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Livori AC, Ademi Z, Ilomäki J, Pol D, Morton JI, Bell JS. No effect of remoteness on clinical outcomes following myocardial infarction: An analysis of 43,729 myocardial infarctions in Victoria, Australia. Int J Cardiol 2024; 398:131593. [PMID: 37979791 DOI: 10.1016/j.ijcard.2023.131593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Remoteness has been shown to predict poor clinical outcomes following myocardial infarction (MI). This study investigated 1-year clinical outcomes following MI by remoteness in Victoria, Australia. METHODS We included all admissions for people discharged from hospital following MI between July 2012 and June 2017 (n = 43,729). Remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA). The relationship between remoteness and major adverse cardiovascular events (MACE) and all-cause mortality over 1-year was evaluated using adjusted Poisson regression, stratified by type STEMI and NSTEMI. RESULTS For NSTEMI, adjusted rates of MACE were 77.5[95% confidence interval 65.1-92.1] for the most remote area versus 83.4[65.5-106.3] for the least remote area per 1000 person-years. For STEMI, rates of MACE were 28.5[18.3-44.6] for the most versus 33.5[18.9-59.4] for the least remote areas per 1000 person-years. With respect to all-cause mortality, NSTEMI mortality rates were 82.2[67.0-100.9] for the most versus 100.8[75.2-135.1] for the least remote areas per 1000 person-years. For STEMI, mortality rates were 24.7[13.7-44.7] for the most versus 22.3[9.8-50.8] for the least remote per 1000 person-years. CONCLUSIONS Rates of MACE and all-cause mortality were similar in regardless of degree of remoteness, suggesting that initiatives to increase access to cardiology care in more remote areas succeeded in reducing previous disparities.
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Affiliation(s)
- Adam C Livori
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia; Grampians Health, Ballarat, VIC, Australia.
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Derk Pol
- Latrobe Regional Hospital, Victoria, Australia
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
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Pollmann AS, Pinto AM, Cadieux D, Seamone CD, George SP, Smith CA, Lewis DR. Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency. Cornea 2024; 43:349-355. [PMID: 37433174 PMCID: PMC10836790 DOI: 10.1097/ico.0000000000003347] [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] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada. METHODS A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time. RESULTS Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19-1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61-0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17-1.17; P = 0.13). CONCLUSIONS Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.
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Affiliation(s)
- André S. Pollmann
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Ashlyn M. Pinto
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Danielle Cadieux
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Christopher D. Seamone
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Stanley P. George
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Corey A. Smith
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Darrell R. Lewis
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
- Herzig Eye Institute and Precision Cornea Centre, Ottawa, ON, Canada
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Livori MClinPharm AC, Ademi Z, Ilomäki J, Pol D, Morton JI, Bell JS. Use of secondary prevention medications in metropolitan and non-metropolitan areas: an analysis of 41,925 myocardial infarctions in Australia. Eur J Prev Cardiol 2023:zwad360. [PMID: 37987181 DOI: 10.1093/eurjpc/zwad360] [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] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND People in remote areas may have more difficulty accessing healthcare following myocardial infarction (MI) than people in metropolitan areas. We determined whether remoteness was associated with initial and 12-month use of secondary prevention medications following MI in Victoria, Australia. METHOD We included all people alive at least 90 days post-discharge following MI between July 2012 and June 2017 in Victoria, Australia (n=41,925). We investigated dispensing of P2Y12 inhibitors (P2Y12i), statins, ACE-inhibitors or angiotensin receptor blockers (ACEI/ARBs), and beta-blockers within 90 days post-discharge. We estimated 12-month medication use using proportion of days covered (PDC). Remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA). Data were analyzed using adjusted parametric regression models stratified by STEMI and NSTEMI. RESULTS There were 10,819 STEMI admissions and 31,106 NSTEMI admissions. Following adjustment across NSTEMI and STEMI, there were no medication classes dispensed in the 90-days post-discharge that differed in a clinically significant way from the least remote (ARIA=0) to the most remote (ARIA=4.8) areas. The largest difference for NSTEMI were ACEi/ARB, with 71%(95%CI 70-72%) versus 80%(76%-83%). For STEMI, it was statins with 89%(88-90%) versus 95%(91-97%). Predicted PDC for STEMI and NSTEMI were not clinically significant across remoteness, with the largest difference in NSTEMI being P2Y12i with 48%(47-50%) versus 55%(51-59%), and in STEMI it was ACEi/ARB with 68%(67-69%) versus 76%(70-80%). CONCLUSION Remoteness does not appear to be a clinically significant driver for medication use following MI. Possible differences in cardiovascular outcomes in metropolitan and non-metropolitan areas are not likely to be explained by access to secondary prevention medications.
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Affiliation(s)
- Adam C Livori MClinPharm
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- Grampians Health, Ballarat, VIC, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Derk Pol
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
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Suchismita A, Ashritha A, Sood V, Lal BB, Khanna R, Kumar G, Alam S. Study of Adherence to Medication in Pediatric Liver Diseases ("SAMPLD" Study) in Indian Children. J Clin Exp Hepatol 2023; 13:22-30. [PMID: 36647409 PMCID: PMC9840084 DOI: 10.1016/j.jceh.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background/objectives Adherence to medication(s) is an essential component of holistic management in any chronic disease including in post liver transplant (LT) patients. Thus, this study aimed to assess adherence to medications in Indian pediatric liver disease patients (including post LT recipients) and to identify variables affecting its occurrence. Methods A cross-sectional study was conducted among pediatric (<18 years of age) subjects with Wilson disease (WD) and autoimmune liver disease (AILD) along with post LT recipients from May 2021 to October 2021. Structured tools using prevalidated questionnaires (Medication adherence measure and the Child & Adolescent Adherence to Medication Questionnaire) were used to collect data related to nonadherence prevalence (based on missed and late doses) and factors influencing the adherence. Results A total of 152 children were included in the study (WD 39.5%, AILD 32.9%, and post LT 27.6%). Prevalence of missed and late dose nonadherence (at a cut-off of ≥20%) was 12.5% and 16.4%, respectively. Older age (odd's ratio/O.R 1.185), stay in a rural area (O.R 5.08), and barriers like bad taste of medication (O.R 4.728) and hard to remember the medication (O.R 7.180) were independently associated with nonadherence (P < 0.05). Conclusions Overall, nonadherence was seen in 12-16%, i.e., around one-sixth of the patients, with least nonadherence seen in post LT recipients (0-2.4%). Older age of the patient, rural place of stay and personal barriers like hard to remember/forgetfulness and bad medication taste were identified as factors independently leading to nonadherence.
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Affiliation(s)
- Arya Suchismita
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A. Ashritha
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikrant Sood
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bikrant B. Lal
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Clinical Research, Institute of Liver & Biliary Sciences, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Pérez-Carrascosa FM, Barrios-Rodríguez R, Gómez-Peña C, Salcedo-Bellido I, Velasco-García ME, Jiménez-Moleón JJ, García-Ruiz A, Navarro-Espigares JL, Requena P, Muñoz-Sánchez C, Arrebola JP. Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis. ENVIRONMENTAL RESEARCH 2022; 213:113609. [PMID: 35667403 DOI: 10.1016/j.envres.2022.113609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Polychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. OBJECTIVE To longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. METHODS Longitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. RESULTS In the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (β: 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (β: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semi-rural residents, where β-HCH was also marginally-significantly associated to APC (β: 3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (β: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by β-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (β: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in G-Computation analyses. CONCLUSION Long-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.
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Affiliation(s)
- Francisco Miguel Pérez-Carrascosa
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; Servicio de Oncología Radioterápica, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Rocío Barrios-Rodríguez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Celia Gómez-Peña
- Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; Servicio de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - José Juan Jiménez-Moleón
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antonio García-Ruiz
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José Luis Navarro-Espigares
- Universidad de Granada, Departamento de Economía Internacional y de España, Granada, Spain; Dirección Económica y Servicios Generales, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Pilar Requena
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Muñoz-Sánchez
- Unidad de Tecnologías de La Información y Comunicaciones, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan Pedro Arrebola
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Impact of Androgen Receptor Gene Expression in Gastric Cancer: a Meta-Analysis Based on the GEO Database, TCGA Database, and Literature. Indian J Surg 2022. [DOI: 10.1007/s12262-020-02168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pan J, Yu H, Hu B, Li Q. Urban-Rural Difference in Treatment Adherence of Chinese Hypertensive Patients. Patient Prefer Adherence 2022; 16:2125-2133. [PMID: 35996727 PMCID: PMC9391986 DOI: 10.2147/ppa.s377203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate the treatment adherence and the main factors associated with adherence for Chinese hypertensive patients between urban and rural areas. PARTICIPANTS AND METHODS A total of 529 hypertensive patients with 328 from urban areas and 201 from rural areas hospitalized in a tertiary hospital in Xi'an, China during the period from May 1 to December 31, 2021 were invited to participate in the cross-sectional study. The adherence to treatment was assessed by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale". Binary logistic regression analysis was used to analyze independent risk factor for treatment adherence of hypertensive patients. General linear model was used to analyze the association of the independent risk factors to treatment adherence in each subgroup of the scale. RESULTS The treatment adherence of Chinese hypertensive patients in rural areas was 23.88% and it was significantly lower than that in urban areas (36.59%). Age and gender were the factors that independently associated with treatment adherence of hypertensive patients regardless of urban or rural status. The duration of antihypertensive drugs used was identified to be the factor that independently associated with treatment adherence only in urban patients. The subgroups including reduced sodium intake and medication taking had significant effects on treatment adherence in certain factors. CONCLUSION The treatment adherence of Chinese hypertensive patients was low, especially in rural areas. More emphasis should be placed on patients in rural areas. Furthermore, more attention and effective strategies should be designed to address factors affecting treatment adherence in both urban and rural areas. Health programs should focus on education including the importance of taking continuous antihypertensive drugs and low sodium diet.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
- Correspondence: Jingjing Pan, Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), 21 JieFang Road, Xi’an, People’s Republic of China, Tel +86 029 61199691 ext 029, Email
| | - Haizhen Yu
- Department of Clinical Laboratory, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
- Haizhen Yu, Department of Clinical Laboratory, Xi’an People’s Hospital (Xi’an Fourth Hospital), 21 JieFang Road, Xi’an, People’s Republic of China, Tel +86 029 61188149 ext 029, Email
| | - Bin Hu
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
| | - Qiongge Li
- Department of Pharmacy, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, People’s Republic of China
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Kim SJ, Kwon OD, Choi HC, Lee EJ, Cho B, Yoon DH. Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study. BMC Neurol 2021; 21:349. [PMID: 34507550 PMCID: PMC8431917 DOI: 10.1186/s12883-021-02384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. METHODS Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. RESULTS Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17-3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31-1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15-1.72). Rural residency (aOR 1.36, 95% CI 1.14-1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05-1.47), lower income (aOR 1.20, 95% CI 1.03-1.40 for middle income class and OR 1.21, 95% CI 1.02-1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00-1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. CONCLUSIONS The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.
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Affiliation(s)
- Seung Jae Kim
- International Healthcare Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | | | - Ho Chun Choi
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea.
- Nuvizen, Palo Alto, California, 94303, USA.
| | - Eung-Joon Lee
- Institute of Public Health and Medical Care, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
- Department of Neurology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Dae Hyun Yoon
- Department of Psychiatry, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Republic of Korea
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Kim SJ, Kwon OD, Kim KS. Prevalence, awareness, treatment, and control of dyslipidemia among diabetes mellitus patients and predictors of optimal dyslipidemia control: results from the Korea National Health and Nutrition Examination Survey. Lipids Health Dis 2021; 20:29. [PMID: 33771170 PMCID: PMC8004432 DOI: 10.1186/s12944-021-01455-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence, awareness, treatment, and control rates of dyslipidemia and identify the predictors of optimal control (low-density lipoprotein cholesterol < 100 mg/dL) among patients with diabetes mellitus (DM). METHODS A cross-sectional study was conducted using the representative Korea National Health and Nutrition Examination Survey (2014-2018). Overall, 4311 patients with DM, aged ≥19 years, and without cardiovascular diseases were selected, and the prevalence, awareness, treatment, and control rates of dyslipidemia were calculated. Univariate and multivariate logistic regression analyses were conducted to evaluate the factors influencing the optimal control of dyslipidemia. RESULTS Dyslipidemia was prevalent in 83.3% of patients with DM, but the awareness and treatment rates were 36.5 and 26.9%, respectively. The control rate among all patients with dyslipidemia was 18.8%, whereas it was 61.1% among those being treated. Prevalence and awareness rates were also significantly higher in women than in men. Dyslipidemia was most prevalent in those aged 19-39 years, but the rates of awareness, treatment, and control among all patients with dyslipidemia in this age group were significantly lower than those in other age groups. The predictors of optimal control were age ≥ 40 years [range 40-49 years: adjusted odds ratio (aOR) 3.73, 95% confidence interval (CI) 1.43-9.72; 50-59 years: aOR 6.25, 95% CI 2.50-15.65; 60-69 years: aOR 6.96, 95% CI 2.77-17.44; 70-79 years: aOR 9.21, 95% CI 3.58-23.74; and ≥ 80 years: aOR 4.43, 95% CI 1.60-12.27]; urban living (aOR 1.44, 95% CI 1.15-1.80); higher body mass index (aOR 1.27, 95% CI 1.13-1.42); lower glycated hemoglobin levels (aOR 0.71, 95% CI 0.67-0.76); hypertension (aOR 1.53, 95% CI 1.22-1.92); poorer self-rated health status (aOR 0.72, 95% CI 0.62-0.84); and receiving regular health check-ups (aOR 1.58, 95% CI 1.25-2.00). CONCLUSIONS Most patients with DM were diagnosed with dyslipidemia, but many were unaware of or untreated for their condition. Therefore, their control rate was suboptimal. Thus, by understanding factors influencing optimal control of dyslipidemia, physicians should make more effort to encourage patients to undergo treatment and thus, adequately control their dyslipidemia.
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Affiliation(s)
- Seung Jae Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- International Healthcare Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Oh Deog Kwon
- Republic of Korea Navy 2nd Fleet Medical Corps, Pyeongtaek-si, Gyeonggi-do, Republic of Korea
| | - Kyung-Soo Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Borg M, Løkke A, Hilberg O. Geographical and socioeconomic differences in compliance with and access to allergen immunotherapy in Denmark: A nationwide registry-based study - 1998-2016. Respir Med 2021; 178:106332. [PMID: 33588210 DOI: 10.1016/j.rmed.2021.106332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) is a cost-effective treatment option in moderate-severe allergic rhino-conjunctivitis. Inequality in access to AIT and variation in compliance related to socioeconomic status or geographical location have not been described previously. OBJECTIVE The aim of the study was to evaluate access to grass pollen AIT at various educational attainment levels in the five regions of Denmark. Furthermore, grass pollen AIT treatment compliance was evaluated with respect to age, educational attainment and geographical area. METHODS The unique civil registration number of every citizen in Denmark was combined with the nationwide Danish National Health Service Prescription Database and Statistics Denmark Database to extract age, gender, residence and educational attainment of every citizen who collected prescribed AIT medication from 1998 to 2016. Then, compliance and use of AIT were calculated with respect to age, geographical location and educational attainment. RESULTS The use of subcutaneous AIT (SCIT) was significantly higher in the Capital Region; this difference was less predominant for sublingual AIT (SLIT). People who were educated only to primary school or vocational training levels were less frequent users of AIT. Compliance was especially low in the Capital Region and among people educated only to primary school level. In the age groups, compliance was similar, apart from SLIT users aged 0-9, for whom compliance was higher. CONCLUSION This nationwide study finds that SLIT has the potential to reduce inequality in access to AIT. A focus intervention is needed to facilitate access to and compliance with AIT in groups with lower socioeconomic status.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
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Aloufi M, Al-Asmari A, Aljohani KS. Prevalence and predictors of medication adherence among adult cardiovascular diseases patients in al-Madinah. SAUDI JOURNAL FOR HEALTH SCIENCES 2021. [DOI: 10.4103/sjhs.sjhs_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jaworsky D, Loutfy M, Lu M, Ye M, Bratu A, Sereda P, Bayoumi A, Richardson L, Kuper A, Hogg RS. Influence of the definition of rurality on geographic differences in HIV outcomes in British Columbia: a retrospective cohort analysis. CMAJ Open 2020; 8:E643-E650. [PMID: 33077535 PMCID: PMC7588262 DOI: 10.9778/cmajo.20200066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Improving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used. METHODS We performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression: rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems. RESULTS Virologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas. INTERPRETATION Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
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Affiliation(s)
- Denise Jaworsky
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Mona Loutfy
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Michelle Lu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Monica Ye
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Andreea Bratu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Paul Sereda
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ahmed Bayoumi
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Lisa Richardson
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ayelet Kuper
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Robert S Hogg
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
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Pan J, Wu L, Wang H, Lei T, Hu B, Xue X, Li Q. Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine (Baltimore) 2019; 98:e16116. [PMID: 31277112 PMCID: PMC6635171 DOI: 10.1097/md.0000000000016116] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess the adherence level of antihypertensive treatment and identify any associated risk factors in a sample of hypertensive patients from China.A cross-sectional study involving 488 Chinese hypertensive patients was conducted in a tertiary hospital in Xi'an, China. Data were collected regarding socio-demographic factors and hypertension-related clinical characteristics. The adherence to treatment was assessed using the previously validated instrument: therapeutic adherence scale for hypertensive patients.A total of 27.46% of patients were compliant with their antihypertensive treatments. Three factors were identified to be independently associated with antihypertensive treatment adherence: gender (P = .034), residence (P = .029), duration of high blood pressure (P < .001). Gender, residence, occupation, and the duration of antihypertensive drugs treatment used were found to have significant effects on treatment adherence in certain categories.Treatment adherence among hypertensive patients in China was poor. More attention and effective strategies should be designed to address factors affecting treatment adherence. Education about hypertension knowledge should be strengthened for patients. Moreover, the importance of lifestyle modification during hypertension treatment is often neglected by patients, therefore, there is an urgent need to educate hypertensive patients about the adherence to lifestyle modifications.
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Affiliation(s)
- Jingjing Pan
- Department of Pharmacy, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | - Lian Wu
- Department of Ophthalmology, Xi’an Fourth Hospital
- Xi’an Forth Hospital Affiliated Northwestern Polytechnical University
| | | | - Tao Lei
- Department of Neurology, Xi’an Fourth Hospital, Xi’an, China
| | - Bin Hu
- Department of Pharmacy, Xi’an Fourth Hospital
| | | | - Qiongge Li
- Department of Pharmacy, Xi’an Fourth Hospital
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Peverelle MR, Baradi A, Paleri S, Lee YS, Sultani R, Toukhsati SR, Hare DL, Janus E, Wilson AM. Higher long-term adherence to statins in rural patients at high atherosclerotic risk. J Clin Lipidol 2019; 13:163-169. [DOI: 10.1016/j.jacl.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 01/17/2023]
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The Frequency of Clinic Visits Was Not Associated with Medication Adherence or Outcome in Children with Inflammatory Bowel Diseases. Can J Gastroenterol Hepatol 2018; 2018:4687041. [PMID: 29682493 PMCID: PMC5845509 DOI: 10.1155/2018/4687041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/17/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Medication nonadherence is a challenge in pediatric patients with inflammatory bowel diseases (IBD). Poor adherence can result in disease flare-ups, disease complicationstherapy escalation, and the need for corticosteroids. The aim was to determine if clinic visit frequency was associated with treatment adherence. METHODS A retrospective chart review of patients attending the Edmonton Pediatric IBD Clinic (EPIC) at the Stollery Children's Hospital from January 2012 to December 2013 was completed. Correlations were made between frequency of clinic visit, percentage of prescriptions filled, percentage of requisitioned blood work completed, rural or urban residence, and steroid-free remission status of patients for the 6 months after the chart review. RESULTS 127 patients were reviewed with 82 patients diagnosed with Crohn's disease (CD) and 46 with ulcerative colitis (UC) which included one IBD-Unclassified. Mean age at diagnosis is 9.17 years and median duration of follow-up is 3.2 years. Almost all patients on infliximab infusions received them "within window." Immunomodulator median adherence rate was 88%. 5-ASA adherence was 82%. A median of 67% of patients had blood work completed as requested. Clinic visit frequency was not associated with adherence to blood work or to medications. Duration of disease was the only independent factor found to be associated with a reduction in blood work and immunomodulator adherence ("OR 0.86 and 95% CI: 0.74-0.99" and "OR 0.82 and 95% CI: 0.71-0.97") per year, respectively. Patients who remained corticosteroid-free in the 6 months after the 2 years' adherence review had an overall median medication adherence rate of 86% compared to only 53% for those who relapsed and required corticosteroids (p = 0.01). CONCLUSION Clinic visit frequency was not associated with patient adherence to medications or blood work. However, disease duration was found to be associated with medication adherence. Adherent patients were more likely to remain in steroid-free remission.
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McAlister FA, Garrison S, Kosowan L, Ezekowitz JA, Singer A. Use of Direct Oral Anticoagulants in Canadian Primary Care Practice 2010-2015: A Cohort Study From the Canadian Primary Care Sentinel Surveillance Network. J Am Heart Assoc 2018; 7:e007603. [PMID: 29374047 PMCID: PMC5850250 DOI: 10.1161/jaha.117.007603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND As questions have been raised about the appropriateness of direct oral anticoagulant (DOAC) dosing among outpatients with atrial fibrillation, we examined this issue in patients being managed by primary care providers. METHODS AND RESULTS This was a retrospective cohort new-user study using electronic medical records from 744 Canadian primary care clinicians. Potentially inappropriate DOAC prescribing was defined as prescribing lower or higher doses than those recommended by guidelines for patients with nonvalvular atrial fibrillation. Of the 6658 patients with nonvalvular atrial fibrillation who were prescribed a DOAC (mean age: 74.8; 55% male), 626 (9.4%) had a CHADS2 score of 0, and 168 (2.5%) had a CHADS-VASc score of 0. Of the DOAC prescriptions, 527 (7.7%) were deemed potentially inappropriate: 496 (7.2%) were potentially underdosed, and 31 (0.5%) were prescribed a dose that was higher than recommended. Patients were more likely to be prescribed lower-than-recommended doses if they were female (adjusted odds ratio [aOR]: 1.3 [95% confidence interval (CI), 1.0-1.5]), had multiple comorbidities (aOR: 1.4 [95% CI, 1.1-1.8])-particularly heart failure (aOR: 1.6 [95% CI, 1.2-2.0]) or dementia (aOR: 1.4 [95% CI, 1.1-1.8])-or if they were also taking aspirin (aOR: 1.7 [95% CI, 1.3-2.1]) or nonsteroidal anti-inflammatory drugs (aOR: 1.2 [95% CI, 1.02-1.5]). Potentially inappropriate DOAC dosing was more common in rural practices (aOR: 2.1 [95% CI, 1.7-2.6]) or smaller practices (aOR: 1.9 [95% CI, 1.6-2.4] for practices smaller than median). CONCLUSIONS The vast majority of DOAC prescriptions in our cohort of primary care-managed patients appeared to be for appropriate doses, particularly since prescribing a reduced dose of DOAC may be appropriate in frail patients or those taking other medications that predispose to bleeding.
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Affiliation(s)
- Finlay A McAlister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Scott Garrison
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Leanne Kosowan
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Justin A Ezekowitz
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Alexander Singer
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Arbuckle C, Tomaszewski D, Aronson BD, Brown L, Schommer J, Morisky D, Linstead E. Evaluating Factors Impacting Medication Adherence Among Rural, Urban, and Suburban Populations. J Rural Health 2018; 34:339-346. [DOI: 10.1111/jrh.12291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/19/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Cody Arbuckle
- Mathematics and Computer Science, Schmid College of Science and Technology; Chapman University; Orange California
| | - Daniel Tomaszewski
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy; Chapman University; Irvine California
| | - Benjamin D. Aronson
- Department of Pharmacy Practice, College of Pharmacy; Ohio Northern University; Ada Ohio
| | - Lawrence Brown
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy; Chapman University; Irvine California
| | - Jon Schommer
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy; University of Minnesota; Minneapolis Minnesota
| | - Donald Morisky
- Department of Community Health Sciences, Fielding School of Public Health; University of California; Los Angeles California
| | - Erik Linstead
- Mathematics and Computer Science, Schmid College of Science and Technology; Chapman University; Orange California
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Abbass I, Revere L, Mitchell J, Appari A. Medication Nonadherence: The Role of Cost, Community, and Individual Factors. Health Serv Res 2017; 52:1511-1533. [PMID: 27558760 PMCID: PMC5517674 DOI: 10.1111/1475-6773.12547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explain the association of out-of-pocket (OOP) cost, community-level factors, and individual characteristics on statin therapy nonadherence. DATA SOURCES BlueCross BlueShield of Texas claims data for the period of 2008-2011. STUDY DESIGN A retrospective cohort of 49,176 insured patients, aged 18-64 years, with at least one statin refill during 2008-2011 was analyzed. Using a weighted proportion of days covered ratio, differences between adherent and nonadherent groups are assessed using chi-squared tests, t-tests, and a clustered generalized linear model with logit link function. PRINCIPAL FINDINGS Statin therapy adherence, measured at 48 percent, is associated with neighborhood-level socioeconomic factors, including race/ethnicity, educational attainment, and poverty level. Individual characteristics influencing adherence include OOP medication cost, gender, age, comorbid conditions, and total health care utilization. CONCLUSIONS This study signifies the importance of OOP costs as a determinant of adherence to medications, but more interestingly, the results suggest that other socioeconomic factors, as measured by neighborhood-level variables, have a greater association on the likelihood of adherence. The results may be of interest to policy makers, benefit designers, self-insured employers, and provider organizations.
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Affiliation(s)
- Ibrahim Abbass
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Lee Revere
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Jordan Mitchell
- School of BusinessUniversity of Houston Clear LakeLeague CityTX
| | - Ajit Appari
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
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Khabbazi A, Karkon Shayan F, Ghojazadeh M, Kavandi H, Hajialiloo M, Esalat Manesh K, Kolahi S. Adherence to treatment in patients with Behçet's disease. Int J Rheum Dis 2017. [DOI: 10.1111/1756-185x.13109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alireza Khabbazi
- Connective Tissue Diseases Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - Farid Karkon Shayan
- Connective Tissue Diseases Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - Morteza Ghojazadeh
- Department of Physiology; Tabriz University of Medical Sciences; Tabriz Iran
| | - Hadise Kavandi
- Connective Tissue Diseases Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - Mehrzad Hajialiloo
- Connective Tissue Diseases Research Center; Tabriz University of Medical Sciences; Tabriz Iran
| | - Kamal Esalat Manesh
- Department of Rheumatology; Kashan University of Medical Sciences; Kashan Iran
| | - Sousan Kolahi
- Connective Tissue Diseases Research Center; Tabriz University of Medical Sciences; Tabriz Iran
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Mekonnen HS, Gebrie MH, Eyasu KH, Gelagay AA. Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia. BMC Pharmacol Toxicol 2017; 18:27. [PMID: 28381241 PMCID: PMC5382443 DOI: 10.1186/s40360-017-0134-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/30/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adherence to prescribed medication is an imperative issue which can be directly linked with the management of chronic diseases like hypertension; failure to adhere can affect the effectiveness of medication as well as the efficiency of the health care system. There is scarcity of information regarding the level of drug adherence for antihypertensive medications and its determinants in Ethiopia, particularly in the study area. Therefore, the aim of this study was to assess adherence level and its determinants for antihypertensive medications among adult hypertensive patients attending the chronic illness clinics of the referral hospitals in northwest Ethiopia. METHODS Institution based cross sectional study was conducted from March to April, 2016. The systematic random sampling technique was used to select 409 study participants from three referral hospitals. The questionnaire was prepared using the World Health Organization (WHO) conceptual model and by reviewing international literature. The data were collected using an interviewer administered questionnaire. The data were entered in to Epi - Info version 7 and then transferred to the statistical package for social science (SPSS) version 20 for data cleaning and analysis. Bivariate analysis was first done to see the association between each independent variables and dependent variable. Variables with a P-value of less than 0.2 in the bivariate analysis were entered in to the multivariate logistic regression model for final analysis. Multivariate analysis was done using Backward logistic regression method. P-value less than 0.05 was considered to determine the statistical significance of the association and odds ratio with a 95% confidence interval was used to determine the presence, strength, and direction of association between covariates (explanatory variables) and the outcome variable. The Morisky medication adherence scale was used to assess the adherence status using > = 6 as adherent or < 6 as non adherent score. RESULTS Four hundred and nine (409) study participants were interviewed with a response rate of 100%. The mean age of the respondents was 54.5 years with (Standard Deviation (SD) ± 13.58). The overall rate of good adherence was 67.2% (95% CI = 62.8, 71.6). Participants who had a favourable attitude towards antihypertensive medications (Adjusted odds ratio (AOR) = 9.88, 95% confidence interval (CI): 5.34, 18.27), having good patient- provider relationship (AOR = 4.25, 95% CI: 2.32, 7.86), having one (AOR = 4.36, 95% CI: 1.34, 14.12) or no (AOR = 3.38, 95% CI:1.01,11.31) co-morbidities, a long duration of treatment (AOR = 1.89, 95%CI: 1.07, 3.35), and a low medical cost (AOR = 2.06, 95% CI: 1.13, 3.76) had associations with good drug adherence for antihypertensive medication/s. CONCLUSIONS The prevalence of good drug adherence for anti-hypertensive medications in this study was high. Prevention of co- morbidities, making medical services accessible, and maintaining good client-provider interaction are of paramount importance for good drug adherence.
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Affiliation(s)
- Habtamu Sewunet Mekonnen
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mignote Hailu Gebrie
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kokeb Haile Eyasu
- Department of Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abebaw Addis Gelagay
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Kempton H, Suttie J. Rural CTCA: Effectively Managing the Tyranny of Distance. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jarari N, Rao N, Peela JR, Ellafi KA, Shakila S, Said AR, Nelapalli NK, Min Y, Tun KD, Jamallulail SI, Rawal AK, Ramanujam R, Yedla RN, Kandregula DK, Argi A, Peela LT. A review on prescribing patterns of antihypertensive drugs. Clin Hypertens 2016; 22:7. [PMID: 27019747 PMCID: PMC4808570 DOI: 10.1186/s40885-016-0042-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/08/2016] [Indexed: 02/08/2023] Open
Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.
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Affiliation(s)
- Noah Jarari
- Department of Pharmacology, University of Benghazi, Benghazi, Libya
| | - Narasinga Rao
- Department of Medicine, Andhra Medical College, Visakhapatnam, India
| | - Jagannadha Rao Peela
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Khaled A Ellafi
- Libyan Cardiac Society, Department of Cardiology, Benghazi Medical Center, Benghazi University, Benghazi, Libya
| | - Srikumar Shakila
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Abdul R Said
- Department of Biochemistry, Quest International University Perak, 227 The Teng Seng Plaza, Level 2, Jalan Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | | | - Yupa Min
- Department of Pathology, Quest International University Perak, Ipoh, Malaysia
| | - Kin Darli Tun
- Department of Pathology, Management and Science University, Selangor, Malaysia
| | | | - Avinash Kousik Rawal
- Department of Biochemistry, St. Mathews Medical University, Grand Cayman, Cayman Islands
| | - Ranjani Ramanujam
- Department of Pharmacology, Dr Ambethkar Medical College, Bengaluru, India
| | | | | | - Anuradha Argi
- Department of Human Genetics, Andhra University, Visakhapatnam, India
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Provider Adherence to National Guidelines for Managing Hypertension in African Americans. Int J Hypertens 2015; 2015:498074. [PMID: 26550489 PMCID: PMC4621359 DOI: 10.1155/2015/498074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted.
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Goeres LM, Gille A, Furuno JP, Erten-Lyons D, Hartung DM, Calvert JF, Ahmed SM, Lee DSH. Rural-Urban Differences in Chronic Disease and Drug Utilization in Older Oregonians. J Rural Health 2015; 32:269-79. [PMID: 26515108 DOI: 10.1111/jrh.12153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize disease burden and medication usage in rural and urban adults aged ≥85 years. METHODS This is a secondary analysis of 5 years of longitudinal data starting in the year 2000 from 3 brain-aging studies. Cohorts consisted of community-dwelling adults: 1 rural cohort, the Klamath Exceptional Aging Project (KEAP), was compared to 2 urban cohorts, the Oregon Brain Aging Study (OBAS) and the Dementia Prevention study (DPS). In this analysis, 121 participants were included from OBAS/DPS and 175 participants were included from KEAP. Eligibility was determined based on age ≥85 years and having at least 2 follow-up visits after the year 2000. Disease burden was measured by the Modified Cumulative Illness Rating Scale (MCIRS), with higher values representing more disease. Medication usage was measured by the estimated mean number of medications used by each cohort. FINDINGS Rural participants had significantly higher disease burden as measured by MCIRS, 23.0 (95% CI: 22.3-23.6), than urban participants, 21.0 (95% CI: 20.2-21.7), at baseline. The rate of disease accumulation was a 0.2 increase in MCIRS per year (95% CI: 0.05-0.34) in the rural population. Rural participants used a higher mean number of medications, 5.5 (95% CI: 4.8-6.1), than urban participants, 3.7 (95% CI: 3.1-4.2), at baseline (P < .0001). CONCLUSIONS These data suggest that rural and urban Oregonians aged ≥85 years may differ by disease burden and medication usage. Future research should identify opportunities to improve health care for older adults.
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Affiliation(s)
- Leah M Goeres
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - Allison Gille
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - Jon P Furuno
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - Deniz Erten-Lyons
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Daniel M Hartung
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - James F Calvert
- Department of Family Medicine, Oregon Health & Science University, Klamath Falls, Oregon
| | - Sharia M Ahmed
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - David S H Lee
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
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Zhang W, Qu HC, Yu M, Zhang Y. The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis. PLoS One 2015; 10:e0130096. [PMID: 26068221 PMCID: PMC4466237 DOI: 10.1371/journal.pone.0130096] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/15/2015] [Indexed: 11/18/2022] Open
Abstract
We conducted a comprehensive meta-analysis of 12 studies to examine whether maxillary protraction face mask associated with rapid maxillary expansion (FM/RME) could be an effective treatment for Class III malocclusion and to evaluate the effect of timing on treatment response. Patients with a maxillary deficiency who were treated with FM with or without RME were compared with those who had an untreated Class III malocclusion. In both treatment groups, forward displacement of the maxilla and skeletal changes were found to be statistically significant. In addition, posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the control group. However, no significant differences were observed between the early treatment groups and late treatment groups. The results indicated that both FM/RME and FM therapy produced favorable skeletal changes for correcting anterior crossbite, and the curative time was not affected by the presence of deciduous teeth, early mixed dentition or late mixed dentition in the patient.
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Affiliation(s)
- Wei Zhang
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, P.R. China
| | - Hong-Chen Qu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Mo Yu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, P.R. China
| | - Yang Zhang
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, P.R. China
- * E-mail:
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Primary non-adherence in Portugal: findings and implications. Int J Clin Pharm 2015; 37:626-35. [PMID: 25832675 DOI: 10.1007/s11096-015-0108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/20/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Portugal is currently facing a serious economic and financial crisis, which is dictating some important changes in the health care sector. Some of these measures may potentially influence patients' access to medication and consequently adherence, which will ultimately impact on health status, especially in chronic patients. AIMS This study aimed at providing a snapshot of adherence in patients with chronic conditions in Portugal between March and April 2012. SETTING Community pharmacy in Portugal. METHOD A cross-sectional pilot study was undertaken, where patients were recruited via community pharmacies to a questionnaire study evaluating the number of prescribed and purchased drugs and, when these figures were inconsistent, the reasons for this. MAIN OUTCOME MEASURES Primary and secondary adherence measures. Failing to purchase prescription items was categorized as primary nonadherence. Secondary nonadherence was attributed to purchasing prescription items, but not taking medicines as prescribed. RESULTS Data were collected from 375 patients. Primary nonadherence was identified in 22.8 % of patients. Regardless of the underlying condition, the most commonly reported reason for primary non-adherence was having spare medicines at home ("leftovers"), followed by financial problems. The latter appeared to be related to the class of medicines prescribed. Primary non-adherence was associated with low income (<475 <euro>/month; p = 0.026). Secondary non-adherence, assessed by the 7-MMAS was detected in over 50 % of all patients, where unintentional nonadherence was higher than intentional nonadherence across all disease conditions. CONCLUSION This study revealed that more than one fifth of chronic medication users report primary nonadherence (22.8 %) and more than 50 % report secondary nonadherence. Data indicates that the existence of spare medicines and financial constraints occurred were the two most frequent reasons cited for nonadherence (47, 6-64, 8 and 19-45.5 %, depending on the major underlying condition, respectively).
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Bethel MA, Green JB, Milton J, Tajar A, Engel SS, Califf RM, Holman RR. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Obes Metab 2015; 17:395-402. [PMID: 25600421 DOI: 10.1111/dom.12441] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 12/18/2022]
Abstract
AIMS To report baseline characteristics and cardiovascular (CV) risk management by region, age, sex and CV event type for 14 724 participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), a randomized, double-blind, placebo-controlled trial exploring whether sitagliptin added to usual type 2 diabetes (T2DM) care affects time to first event in the composite endpoint of CV death, non-fatal myocardial infarction (MI), non-fatal stroke or unstable angina hospitalization. METHODS TECOS enrolled patients aged ≥50 years, with T2DM and CV disease from 38 countries in five regions: North America, Eastern Europe, Western Europe, Asia Pacific and Latin America. Participants had a glycated haemoglobin concentration of 6.5-8.0% (48-64 mmol/mol) and were receiving oral and/or insulin-based antihyperglycaemic therapy. Analysis of variance or logistic regression was used to compare regional CV risk factors and treatments, referenced to North America. RESULTS Patients had a mean [1 standard deviation (SD)] age of 66 (8) years, a median (interquartile range) diabetes duration of 9.4 (4.9, 15.3) years, and a mean (SD) body mass index 30.2 (5.7) kg/m² . Compared with North America, blood pressure and lipids were higher in all regions. Statin use was lowest in Latin America (68%) and Eastern Europe (70%) and aspirin use was lower compared with North America in all regions except Asia Pacific. Achievement of treatment targets did not differ by age group or insulin usage, but men and participants with previous MI were more likely than women or those with previous stroke or peripheral arterial disease to reach most treatment goals. CONCLUSION The CV risk factors of participants in TECOS are reasonably controlled, but differences in CV risk management according to region, sex and history of disease exist. This diversity will enhance the generalizability of the trial results.
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Affiliation(s)
- M A Bethel
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Qu HC, Zhang W, Yan S, Liu YL, Wang P. Urinary nerve growth factor could be a biomarker for interstitial cystitis/painful bladder syndrome: a meta-analysis. PLoS One 2014; 9:e106321. [PMID: 25181532 PMCID: PMC4152268 DOI: 10.1371/journal.pone.0106321] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/29/2014] [Indexed: 01/15/2023] Open
Abstract
To examine whether urinary nerve growth factor (NGF) could serve as a biomarker for interstitial cystitis/painful bladder syndrome (IC/PBS), we conducted a comprehensive meta-analysis of 9 studies. Among the studies considered, patients with IC/PBS had higher urinary NGF and NGF/Cr levels compared to those of healthy people (SMD = 1.94, 95%CI = 0.79-3.08, P = 0.0009 and SMD = 1.79, 95%CI = 0.65-2.93, P = 0.002, respectively). In addition, there was a significant difference between patients with IC/PBS and patients with overactive bladder (OAB) symptoms with respect to the urinary NGF and NGF/Cr levels (SMD = -0.62, 95%CI = -1.00--0.24, P = 0.001 and SMD = -0.70, 95%CI = -1.01--0.39, P<0.0001, respectively). Furthermore, patients had a significantly lower urinary NGF level after successful treatment (SMD = 1.74, 95%CI = 0.32-3.17, P = 0.02). In conclusion, urinary NGF could be a useful biomarker for the diagnosis of OAB, a urinary biomarker for the differential diagnosis of IC/PBS and OAB (when a critical urinary NGF or NGF/Cr level is needed), and a predictive biomarker to help guide treatment.
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Affiliation(s)
- Hong-Chen Qu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Wei Zhang
- Department of Orthodontics, The Dental Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Shi Yan
- Department of Urological Surgery, The Third Hospital of Shenyang, Shenyang, Liaoning, P. R. China
| | - Yi-Li Liu
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Ping Wang
- Department of Urological Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
- * E-mail:
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