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Hoarau D, Ramos I, Termoz A, Fernandez V, Rambure M, Allemann SS, Derex L, Haesebaert J, Schott AM, Viprey M. Determinants of adherence to post-stroke/transient ischemic attack secondary prevention medications: A cohort study. Eur J Neurol 2024; 31:e16395. [PMID: 38953278 DOI: 10.1111/ene.16395] [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: 01/09/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Adherence to post-stroke secondary prevention medications mitigates recurrence risk. This study aimed to measure adherence to secondary prevention medications during 3 years post-ischemic stroke/transient ischemic attack, using prescription and dispensing data, and identify factors associated with suboptimal adherence. METHODS This multicenter, prospective, cohort study involved patients from the STROKE 69 cohort, which included all consecutive patients with suspected acute stroke admitted between November 2015 and December 2016 to any emergency department or stroke center in the Rhône area in France. Prescription data for antihypertensive agents, antidiabetic agents, lipid-lowering drugs, and antithrombotics were collected. Dispensing data were provided by the French regional reimbursement database. Adherence was calculated using the continuous medication acquisition index. Associations between suboptimal adherence and potential influencing factors across the World Health Organization's five dimensions were explored through univariate and multivariate analyses. RESULTS From 1512 eligible patients, 365 were included. Optimal adherence to overall treatment (≥90%) was observed in 61%, 62%, and 65% of patients in the first, second, and third years, respectively. Education level (high school diploma or higher: OR = 3.24, 95% CI [1.49; 7.36]) and depression (Hospital Anxiety and Depression Scale-Depression scores 8-10: OR = 1.90, 95% CI [1.05; 3.44]) were significantly associated with suboptimal adherence. CONCLUSIONS Overall adherence to secondary prevention medications was fairly good. Having an initial diagnosis of transient ischemic attack, a high level of education, or depression was associated with increased odds of suboptimal adherence, while having a history of heart rhythm disorder was associated with lower odds.
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Affiliation(s)
- Damien Hoarau
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Inès Ramos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | | | - Marie Rambure
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Marie Viprey
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
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2
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Hansen CME, Breukelman AJ, van den Bemt PMLA, Zwitserloot AM, van Dijk L, van Boven JFM. Medication adherence to CFTR modulators in patients with cystic fibrosis: a systematic review. Eur Respir Rev 2024; 33:240060. [PMID: 39142708 PMCID: PMC11322823 DOI: 10.1183/16000617.0060-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/18/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND In the last decade, a fundamental shift in the treatment of cystic fibrosis (CF) took place due to the introduction of CF transmembrane conductance regulator (CFTR) modulators. Adequate medication adherence is a prerequisite for their effectiveness, but little is known about adherence to CFTR modulators. We aimed to assess the extent of medication adherence to CFTR modulators in patients with CF and assess which characteristics are associated with adherence. METHODS A systematic review following PRISMA guidelines was performed. Studies needed to report adherence to CFTR modulators. Main outcomes were: 1) level of medication adherence and 2) associations of demographic and/or clinical characteristics with adherence. RESULTS In total, 4082 articles were screened and 21 full-text papers were assessed for eligibility. Ultimately, seven studies were included. Most studies were retrospective and focused on adherence to ivacaftor or lumacaftor-ivacaftor with only one focusing on elexacaftor-tezacaftor-ivacaftor. The majority used pharmacy refill data with adherence determined with the proportion of days covered (PDC) or the medication possession ratio (MPR). One study additionally used electronic monitoring and patient self-reported adherence. Adherence was 0.62-0.99 based on pharmacy data (PDC or MPR), 61% via electronic monitoring and 100% via self-report. Age <18 years appeared to be associated with good adherence, as was a higher lung function. CONCLUSIONS Despite the wide variety of adherence methods used, adherence to CFTR modulators is suboptimal, based on objective measures such as pharmacy refill data or electronic monitoring. CFTR modulator adherence measurement and definitions requires more standardisation with a preference for objective and granular methods.
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Affiliation(s)
- Carina M E Hansen
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
| | - Anna J Breukelman
- University of Groningen, Department of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Annelies M Zwitserloot
- University of Groningen, University Medical Center Groningen (UMCG), Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergy, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen (UMCG), Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Liset van Dijk
- University of Groningen, Department of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Groningen, The Netherlands
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Job F M van Boven
- University of Groningen, University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen (UMCG), Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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3
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Burgel PR, Ballmann M, Drevinek P, Heijerman H, Jung A, Mainz JG, Peckham D, Plant BJ, Schwarz C, Taccetti G, Smyth A. Considerations for the use of inhaled antibiotics for Pseudomonas aeruginosa in people with cystic fibrosis receiving CFTR modulator therapy. BMJ Open Respir Res 2024; 11:e002049. [PMID: 38702073 PMCID: PMC11086488 DOI: 10.1136/bmjresp-2023-002049] [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: 09/01/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and pulmonary exacerbations. The prevalence of Pseudomonas aeruginosa rises rapidly in the teenage years, and this organism is the most common cause of chronic lung infection in adults with cystic fibrosis (CF). It is associated with an accelerated decline in lung function and premature death. New P. aeruginosa infections are treated with antibiotics to eradicate the organism, while chronic infections require long-term inhaled antibiotic therapy. The prevalence of P. aeruginosa infections has decreased in CF registries since the introduction of CF transmembrane conductance regulator modulators (CFTRm), but clinical observations suggest that chronic P. aeruginosa infections usually persist in patients receiving CFTRm. This indicates that pwCF may still need inhaled antibiotics in the CFTRm era to maintain long-term control of P. aeruginosa infections. Here, we provide an overview of the changing perceptions of P. aeruginosa infection management, including considerations on detection and treatment, the therapy burden associated with inhaled antibiotics and the potential effects of CFTRm on the lung microbiome. We conclude that updated guidance is required on the diagnosis and management of P. aeruginosa infection. In particular, we highlight a need for prospective studies to evaluate the consequences of stopping inhaled antibiotic therapy in pwCF who have chronic P. aeruginosa infection and are receiving CFTRm. This will help inform new guidelines on the use of antibiotics alongside CFTRm.
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Affiliation(s)
- Pierre-Régis Burgel
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- ERN-lung CF Network, Frankfurt, Germany
| | - Manfred Ballmann
- Kinder- und Jugendklinik der Universitätsmedizin Rostock, Rostock, Germany
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Harry Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital, Zurich, Switzerland
| | - Jochen G Mainz
- Medizinische Hochschule Brandenburg (MHB) University, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Daniel Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Barry J Plant
- Cork Adult Cystic Fibrosis Centre, Cork University Hospital, University College, Cork, Republic of Ireland
| | - Carsten Schwarz
- HMU-Health and Medical University Potsdam, Internal Medicine and Pneumology, Clinic Westbrandenburg, Division of Cystic Fibrosis, CF Center Westbrandenburg, Campus Potsdam, Potsdam, Germany
| | - Giovanni Taccetti
- Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Centre, Department of Paediatric Medicine, Florence, Italy
| | - Alan Smyth
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Tang KWK, Millar BC, Moore JE. Improving health literacy of antibiotic use in people with cystic fibrosis (CF)-comparison of the readability of patient information leaflets (PILs) from the EU, USA and UK of 23 CF-related antibiotics used in the treatment of CF respiratory infections. JAC Antimicrob Resist 2023; 5:dlad129. [PMID: 38046567 PMCID: PMC10691746 DOI: 10.1093/jacamr/dlad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background Antibiotic adherence is poor amongst people with cystic fibrosis (CF). Low-quality patient information leaflets (PILs), which accompany prescription antibiotics, with poor readability may contribute to poor antibiotic adherence, with the potential for antimicrobial resistance (AMR) development. The aim of this study was to examine the readability of antibiotic PILs used to treat CF lung infections. Methods CF-related antibiotics (n = 23; seven classes: aminoglycosides, β-lactams, fluoroquinolones, macrolides/lincosamides, oxazolidinones, tetracyclines, trimethoprim/sulfamethoxazole) were investigated. Readability of PILs (n = 141; 23 antibiotics) from the EU (n = 40), USA (n = 42) and UK (n = 59) was calculated. Results Mean [± standard error of mean (SEM)] values for the Flesch Reading Ease (FRE) for EU, USA and UK were 50.0 ± 1.1, 56.2 ± 1.3 and 51.7 ± 1.1, respectively (FRE target ≥60). Mean (± SEM) values for the Flesch Kinkaid Grade Level (FKGL) for the EU, USA and UK were 9.0 ± 0.2, 7.5 ± 0.2 and 9.6 ± 0.2, respectively (FKGL target ≤8). US PILs were significantly shorter (P < 0.0001) in words (mean ± SEM = 1365 ± 52), than either UK or EU PILs, with fewer sentences (P < 0.0001), fewer words per sentence (P < 0.0001) and fewer syllables per word. The mean ( ± SEM) reading time of UK PILs (n = 59) was 12.7 ± 0.55 mins . Conclusions Readability of antibiotic PILs is poor. Improving PIL readability may lead to improved health literacy, which may translate to increased antibiotic adherence and AMR avoidance. Authors preparing written materials for the lay/patient CF community are encouraged to employ readability calculators, so that final materials are within recommended readability reference parameters, to support the health (antibiotic) literacy of their readers.
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Affiliation(s)
- Ka Wah Kelly Tang
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
| | - Beverley C Millar
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
| | - John E Moore
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD Northern Ireland, UK
- Northern Ireland Regional Adult Cystic Fibrosis Centre, Level 8, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland, UK
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Viprey M, Mougeot F, Dima AL, Haesebaert J, Occelli P, Durieu I, Rouzé H, Reynaud Q, Touzet S. A Participatory Approach Involving Patients with Cystic Fibrosis and Healthcare Professionals for the Co-Design of an Adherence-Enhancing Intervention Toolkit. Patient Prefer Adherence 2023; 17:995-1004. [PMID: 37063606 PMCID: PMC10103710 DOI: 10.2147/ppa.s389792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose Cystic fibrosis (CF) is an inherited life-shortening disease involving a significant treatment burden. Few interventions have been proven effective in improving adherence, and of these fewer have been adopted for implementation. Patient participation in research is increasingly desired in developing relevant health care services. A participatory approach was implemented in an adult CF center to co-design an adherence-enhancing intervention toolkit. We aimed to report on the participatory process and the results regarding the co-designed intervention. Patients and Methods Two focus group sessions and four working sessions were conducted at 4-week intervals with three healthcare professionals (HCP; physician, nurse, physiotherapist), eight patients, and two researchers (sociologist, public health pharmacist). The two initial focus group sessions were dedicated to the collection of narratives about CF treatment experiences to identify drivers of adherence. The next four working sessions were dedicated to the reflection on solutions that could alleviate the difficulties identified and be used in current clinical practice. The researchers observed during all sessions the interactions between participants, group dynamics, and process of implementation of the collective reflection. Results The process facilitated an active participation of patients and HCP, who contributed equally to the intervention development. The co-design adherence-enhancing intervention toolkit consisted in a self-questionnaire to be completed by patients before the medical consultation and used as a communication support during the consultation, plus a toolkit of solutions to be proposed by the HCP for each barrier identified by patients, and to be followed up during the next consultation. Conclusion This study demonstrated that a participatory approach involving CF patients and HCP lead to the development of an adherence-enhancing intervention toolkit, using a 6-session format; the benefits of the co-designed intervention on the medication adherence have yet to be tested in a multicenter, open-label study in 3 centers in France.
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Affiliation(s)
- Marie Viprey
- Hospices Civils de Lyon, Pôle Santé Publique, Service des Données de Santé, Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Correspondence: Marie Viprey, Hospices Civils de Lyon, Service des Données de Santé, 162 Avenue Lacassagne, Lyon, 69003, France, Tel +33 4 72 11 51 39, Fax +33 4 72 11 57 20, Email
| | | | - Alexandra Lelia Dima
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France
| | - Pauline Occelli
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France
| | - Isabelle Durieu
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Centre de Référence Adulte de la Mucoviscidose, Pierre Bénite, France
| | - Héloïse Rouzé
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Lyon, France
| | - Quitterie Reynaud
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Centre de Référence Adulte de la Mucoviscidose, Pierre Bénite, France
| | - Sandrine Touzet
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Santé au Travail, Lyon, France
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Hatziagorou E, Manika K, Kyrvasili SS, Kotoulas SC, Chrysochoou EA, Kouroukli E, Sionidou M, Tsanakas J. Pulmonary medication adherence among children and adults with cystic fibrosis: Is there an association with disease severity? Pediatr Pulmonol 2022; 57:3017-3026. [PMID: 35997065 DOI: 10.1002/ppul.26126] [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: 05/09/2022] [Revised: 07/09/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adherence to pulmonary medication is pivotal in delaying the progression of lung disease in cystic fibrosis (CF). Further exploring the consequences of poor adherence and its impact on disease severity may be valuable to personalize CF treatment strategy. AIM To evaluate indicators of disease severity among children and adults with CF and investigate which of them are related to pulmonary medication adherence. METHODS This is a retrospective cohort study. Data of children and adults followed up in one pediatric and one adult CF Unit were evaluated over 4 years. Disease severity was assessed by measuring body mass index (BMI), lung function, history of pulmonary exacerbations, and medication complexity. Adherence was assessed by calculating a 12-month medication possession ratio (MPR) for each pulmonary medication and then averaged for a composite MPR (cMPR) for each patient. Regression analysis was performed to explore the association of adherence with disease severity. RESULTS Ninety-five patients were included in our study, 52 children and 43 adults. The overall cMPR was 0.74 (SD = 0.25); 0.68 (SD = 0.24) for children and 0.81 (SD = 0.24) for adults. Adults presented higher adherence, with overall mean cMPR 0.81 (SD = 0.24) compared to children with mean cMPR 0.68 (SD = 0.24) (p < 0.05, 95% CI = -0.27 to -0.03). Adherence was inversely related to FEV1 % predicted (β = -0.002, 95% CI = -0.004 to 0, p = 0.023) and FVC% predicted (β = -0.003, 95% CI = -0.005 to -0.001, p = 0.006) in regression analysis. Adherence was not found to be associated with BMI, history of exacerbations and medication complexity. The analysis of each medication showed that adherence to Dornase-alpha, Tobramycin and Colomycin was significantly related to specific disease severity indicators. CONCLUSION An overall moderate to high level of adherence was found among our study population. Adults presented higher adherence compared to children. FEV1% and FVC% predicted were related to a significant decrease in adherence. Among our group of CF patients with an overall moderate to high level of adherence, adherence to pulmonary medication was inversely related to disease severity.
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Affiliation(s)
- Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Manika
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Syrmo Styliani Kyrvasili
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Serafeim Chrysovalantis Kotoulas
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - Elisavet Anna Chrysochoou
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleana Kouroukli
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Sionidou
- Adult Cystic Fibrosis Unit, Pulmonary Department, "G. Papanikolaou" Hospital, Aristotle University of Thessaloniki, Exohi, Thessaloniki, Greece
| | - John Tsanakas
- Cystic Fibrosis Unit, 3rd Paediatric Department, "Hippokration" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Møller R, Nielsen BU, Faurholt-Jepsen D, Katzenstein TL, Skov M, Philipsen LKD, Pressler T, Johansen HK, Qvist T. Use of inhaled antibiotics among Danish patients with cystic fibrosis. Pediatr Pulmonol 2022; 57:1726-1734. [PMID: 35478387 PMCID: PMC9324817 DOI: 10.1002/ppul.25942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Inhaled antibiotics are an important part of cystic fibrosis (CF) airway disease management and should be individualized to fit the microorganism and match patient needs. To investigate the implementation of personalized treatment, this study mapped the use of different types of inhaled antibiotics and adherence patterns. METHODS We performed individual structured interviews in a cross-sectional study at the CF Centre in Copenhagen, Denmark. Patients with CF older than 15 years attending clinical consultations were included. Clinical data were obtained from centralized databases. RESULTS Among 149 participants, 107 (72%) had indication for treatment with inhaled antibiotics. In this group, 97 (91%) reported the use of inhaled antibiotics within the last 12 months. Change from one inhaled antibiotic to another during that period was reported by 31 (29%), and 17 (25%) with Pseudomonas aeruginosa had used off-label antibiotics. Adherence to a minimum of one daily dose of antibiotic was reported by 78%, while adherence to all daily doses was 28 percentage points lower. Skipping inhalations was due to side effects and doubt about the effect in less than 5% of cases. CONCLUSION Change of inhaled antibiotics and use of off-label antibiotics for inhalation were common and side effects were a rare cause of nonadherence. This suggests satisfactory implementation of the principle of tailored antibiotic inhalation prescription in the Copenhagen CF population. Adherence to at least one daily inhalation dose was markedly higher than adherence to multiple daily inhalations.
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Affiliation(s)
- Rikke Møller
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | - Bibi Uhre Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | - Terese Lea Katzenstein
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | - Marianne Skov
- Department of Pediatrics, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | | | - Tacjana Pressler
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark.,Department of Pediatrics, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
| | - Helle Krogh Johansen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tavs Qvist
- Department of Infectious Diseases, University Hospital of Copenhagen, Cystic Fibrosis Centre, Copenhagen, Denmark
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8
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Volpi S, Carnovale V, Colombo C, Raia V, Blasi F, Pappagallo G. Use of mucoactive agents in cystic fibrosis: A consensus survey of Italian specialists. Health Sci Rep 2022; 5:e604. [PMID: 35677472 PMCID: PMC9169509 DOI: 10.1002/hsr2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background The goal of mucoactive therapies in cystic fibrosis (CF) is to enhance sputum clearance and to reduce a progressive decline in lung function over the patient's lifetime. We aimed to investigate the level of consensus among specialists from Italian CF Centers on appropriateness of therapeutic use of dornase alfa (rhDNase) for CF patients. Method A consensus on appropriate prescribing in CF mucoactive agents was appraised by an online Delphi method, based on a panel of 27 pulmonologists, coordinated by a Scientific Committee of six experts in medical care of patients with CF. Results Full or very high consensus was reached on several issues related to therapeutic use of dornase alfa for CF patients in clinical practice. Conclusions The consensus reached on a number of topics regarding use of mucoactive agents in patients with CF can help guide clinicians in daily practice based on expert experience and define the most appropriate therapeutic strategy for the individual patient.
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Affiliation(s)
- Sonia Volpi
- Cystic Fibrosis Center Azienda Ospedialiera Universitaria Integrata Verona Italy
| | - Vincenzo Carnovale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Cystic Fibrosis Center Milan Italy
| | - Carla Colombo
- Department of Translational Medical Science, Cystic Fibrosis Centre, Adult Unit University “Federico II” Naples Italy
| | - Valeria Raia
- Section of Pediatrics, Department of Translational Medical Sciences “University Federico II” Naples Italy
| | - Francesco Blasi
- Department of Internal Medicine Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
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9
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Abstract
ABSTRACT Cystic fibrosis is an autosomal recessive genetic disorder that causes a lifetime of debilitating and potentially fatal complications affecting the lungs and other organ systems. Over 1,700 gene mutations that cause this rare disorder have been identified. This article describes the current treatment landscape for adults with CF, including the 2019 FDA approval of a breakthrough triple-drug combination therapy that may significantly improve the quality of life for an estimated 90% of patients with CF.
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Wendekier C, Wendekier-Raybuck K. Cystic fibrosis: A changing landscape. Nursing 2021; 51:32-38. [PMID: 34014874 DOI: 10.1097/01.nurse.0000751344.57701.75] [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: 11/26/2022]
Abstract
ABSTRACT Cystic fibrosis (CF) is an autosomal recessive genetic disorder that causes a lifetime of debilitating and life-threatening complications affecting the lungs and other organ systems. Over 1,700 gene mutations that cause this rare disorder have been identified. This article describes the current treatment landscape for adults with CF, including the 2019 FDA approval of a breakthrough triple-drug combination therapy that may significantly improve the quality of life for an estimated 90% of patients with CF.
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Affiliation(s)
- Camille Wendekier
- Camille Wendekier is program director, leadership/education at Saint Francis University in Loretto, Pa., and Katheryn Wendekier-Raybuck is a pharmacist in Pittsburgh, Pa
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Banks JT, Rosenfeld M, Mancl L, Chi DL. Survey and electronic health record-based medication use agreement in children with cystic fibrosis: A retrospective cross-sectional study. Int J Paediatr Dent 2021; 31:247-253. [PMID: 32936971 DOI: 10.1111/ipd.12724] [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: 07/05/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication use is important to collect accurately in medically complex patients in both clinical and research settings. AIM We assessed patient-level agreement for medication use between self-reported survey and electronic health record (EHR) for children with cystic fibrosis (CF). METHODS Our retrospective cross-sectional study focused on children with CF ages 6-20 years from Seattle Children's Hospital in Washington state, USA (N = 85). A self- or parent-reported survey included questions on current use of specific medications and antibiotic use in the past 2 months. We compared survey data with data abstracted from the individual's EHR and derived Cohen's Kappa statistics to estimate the level of agreement between the two methods. RESULTS Self-reported medication use was generally higher in the survey than in the EHR. The level of agreement ranged from slight for probiotics (74.1% agreement; 95% confidence interval [CI]: 64.6%-83.6%; kappa: 0.07), pancreatic enzymes (80% agreement; 95% CI: 71.3%-88.7%; kappa: 0.12), and vitamin D (55.3% agreement; 95% CI: 44.5%-66.1%; kappa: 0.20) to moderate for chronic azithromycin (80% agreement; 95% CI: 7.13%-88.7%; kappa: 0.50), proton pump inhibitors (76.5% agreement; 95% CI: 67.3%-85.7%; kappa: 0.46), and oral antibiotics (70.6% agreement; 95% CI: 60.7%-80.5%; kappa: 0.42). CONCLUSION There is considerable heterogeneity in level of agreement in medication use between self-reported survey and EHR data for children with CF. Standardized approaches are needed to improve the accuracy of medication data collected in clinical practice and research.
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Affiliation(s)
- Jordan T Banks
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Margaret Rosenfeld
- Department of Pulmonology, Seattle Children's Hospital, Seattle, WA, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Del Corral T, La Touche R, Cebrià I Iranzo MÀ, Olmos R, Blanco-Royano F, López-de-Uralde-Villanueva I. Development and Validation of the AdT-Physio Scale: A Tool to Assess Adherence and Perception of Physical Therapist Intervention in Patients With Cystic Fibrosis. Phys Ther 2020; 100:2063-2074. [PMID: 32754747 DOI: 10.1093/ptj/pzaa136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/28/2019] [Accepted: 06/22/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a scale to measure patient adherence to physical therapist intervention and to report psychometric properties in patients with cystic fibrosis (CF). METHODS This observational, multicenter, qualitative, and cross-sectional study was divided into 2 phases: development of scale items (content validity) and assessment of psychometric properties (construct validity, reliability, and convergent/discriminant validity). Recruited were 121 patients with CF (aged ≥16 years). Sociodemographic characteristics, lung function testing, Coping with Stress Self-Efficacy, brief Coping Orientation to Problems Experienced inventory, and the scale of Adherence to Treatment of Physiotherapy (AdT-Physio) scale were evaluated. RESULTS The final version of the AdT-Physio scale consists of 15 items distributed across 2 subscales: compliance and beliefs about treatment/therapist. The scale showed high internal consistency (Cronbach α = .897; 95% CI = 0.868-0.922) and subscales above 0.800. The 2-factor confirmatory factor analysis model fitted the data reasonably well: χ2 (76) = 111.96, comparative fit index = 0.982, Tucker-Lewis index = 0.978, root mean square error of approximation = 0.063, 95% CI = 0.036 to 0.086, and weighted root mean square residual = 0.720. No floor or ceiling effects were identified. There was a positive, significant, and moderate-low magnitude correlation with the total Coping Orientation to Problems Experienced inventory (r = .360) and Coping with Stress Self-Efficacy subscale efficacy expectations scores (r = .304). For discriminant validity, there was a positive, significant, and moderate correlation between the total and the age of the patients (r = .354). CONCLUSIONS The AdT-Physio scale is psychometrically valid and reliable for use in the clinic for the assessment of adherence to physical therapy in patients with CF. IMPACT Ultimately, the authors propose this documentary instrument to assess the evaluation of the therapeutic alliance in a valid and objective manner. The AdT-Physio scale provides us with a greater degree of understanding of the problems behind noncompliance with treatment to advance person-centered decisions in physical therapy and thereby enhance the effectiveness of care.
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Affiliation(s)
- Tamara Del Corral
- Department of Physiotherapy, Faculty of Health Sciences; and Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, Centre for Advanced University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | - Roy La Touche
- Department of Physiotherapy, Faculty of Health Sciences, Center for Advanced Studies, LaSalle University, Madrid, Autonomous University of Madrid, Calle la Salle, 10, 28023, Madrid, Spain; and Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, Centre for Advanced University Studies La Salle, Autonomous University of Madrid
| | - Maria Àngels Cebrià I Iranzo
- Department of Physiotherapy, University of Valencia, and University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Ricardo Olmos
- Department of Social Psychology and Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Fernando Blanco-Royano
- Training Institute of Masseur-Kinesitherapists, the Health Renaissance, Hôpital de la Musse, Saint Sébastien de Morsent, France. At the time of the study, Mr Blanco-Royano was affiliated with Department of Nursing and Physiotherapy, Faculty of Medicine, CEU-San Pablo University, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Poulimeneas D, Grammatikopoulou MG, Devetzi P, Petrocheilou A, Kaditis AG, Papamitsou T, Doudounakis SE, Vassilakou T. Adherence to Dietary Recommendations, Nutrient Intake Adequacy and Diet Quality among Pediatric Cystic Fibrosis Patients: Results from the GreeCF Study. Nutrients 2020; 12:nu12103126. [PMID: 33066268 PMCID: PMC7602117 DOI: 10.3390/nu12103126] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023] Open
Abstract
Nutrition is an important component of cystic fibrosis (CF) therapy, with a high-fat diet being the cornerstone of treatment. However, adherence to the dietary recommendations for CF appears suboptimal and burdensome for most children and adolescents with CF, leading to malnutrition, inadequate growth, compromised lung function and increased risk for respiratory infections. A cross-sectional approach was deployed to examine the degree of adherence to the nutrition recommendations and diet quality among children with CF. A total of 76 children were recruited from Aghia Sophia’s Children Hospital, in Athens, Greece. In their majority, participants attained their ideal body weight, met the recommendations for energy and fat intake, exceeding the goal for saturated fatty acids consumption. Carbohydrate and fiber intake were suboptimal and most participants exhibited low or mediocre adherence to the Mediterranean diet prototype. It appears that despite the optimal adherence to the energy and fat recommendations, there is still room for improvement concerning diet quality and fiber intake.
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Affiliation(s)
- Dimitrios Poulimeneas
- Department of Public Health Policy, School of Public Health, University of West Attica, 196, Alexandras Avenue, GR-11521 Athens, Greece;
- Department of Nutrition and Dietetics, Harokopio University, E. Venizelou 70, GR-17671 Athens, Greece
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57001 Thessaloniki, Greece; (M.G.G.); (P.D.)
| | - Panagiota Devetzi
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57001 Thessaloniki, Greece; (M.G.G.); (P.D.)
- Faculty of Biotechnology, Universidade Católica Portuguesa, Rua de Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Argyri Petrocheilou
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
| | - Athanasios G. Kaditis
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece
- Correspondence: (T.P.); (T.V.)
| | - Stavros E. Doudounakis
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196, Alexandras Avenue, GR-11521 Athens, Greece;
- Correspondence: (T.P.); (T.V.)
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Robinson L, Maguire C, Hoo ZH, Wildman MJ. Making the invisible visible: the availability and desirability of adherence data in routine CF care- findings from a national questionnaire survey. F1000Res 2019; 8:1904. [PMID: 32051757 PMCID: PMC6996524 DOI: 10.12688/f1000research.21033.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Inhaled medications for cystic fibrosis (CF) are effective but adherence is low. Clinicians find it difficult to estimate how much treatment people with CF (PWCF) take, whilst objective adherence measurement demonstrates that patients are poorly calibrated with a tendency to over-estimate actual adherence. The diagnostic approach to a PWCF with deteriorating clinical status and very low adherence is likely to be different to the approach to a deteriorating patient with optimal adherence. Access to objective adherence data in routine consultations could help to overcome diagnostic challenges for clinicians and people with CF. Attitudes of clinicians to the use and importance of routinely available adherence data is unknown. Methods: We conducted an online questionnaire survey with UK CF centres. We asked five questions relating to the current use and perception of objective measurements of adherence in routine care. Results: A total of eight CF centres completed the questionnaire. Few of the responding centres have adherence data readily available in routine clinics (13% of centres use medicines possession ratio; of centres with access to I-nebs® it was estimated that 17% of patients had I-neb data regularly available in clinics). All centres considered the availability of objectively measured adherence data to be important. Respondents identified that systems developed to provide adherence data in clinical practice must provide data to both clinicians and patients that is readily understood and easy to use. Conclusions: Centres perceived the availability of adherence data in routine care to be important but objective measures of adherence is rarely available at present.
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Affiliation(s)
- Louisa Robinson
- Clinical Trials Research Unit, University of Sheffield, Sheffield, South Yorkshire, S1 4DA, UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Sheffield, South Yorkshire, S1 4DA, UK
| | - Zhe Hui Hoo
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, S5 7AU, UK
- School of Health and Related Research, University of Sheffield, Sheffield, Yorkshire, S1 4DA, UK
| | - Martin J. Wildman
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, S5 7AU, UK
- School of Health and Related Research, University of Sheffield, Sheffield, Yorkshire, S1 4DA, UK
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