30626562 PMCID: PMC6329430 DOI: 10.2196/10421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023] Open
Abstract
Background Current interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions. Objective This review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions. Methods A rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy. Results A total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences). Conclusions We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs.
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Affiliation(s)
- Hannah Long
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne K Bartlett
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Son YJ, Shim DK, Seo EK, Seo EJ. Health Literacy but Not Frailty Predict Self-Care Behaviors in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112474. [PMID: 30404140 PMCID: PMC6265912 DOI: 10.3390/ijerph15112474] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/31/2018] [Accepted: 11/03/2018] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is a chronic condition requiring continuous self-care. Health literacy is increasingly recognized as a key factor of self-care behaviors in patients with chronic diseases. Recently, frailty in chronic diseases has also been associated with self-care behaviors. However, relationships among health literacy, frailty, and self-care in the HF population are not well understood. Therefore, this cross-sectional study aimed to identify the impact of health literacy and frailty on self-care behaviors in patients with HF. Data were collected from 281 adults attending a cardiovascular outpatient clinic in Korea. Health literacy, frailty, and self-care behaviors were measured using Korean-validated instruments. The mean scores of health literacy and self-care behaviors were 8.89 (±3.44) and 31.49 (±5.38), respectively. The prevalence of frailty was around 26.3%. Health literacy was significantly associated with frailty and self-care behaviors. In a hierarchical linear regression analysis, health literacy was a significant determinant of self-care behaviors after adjusting for confounding variables, but frailty was not. Educational level was also a significant predictor of self-care behaviors. Our main findings showed that health literacy can facilitate improvements in HF self-care behaviors. Healthcare professionals should assess patients’ health literacy and educational backgrounds when designing self-management programs.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.
| | - Dae Keun Shim
- Medical director of Cardio-cerebrovascular Center, Good Morning Hospital, Pyeongtaek 17874, Korea.
| | - Eun Koung Seo
- Director, Department of Nursing, Good Morning Hospital, Pyeongtaek 17874, Korea.
| | - Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon 16499, Korea.
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Niriayo YL, Kumela K, Kassa TD, Angamo MT. Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia. PLoS One 2018; 13:e0206120. [PMID: 30352096 PMCID: PMC6198973 DOI: 10.1371/journal.pone.0206120] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia. METHODS A hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses. RESULT Of 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03-14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22-10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91-8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38-11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28-10.51). CONCLUSION DTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Tarekegn Angamo
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobar, Australia
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Dellafiore F, Arrigoni C, Pittella F, Conte G, Magon A, Caruso R. Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study. BMJ Open 2018; 8:e021966. [PMID: 30269065 PMCID: PMC6169756 DOI: 10.1136/bmjopen-2018-021966] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM The aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF). METHODS AND RESULTS A monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort's demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients' discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient-caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%-18.0%. CONCLUSION This study sets the stage for future research where elements of the patient-caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients' self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.
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Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Pavia, Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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40
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Andersson L, Nordgren L. Heart Failure Patients' Perceptions of Received and Wanted Information: A Cross-Sectional Study. Clin Nurs Res 2018; 28:340-355. [PMID: 29986617 DOI: 10.1177/1054773818787196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate heart failure patients' perceptions of received and wanted information and to identify differences regarding received and wanted information in relation to sociodemographic variables. A cross-sectional descriptive design was used. Patients with heart failure ( n = 192) were recruited from six primary health care centers in Sweden. Data were collected by a postal questionnaire. A majority of the respondents had received information about the condition and the medication. Within primary health care, most respondents had been informed about medication. The respondents wanted more information about continued care and treatment, medication, and the condition. There were significant differences between sociodemographic groups concerning what information they wanted. Clinical nurses can support patients with heart failure by using evidence-based methods that strengthen the patients' self-efficacy and by individualized information that increases patients' knowledge and improves their self-care behaviors. Future studies are needed to identify informational needs of particular fragile groups of patients.
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Affiliation(s)
- Lena Andersson
- 1 Vårdcentralen Centrum Flen, Sweden.,2 Research and Development Centre, Sörmland County Council/Centre for Clinical Research Sörmland, Uppsala University, Sweden
| | - Lena Nordgren
- 2 Research and Development Centre, Sörmland County Council/Centre for Clinical Research Sörmland, Uppsala University, Sweden.,3 Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Xu R, Xie X, Li S, Chen X, Wang S, Hu C, Lv X. Interventions to improve medication adherence among Chinese patients with hypertension: a systematic review and meta-analysis of randomized controlled trails. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:291-301. [PMID: 29693291 DOI: 10.1111/ijpp.12452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to understand the effectiveness of medication adherence (MA) interventions among Chinese patients with hypertension. METHODS A literature search was conducted with three English databases (PubMed, Web of Science and Embase) and three Chinese databases (China National Knowledge Infrastructure, Wanfang and VIP Database for Chinese Technical Periodicals) for the period from 1970 to October 2017. Only both RCTs with a minimum of 10 participants in each intervention group and Chinese patients with hypertension as participants were included. A random-effects model was applied to calculate pooled effect sizes with 95% CI. Subgroup analysis was conducted to identify potential sources of heterogeneity from duration of intervention, type of intervener, methods of intervention and sites of intervention. Funnel plots and Egger's test were used to evaluate for publication bias. KEY FINDINGS A total of 48 studies met criteria for the meta-analysis, including 14 568 participants, testing 57 independent comparisons. Overall, the effect size revealed that interventions significantly improved MA (pooled relative risk = 1.59, 95% CI: 1.43 to 1.78; pooled Cohen's d = 1.42, 95% CI: 0.976 to 1.876). Interventions were found to significantly reduce blood pressure (BP) (systolic BP: Cohen's d = -0.85, 95% CI: -1.11 to -0.60 and diastolic BP: Cohen's d = -0.73, 95% CI: -1.00 to -0.46). Longer duration of intervention gave better effectiveness. Physician as interventionist, regular follow-up visits and interventions conducted at a hospital were associated with better effectiveness. CONCLUSION Adherence interventions improve MA and reduce uncontrolled BP among Chinese patients with hypertension. In the future, investigators should adopt a skill set to address the problem of poor MA.
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Affiliation(s)
- Rixiang Xu
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Xuefeng Xie
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Shuting Li
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Xiaoyu Chen
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Sheng Wang
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China
| | - Xiongwen Lv
- School of Pharmacy, Anhui Medical University, Hefei, China.,Institute for Liver Disease, Anhui Medical University, Hefei, China
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Abstract
BACKGROUND By 2050, one-third of US residents will be Latino, with an incidence of heart failure (HF) higher than other ethnicities. Culturally linked risk factors and socioeconomic challenges result in cardiometabolic risks, healthcare disparities, and worsening health outcomes. Individuals with low health literacy (HL) and HF are less likely to possess tools for optimal self-care, disease management, or preventative health strategies. OBJECTIVE In this systematic review, we analyzed the literature studying older Latinos with HF and limited HL. METHOD We searched the literature and used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in an iterative process. Inclusion criteria were research studies, Latinos, HF, and HL. RESULTS Eight quantitative studies were identified for final review. Inadequate HL was reported in 87.2% of elderly Latinos. Higher HL was associated with more HF knowledge. Clinics serving minorities reported lower HL levels and higher medical complexity. CONCLUSIONS Nurses and advanced practice nurses serve a pivotal role improving access and understanding of health information. Before conducting intervention research affecting clinical outcomes, it is essential to describe elderly Latinos with HF and their HL and self-care levels. Barriers identified confirm the need to alter research protocols for older adults and ensure the availability of assistive devices. The need to examine HL in older Latinos with HF is confirmed by the medical complexity of ethnic minority patients with limited HL, limited HL in the elderly, and the relationship of HL with HF knowledge. In culturally diverse populations, HL levels alone may not be reliable predictors of a person's ability to self-manage, recognize symptoms, and develop, implement, and revise a self-care action plan to manage their health.
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Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC Grand Rounds: Improving medication adherence for chronic disease management - Innovations and opportunities. Am J Transplant 2018; 18:514-517. [PMID: 29381269 DOI: 10.1111/ajt.14649] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Andrea B Neiman
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Todd Ruppar
- Rush University, College of Nursing, Chicago, IL, USA
| | - Michael Ho
- Veteran's Administration Medical Center, Denver, CO, USA.,University of Colorado Denver, Denver, CO, USA
| | | | - Paul J Weidle
- U.S. Public Health Service Commissioned Corps, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA, USA
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Office of the Associate Director for Science, CDC, Atlanta, GA, USA
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Neiman AB, Ruppar T, Ho M, Garber L, Weidle PJ, Hong Y, George MG, Thorpe PG. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management - Innovations and Opportunities. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1248-1251. [PMID: 29145353 PMCID: PMC5726246 DOI: 10.15585/mmwr.mm6645a2] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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45
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Andrews AM, Russell CL, Cheng AL. Medication Adherence Interventions for Older Adults With Heart Failure: A Systematic Review. J Gerontol Nurs 2017; 43:37-45. [DOI: 10.3928/00989134-20170523-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/18/2017] [Indexed: 11/20/2022]
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46
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Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. J Am Soc Nephrol 2017; 28:2290-2301. [PMID: 28630231 PMCID: PMC5533244 DOI: 10.1681/asn.2017020216] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient's unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively few interventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community's goal of "one transplant for life" is to become a reality, then solutions for medication nonadherence must be found and implemented.
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Affiliation(s)
- Thomas E. Nevins
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Peter W. Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
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47
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Ruppar TM, Dunbar-Jacob JM, Mehr DR, Lewis L, Conn VS. Medication adherence interventions among hypertensive black adults. J Hypertens 2017; 35:1145-1154. [DOI: 10.1097/hjh.0000000000001260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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48
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Tan BY, Shafie AA, Hassali MAA, Saleem F, Muneswarao J. Improving medication adherence through calendar packaging: results of a randomized controlled trial among hypertensive patients. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bee Ying Tan
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Minden Pulau Pinang Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Minden Pulau Pinang Malaysia
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Minden Pulau Pinang Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences; University of Baluchistan; Quetta Pakistan
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Chang LY, Wu SY, Chiang CE, Tsai PS. Depression and self-care maintenance in patients with heart failure: A moderated mediation model of self-care confidence and resilience. Eur J Cardiovasc Nurs 2017; 16:435-443. [PMID: 28059552 DOI: 10.1177/1474515116687179] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the recognition of the negative effects of depressive symptoms on self-care confidence and self-care maintenance in patients with heart failure, little is known about the moderating role of resilience underlying these relations. AIMS To explore whether depressive symptoms affect self-care maintenance through self-care confidence and whether this mediating process was moderated by resilience. METHODS The sample comprised 201 community-dwelling and medically stable patients with echocardiographically documented heart failure. A moderated mediation model was conducted to test whether self-care confidence mediated the association between depressive symptoms and self-care maintenance, and whether resilience moderated the direct and indirect effects of depressive symptoms after adjustment for covariates. RESULTS Depressive symptoms reduced self-care maintenance indirectly by decreasing self-care confidence (indirect effect: -0.22, 95% confidence interval: -0.36, -0.11), and this pathway was only significant for patients with moderate and high levels and not with low levels of resilience. Resilience also moderated the direct effects of depressive symptoms on self-care maintenance such that the negative association between depressive symptoms and self-care maintenance was reversed by the existence of high resilience. CONCLUSIONS Resilience moderated the direct and indirect effects of depressive symptoms through self-care confidence on self-care maintenance in heart failure patients. Efforts to improve self-care maintenance by targeting depressive symptoms may be more effective when considering self-care confidence in patients with moderate to high levels of resilience.
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Affiliation(s)
- Ling-Yin Chang
- 1 Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Shan-Ying Wu
- 2 Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Chern-En Chiang
- 3 General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
| | - Pei-Shan Tsai
- 4 School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,5 Sleep Research Center, Taipei Medical University Hospital, Taiwan.,6 Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taiwan
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Ruppar TM, Dobbels F, Lewek P, Matyjaszczyk M, Siebens K, De Geest SM. Systematic Review of Clinical Practice Guidelines for the Improvement of Medication Adherence. Int J Behav Med 2016; 22:699-708. [PMID: 25805550 DOI: 10.1007/s12529-015-9479-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear. PURPOSE This review evaluated clinical practice guidelines designed to help health care providers address patients' medication adherence. METHOD Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation. RESULTS We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10). CONCLUSION Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes.
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Affiliation(s)
| | | | | | | | | | - Sabina M De Geest
- University of Leuven (KU Leuven), Leuven, Belgium.,University of Basel, Basel, Switzerland
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