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Kelleher J, Durkin K, Fedele DA, Moffett K, Filigno SS, Lynn C, Everhart RS, Stark LJ, Duncan CL. Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement. J Pediatr Psychol 2024; 49:491-500. [PMID: 38752579 PMCID: PMC11258803 DOI: 10.1093/jpepsy/jsae034] [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: 11/01/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF. METHODS 37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence. RESULTS 43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant. CONCLUSIONS When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.
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Affiliation(s)
- Jennifer Kelleher
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Kristine Durkin
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Kathryn Moffett
- Department of Pediatrics, West Virginia University Health Sciences Center, Morgantown, WV, United States
| | - Stephanie S Filigno
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Courtney Lynn
- Pediatric Mental Health Institute, Children’s Hospital Colorado, Aurora, CO, United States
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori J Stark
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV, United States
- Department of Pediatrics, West Virginia University Health Sciences Center, Morgantown, WV, United States
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 7:CD013610. [PMID: 37462324 PMCID: PMC10353490 DOI: 10.1002/14651858.cd013610.pub2] [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] [Indexed: 07/20/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic disorder predominantly affecting the lungs and pancreas. Airway clearance techniques (ACTs) and exercise therapy are key components of physiotherapy, which is considered integral in managing CF; however, low adherence is well-documented. Poor physiotherapy adherence may lead to repeated respiratory infections, reduced exercise tolerance, breathlessness, reduced quality of life, malaise and reduced life expectancy, as well as increased use of pharmacology, healthcare access and hospital admission. Therefore, evidence-based strategies to inform clinical practice and improve adherence to physiotherapy may improve quality of life and reduce treatment burden. OBJECTIVES To assess the effects of interventions to enhance adherence to airway clearance treatment and exercise therapy in people with CF and their effects on health outcomes, such as pulmonary exacerbations, exercise capacity and health-related quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 1 March 2023. We also searched online trials registries and the reference lists of relevant articles and reviews. Date of last search: 28 March 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of parallel design assessing any intervention aimed at enhancing adherence to physiotherapy in people with CF versus no intervention, another intervention or usual care. DATA COLLECTION AND ANALYSIS Two review authors independently checked search results for eligible studies and independently extracted data. We used standard procedures recommended by Cochrane and assessed the certainty of evidence using the GRADE system. MAIN RESULTS Two RCTs (77 participants with CF; age range 2 to 20 years; 44 (57%) males) met the inclusion criteria of this review. One study employed an intervention to improve adherence to exercise and the second an intervention to improve adherence to ACT. Both studies measured outcomes at baseline and at three months, but neither study formally assessed our primary outcome of adherence in terms of our planned outcome measures, and results were dependent on self-reported data. Adherence to ACTs One RCT (43 participants) assessed using specifically-composed music alongside ACTs compared to self-selected or no music (usual care). The ACT process consisted of nebuliser inhalation treatment, ACTs and relaxation or antibiotic nebuliser treatment. We graded all evidence as very low certainty. This study reported adherence to ACTs using the Morisky-Green questionnaire and also participants' perception of treatment time and enjoyment, which may influence adherence (outcome not reported specifically in this review). We are uncertain whether participants who received specifically-composed music may be more likely to adhere at six and 12 weeks compared to those who received usual care, risk ratio (RR) 1.75 (95% confidence interval (CI) 1.07 to 2.86) and RR 1.56 (95% CI 1.01 to 2.40) respectively. There may not be any difference in adherence when comparing specifically-composed music to self-selected music at six weeks, RR 1.21 (95% CI 0.87 to 1.68) or 12 weeks, RR 1.52 (95% CI 0.97 to 2.38); or self-selected music to usual care at six weeks, RR 1.44 (95% CI 0.82 to 2.52) or 12 weeks, RR 1.03 (95% CI 0.57 to 1.86). The music study also reported the number of respiratory infections requiring hospitalisation at 12 weeks, with no difference seen in the risk of hospitalisation between all groups. Adherence to exercise One RCT (24 participants) compared the provision of a manual of aerobic exercises, recommended exercise prescription plus two-weekly follow-up phone calls to reinforce exercise practice over a period of three months to verbal instructions for aerobic exercise according to the CF centre's protocol. We graded all evidence as very low certainty. We are uncertain whether an educational intervention leads to more participants in the intervention group undertaking increased regular physical activity at three months (self-report), RR 3.67 (95% CI 1.24 to 10.85), and there was no reported difference between groups in the number undertaking physical activity three times per week or undertaking at least 40 minutes of physical activity. No effect was seen on secondary outcome measures of spirometry, exercise capacity or any CF quality of life domains. This study did not report on the frequency of respiratory infections (hospitalised or not) or adverse events. AUTHORS' CONCLUSIONS We are uncertain whether a music-based motivational intervention may increase adherence to ACTs or affect the risk of hospitalisation for a respiratory infection. We are also uncertain whether an educational intervention increases adherence to exercise or reduces the frequency of respiratory infection-related hospital admission. However, these results are largely based on self-reported data and the impact of strategies to improve adherence to ACT and exercise in children and adolescents with stable CF remains inconclusive. Given that adherence to ACT and exercise therapy are fundamental to the clinical management of people with CF, there is an urgent need for well-designed, large-scale clinical trials in this area, which should conform to the CONSORT statement for standards of reporting and use appropriate, validated outcome measures. Studies should also ensure full disclosure of data for all important clinical outcomes.
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Affiliation(s)
- Mandy Jones
- c/o Cochrane Cystic Fibrosis, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alex Harvey
- School of Health Sciences and Social Care, Brunel University London, Uxbridge, UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Dawson S, Girling CJ, Cowap L, Clark-Carter D. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 3:CD013766. [PMID: 36989170 PMCID: PMC10054300 DOI: 10.1002/14651858.cd013766.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Adherence to treatment, including inhaled therapies, is low in people with cystic fibrosis (CF). Although psychological interventions for improving adherence to inhaled therapies in people with CF have been developed, no previous published systematic review has evaluated the evidence for efficacy of these interventions. OBJECTIVES The primary objective of the review was to assess the efficacy of psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (CF). The secondary objective was to establish the most effective components, or behaviour change techniques (BCTs), used in these interventions. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, which is compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched databases (PubMed; PsycINFO; EBSCO; Scopus; OpenGrey), trials registries (World Health Organization International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), and the reference lists of relevant articles and reviews, with no restrictions on language, year or publication status. Date of search: 7 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different types of psychological interventions for improving adherence to inhaled therapies in people with CF of any age, or comparing psychological interventions with usual care. We included quasi-RCTs if we could reasonably assume that the baseline characteristics were similar in both groups. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and completed data extraction, risk of bias assessments, and BCT coding (using the BCT Taxonomy v1) for all included trials. We resolved any discrepancies by discussion, or by consultation with a third review author as necessary. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 10 trials (1642 participants) in the review (children and adolescents in four trials; adults in five trials; and children and adults in one trial). Nine trials compared a psychological intervention with usual care; we could combine data from some of these in a number of quantitative analyses. One trial compared a psychological intervention with an active comparator (education plus problem-solving (EPS)). We identified five ongoing trials. Psychological interventions were generally multi-component and complex, containing an average of 9.6 BCTs (range 1 to 28). The two most commonly used BCTs included 'problem-solving' and 'instruction on how to perform the behaviour'. Interventions varied in their type, content and mode of delivery. They included a problem-solving intervention; a paper-based self-management workbook; a telehealth intervention; a group training programme; a digital intervention comprising medication reminders and lung function self-monitoring; a life-coaching intervention; a motivational interviewing (MI) intervention; a brief MI intervention (behaviour change counselling); and a digital intervention combined with behaviour change sessions. Intervention duration ranged from 10 weeks to 12 months. Assessment time points ranged from six to eight weeks up to 23 months. Psychological interventions compared with usual care We report data here for the 'over six months and up to 12 months' time point. We found that psychological interventions probably improve adherence to inhaled therapies (primary outcome) in people with CF compared with usual care (mean difference (MD) 9.5, 95% confidence interval (CI) 8.60 to 10.40; 1 study, 588 participants; moderate-certainty evidence). There was no evidence of a difference between groups in our second primary outcome, treatment-related adverse events: anxiety (MD 0.30, 95% CI -0.40 to 1.00; 1 study, 535 participants), or depression (MD -0.10, 95% CI -0.80 to 0.60; 1 study, 534 participants), although this was low-certainty evidence. For our secondary outcomes, there was no evidence of a difference between groups in terms of lung function (forced expiratory volume in one second (FEV1) % predicted MD 1.40, 95% CI -0.20 to 3.00; 1 study, 556 participants; moderate-certainty evidence); number of pulmonary exacerbations (adjusted rate ratio 0.96, 95% CI 0.83 to 1.11; 1 study, 607 participants; moderate-certainty evidence); or respiratory symptoms (MD 0.70, 95% CI -2.40 to 3.80; 1 study, 534 participants; low-certainty evidence). However, psychological interventions may improve treatment burden (MD 3.90, 95% CI 1.20 to 6.60; 1 study, 539 participants; low-certainty evidence). The overall certainty of the evidence ranged from low to moderate across these outcomes. Reasons for downgrading included indirectness (current evidence included adults only whereas our review question was broader and focused on people of any age) and lack of blinding of outcome assessors. Psychological interventions compared with an active comparator For this comparison the overall certainty of evidence was very low, based on one trial (n = 128) comparing an MI intervention to EPS for 12 months. We are uncertain whether an MI intervention, compared with EPS, improves adherence to inhaled therapies, lung function, or quality of life in people with CF, or whether there is an effect on pulmonary exacerbations. The included trial for this comparison did not report on treatment-related adverse events (anxiety and depression). We downgraded all reported outcomes due to small participant numbers, indirectness (trials included only adults), and unclear risk of bias (e.g. selection and attrition bias). AUTHORS' CONCLUSIONS Due to the limited quantity of trials included in this review, as well as the clinical and methodological heterogeneity, it was not possible to identify an overall intervention effect using meta-analysis. Some moderate-certainty evidence suggests that psychological interventions (compared with usual care) probably improve adherence to inhaled therapies in people with CF, without increasing treatment-related adverse events, anxiety and depression (low-certainty evidence). In future review updates (with ongoing trial results included), we hope to be able to establish the most effective BCTs (or 'active ingredients') of interventions for improving adherence to inhaled therapies in people with CF. Wherever possible, investigators should make use of the most objective measures of adherence available (e.g. data-logging nebulisers) to accurately determine intervention effects. Outcome reporting needs to be improved to enable combining or separation of measures as appropriate. Likewise, trial reporting needs to include details of intervention content (e.g. BCTs used); duration; intensity; and fidelity. Large trials with a longer follow-up period (e.g. 12 months) are needed in children with CF. Additionally, more research is needed to determine how to support adherence in 'under-served' CF populations.
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Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Innovation Centre, Sheffield, UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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McGrady ME, Ketterl TG, Norris RE, Perentesis JP, Pettee D, Mara CA, Breen G, Pai ALH. Barriers to medication adherence among adolescents and young adults with cancer. Pediatr Blood Cancer 2023; 70:e30186. [PMID: 36602026 DOI: 10.1002/pbc.30186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Adherence promotion is a critical component of adolescent and young adult (AYA) cancer care, but predictors of nonadherence that could be targeted in intervention efforts remain largely unknown. The purpose of this multi-site longitudinal observational study was to examine the relationship between barriers and medication adherence among AYAs with cancer. PROCEDURE Sixty-five AYAs (ages 15-24 years; mean age = 18.97 years, SD = 2.51; Mmean time since diagnosis = 1.42 years, SD = 1.95) with newly diagnosed or relapsed cancer completed self-report measures of barriers and adherence at quarterly study visits and used an electronic adherence monitoring device for 12 months. Longitudinal mixed effects models were used to examine our primary hypothesis that greater barriers are related to lower adherence over time. Descriptive statistics were used to explore our secondary aim of describing the frequency and patterns of barriers endorsed by AYAs with cancer. RESULTS After controlling for covariates (time, medication type, race, ethnicity, diagnosis, time since diagnosis), a greater number of barriers was associated with lower electronically monitored (β = -5.99, p = .005) and self-reported (β = -1.92, p < .001) adherence. The specific barriers endorsed by AYAs differed across participants, and the majority of AYAs endorsed an entirely different pattern of barriers than any other AYA in the study. CONCLUSION Barriers are associated with nonadherence and may be a promising target for intervention. Individual variability across barriers, however, suggests that tailoring may be necessary, and a promising next step is to explore personalized approaches to adherence promotion.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John P Perentesis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Pettee
- Division of Pediatric Hematology Oncology, Akron Children's Hospital, Akron, Ohio, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gabriella Breen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Dimenäs SL, Östberg A, Lundin M, Lundgren J, Abrahamsson KH. Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study. Int J Dent Hyg 2022; 20:609-619. [PMID: 35925040 PMCID: PMC9804348 DOI: 10.1111/idh.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/16/2022] [Accepted: 07/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Adequate oral hygiene, that is self-performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person-centred, theory-based, oral health education program for improved oral hygiene. METHODS Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person-centred education program in a preceding clinical field study (ClinicalTrials.gov NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio-demographic profiles within Region Västra Götaland, Sweden. Interviews were audio-taped, transcribed verbatim and analysed with qualitative content analysis. RESULTS A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person-centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. CONCLUSIONS The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions.
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Affiliation(s)
- Sandra L. Dimenäs
- Department of Periodontology, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Anna‐Lena Östberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mona Lundin
- Department of Education, Communication and Learning, Faculty of EducationUniversity of GothenburgGothenburgSweden
| | - Jesper Lundgren
- Department of Psychology, Faculty of Social SciencesUniversity of GothenburgGothenburgSweden
| | - Kajsa H. Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
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Rowbotham NJ, Daniels TE. Airway clearance and exercise for people with cystic fibrosis: Balancing longevity with life. Pediatr Pulmonol 2022; 57 Suppl 1:S50-S59. [PMID: 34672434 DOI: 10.1002/ppul.25734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/05/2022]
Abstract
Airway clearance has been an integral part of cystic fibrosis (CF) care for almost as long as CF has been identified as a condition. From diagnosis as a neonate through to end-of-life care, airway clearance is an everyday aspect of life, adding a considerable treatment burden to the lives of people with CF. There are many different techniques used for airway clearance which have evolved over time with an aim to improve effectiveness, support adherence and, more recently, to consider the impact of burden. A popular thought is whether airway clearance could be replaced by exercise. With new precision therapies in the form of CFTR modulators available, the CF landscape is rapidly changing, raising the question of whether certain treatments are needed at all. Depending on factors such as CFTR mutation, age, and pre-existing lung damage before starting a CFTR modulator, individuals with CF may need different levels of intensity and type of maintenance treatment. Precision medicine is likely to lead to the need for increased precision and individualized management around other maintenance therapies such as airway clearance.
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Affiliation(s)
- Nicola J Rowbotham
- Evidence Based Child Health Group, University of Nottingham, Nottingham, UK
| | - Tracey E Daniels
- York Hull Adult Cystic Fibrosis Centre, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.,School of Science, Technology and Health, York St John University, York, UK
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Richards B, Osborne SR, Simons M. Introducing a MAP for adherence care in the paediatric cystic fibrosis clinic: a multiple methods implementation study. BMC Health Serv Res 2022; 22:109. [PMID: 35078462 PMCID: PMC8790869 DOI: 10.1186/s12913-021-07373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with cystic fibrosis are required to adhere to a burdensome daily treatment regimen. Comprehensive adherence protocols can support more consistent use of adherence interventions and improve treatment adherence rates. This study aimed to explore the feasibility, acceptability, and appropriateness of implementing an adherence protocol into the outpatient cystic fibrosis clinic of a tertiary, paediatric hospital. METHODS This implementation study employed a pre-post observation design, using multiple methods. Focus groups and semi-structured interviews were conducted pre-implementation to understand clinician and consumer perspectives on adherence care. A multicomponent adherence protocol (including multidisciplinary written treatment plans, digital mental health screening and customised communication tools) was then implemented as standard care for a three-month implementation phase. Quantitative data was collected throughout using purpose-designed audit tools and surveys. The Replicating Effective Practice (REP) Framework guided the implementation process. Analysis was informed by The Consolidated Framework for Implementation Research (CFIR) to identify factors that support or challenge the integration of adherence protocols into standard care. RESULTS Thirteen clinicians, eight parents and two adolescents participated in focus groups or interviews that informed development of the tailored multicomponent adherence protocol for implementation. Medical chart audits demonstrated that the protocol was used with 44-57% of eligible consumers three months after introduction. Eighteen clinicians and five consumers participated in post-implementation phase questionnaires. The protocol was considered acceptable and appropriate to clinicians and consumers. Changes in clinicians' practice behaviour were short-lived peaks in response to targeted intervention strategies throughout the implementation phase, such as audit and feedback. CONCLUSIONS An adherence protocol is not an "off the shelf" solution to the adherence challenge in a hospital outpatient setting. Despite the tailored adherence protocol being considered appropriate and acceptable to clinicians and consumers, low fidelity indicates limited feasibility in the outpatient clinic setting, where multi-disciplinary members are all considered responsible for adherence care interventions. Key implementation factors and strategies to consider prior to introducing an adherence protocol are described. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12619001730190 (Retrospectively registered).
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Affiliation(s)
- Bianca Richards
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland, 4101, Australia
| | - Sonya R Osborne
- School of Nursing and Midwifery, Faculty of Health, Engineering, and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, 11 Salisbury Road, Ipswich, Queensland, 4305, Australia.
- Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia.
| | - Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland, 4101, Australia
- Centre for Children's Burns and Trauma Research, The University of Queensland, Child Health Research Centre, 62 Graham Street, South Brisbane, Queensland, 4101, Australia
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Lumley E, Drabble SJ, Scott A, Wildman MJ, O’Cathain A. Objective Nebuliser Adherence Data as "Proof" of Adherence in the Management of Cystic Fibrosis: A Qualitative Interview Study. Patient Prefer Adherence 2022; 16:771-780. [PMID: 35370406 PMCID: PMC8965329 DOI: 10.2147/ppa.s353434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Low adherence to medication via nebulisers is linked to poor clinical outcomes for people with Cystic Fibrosis (PWCF). Advances in technology allow electronic monitoring of nebuliser usage and feedback of objective adherence data to PWCF and clinical teams caring for them. CFHealthHub is a new intervention that collects and displays objective adherence data in easy-to-read formats with the aim of improving nebuliser adherence and health. There is little understanding of how objective adherence data is perceived by PWCF and healthcare professionals (HCPs). PATIENTS AND METHODS A qualitative study using semi-structured interviews with 22 PWCF and 31 HCPs who had used the CFHealthHub intervention. RESULTS Objective adherence data was welcomed by the majority of PWCF in the sample, and HCP delivering the intervention, because the data allowed PWCF to reflect on patterns of adherence or non-adherence. Ease of use and characteristics of data display were important, particularly the use of a "traffic light" system to allow PWCF to easily see if they were meeting their adherence targets. For PWCF objective adherence data was used as "proof to self", offering reassurance to high adherers, and a wake-up call to those with lower levels of adherence. It could also provide 'proof to others' where PWCF had higher levels of adherence than HCP or family members believed. The data could sometimes change HCP perceptions of PWCF's identities as poor adherers. Where adherence was not high, data was used to facilitate honest discussions between PWCF and HCPs about how to increase adherence. HCPs perceived that it was important to use the data positively to motivate, rather than criticise, PWCF. CONCLUSION Objective nebuliser adherence data in CFHealthHub can offer proof of adherence to PWCF and HCPs. It is important to use it constructively to facilitate discussions on how to improve adherence.
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Affiliation(s)
- Elizabeth Lumley
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
- Correspondence: Elizabeth Lumley, Health and Care Research Unit, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK, Tel +44 114 2224294, Email
| | - Sarah J Drabble
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Scott
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alicia O’Cathain
- Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Zobell JT, Moss J, Heuser SM, Asfour F. Impact of pharmacy technicians as part of an integrated health-system pharmacy team on improvement of medication access in the care of cystic fibrosis patients. Pediatr Pulmonol 2020; 55:3351-3357. [PMID: 32876997 DOI: 10.1002/ppul.25050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease requiring patients to take multiple medications per day. Multiple barriers exist affecting access and adherence. Studies have demonstrated the positive outcomes of pharmacist involvement in CF care. The purpose of this study is to characterize the impact of pharmacy technicians on medication access in the care of CF patients. METHODS A retrospective review and analysis of patient medication profiles for patients followed by the integrated pharmacy care process model was performed. Two electronic prescription pathways with pharmacy technician involvement were analyzed. One pathway using a specialty pharmacy CF pharmacy technician (SP technician) examined CF specialty medication delivery times. The other pathway examined the impact of the clinic-based CF pharmacy technician (CB technician) on the number of filling pharmacies for patients. RESULTS One-hundred and fifty-three patients met inclusion criteria in the CF specialty medication delivery analysis, and 56 patients met inclusion criteria filling pharmacy analysis. The median delivery time for dornase alfa decreased from 8 days to 3 days, p < .00001. The number of patients utilizing one filling pharmacy increased from 8 (14%) to 21 (38%) (p = .005); and utilizing three filling pharmacies decreased from 14 (25%) to 1 (2%) (p = .003). CONCLUSION The study demonstrated that pharmacy technicians as part of an integrated health-system pharmacy care process model improve medication access in the care of CF patients.
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Affiliation(s)
- Jeffery T Zobell
- Pharmacy Department, Intermountain Primary Children, Salt Lake City, Utah, USA.,Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Justin Moss
- Pharmacy Department, Intermountain Primary Children, Salt Lake City, Utah, USA.,Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA
| | - Stephanie M Heuser
- Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Pharmacy Department, Intermountain Specialty Pharmacy, Taylorsville, Utah, USA
| | - Fadi Asfour
- Intermountain Healthcare, Primary Children's Cystic Fibrosis Center, Salt Lake City, Utah, USA.,Pediatric Pulmonology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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10
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Dawson S, Cowap L, Clark-Carter D, Girling CJ. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Life Sciences & Education; Staffordshire University; Stoke-on-Trent UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR; University of Sheffield, Innovation Centre; Sheffield UK
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11
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Drabble SJ, O'Cathain A, Scott AJ, Arden MA, Keating S, Hutchings M, Maguire C, Wildman M. Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study. J Med Internet Res 2020; 22:e16782. [PMID: 32697197 PMCID: PMC7576463 DOI: 10.2196/16782] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/14/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Adherence to nebulizer treatments in adults with cystic fibrosis (CF) is often low. A new complex intervention to help adults with CF increase their adherence to nebulizer treatments was tested in a pilot randomized controlled trial (RCT) in 2 UK CF centers. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time and to a tailored website to display graphs of adherence data and educational and problem-solving information about adherence. A trained interventionist helped patients identify ways to increase their adherence. Objective This study aims to explore the mechanisms of action underpinning the intervention. Methods A qualitative interview study was conducted concurrently with a pilot RCT. In total, 25 semistructured interviews were conducted with 3 interventionists at 2 time points, 14 patients in the intervention arm of the trial, and 5 members of the multidisciplinary teams offering wider care to patients. A framework approach was used for the analysis. Results The intervention was informed by a theoretical framework of behavior change. There was evidence of the expected behavior change mechanisms of action. There was also evidence of additional mechanisms of action associated with effective telehealth interventions for self-management support: relationships, visibility, and fit. Patients described how building a relationship with the interventionist through face-to-face visits with someone who cared about them and their progress helped them to consider ways of increasing adherence to medication. Rather than seeing the visibility of adherence data to clinicians as problematic, patients found this motivating, particularly if they received praise about progress made. The intervention was tailored to individuals, but there were challenges in how the intervention fitted into some patients’ busy lives when delivered through a desktop computer. Conclusions The mechanisms of action associated with effective telehealth interventions for self-management operated within this new intervention. The intervention was modified to strengthen mechanisms of action based on these findings, for example, delivery through an app accessed via mobile phones and then tested in an RCT in 19 UK CF centers. Trial Registration International Standard Randomized Controlled Trial Number 13076797; http://www.isrctn.com/ISRCTN13076797
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Affiliation(s)
- Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alexander J Scott
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Samuel Keating
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Marlene Hutchings
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Chin Maguire
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Martin Wildman
- Sheffield Adult CF Centre, Sheffield Teaching Hospitals, Sheffield, United Kingdom
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12
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Jones M, Moffatt F, Harvey A, Ryan JM. Interventions for improving adherence to airway clearance treatment and exercise in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mandy Jones
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Fiona Moffatt
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - Alex Harvey
- School of Health Sciences and Social Care; Brunel University; Uxbridge UK
| | - Jennifer M Ryan
- Institute of Environment, Health and Societies; Brunel University London; Uxbridge UK
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13
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Dixon E, Puckey M, Collins N, Marsh G, Pabary R. Striving for perfection, accepting the reality: A reflection on adherence to airway clearance and inhalation therapy for paediatric patients with chronic suppurative lung disease. Paediatr Respir Rev 2020; 34:46-52. [PMID: 31130423 DOI: 10.1016/j.prrv.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
Non-adherence to prescribed treatment is considered the foremost cause of treatment failure in chronic medical conditions. Airway clearance techniques (ACT) play a key role in the management of chronic suppurative lung disease yet, along with inhaled therapies such as nebulised antibiotics, adherence to these is often lower than to other treatments. In this review we discuss methods of monitoring adherence to these therapies and potential barriers and outline suggestions for improving adherence in the paediatric population.
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Affiliation(s)
- Emma Dixon
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Michele Puckey
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Nicola Collins
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Gemma Marsh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Rishi Pabary
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom.
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14
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Martin R, Arden M, Porritt J, Wildman M, Naughton F. Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations. Healthcare (Basel) 2020; 8:healthcare8010022. [PMID: 31972991 PMCID: PMC7151352 DOI: 10.3390/healthcare8010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF.
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Affiliation(s)
- Rosie Martin
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
- Correspondence:
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | - Jenny Porritt
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
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15
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Zupanič MV, Škerjanc A. Cystic fibrosis and career counselling. Cent Eur J Public Health 2020; 27:279-284. [PMID: 31951686 DOI: 10.21101/cejph.a5634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cystic fibrosis is a genetic disorder that affects mostly lungs but also other organs. Modern treatment has transformed once fatal disease of childhood into the chronic disease of adulthood. Hence more patients enter the job market. Very few adolescents with cystic fibrosis receive some formal career guidance. There is still no professional career guidance for them in Slovenia. METHODS Literature on workability of patients with cystic fibrosis was reviewed. Following the articles and Slovenian and foreign manuals the guidelines on career counselling of young patients with cystic fibrosis is proposed, as well as the suggestions for professional qualification of these patients. RESULTS The results of the studies present that workability of patients with cystic fibrosis is associated to forced expiratory volume in 1 second (FEV1) (p < 0.05), the achieved educational level more than 3 years of faculty study (p < 0.001-p < 0.013), self-assessment of quality of life (p = 0.005), age (p = 0.01), and the number of admissions to the hospital (p = 0.001). CONCLUSIONS The interactions among work, quality of life and survival require that healthcare workers strive to help their patients with cystic fibrosis to succeed in their professional lives. The young patients should achieve the highest level of education possible and follow their wishes in line with the realistic possibilities.
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Affiliation(s)
- Marija Vita Zupanič
- University Medical Centre Maribor, Department of Ophthalmology, Maribor, Slovenia
| | - Alenka Škerjanc
- University Medical Centre Ljubljana, Clinical Institute for Occupational, Traffic and Sports Medicine, Ljubljana, Slovenia
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16
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Bell SC, Mall MA, Gutierrez H, Macek M, Madge S, Davies JC, Burgel PR, Tullis E, Castaños C, Castellani C, Byrnes CA, Cathcart F, Chotirmall SH, Cosgriff R, Eichler I, Fajac I, Goss CH, Drevinek P, Farrell PM, Gravelle AM, Havermans T, Mayer-Hamblett N, Kashirskaya N, Kerem E, Mathew JL, McKone EF, Naehrlich L, Nasr SZ, Oates GR, O'Neill C, Pypops U, Raraigh KS, Rowe SM, Southern KW, Sivam S, Stephenson AL, Zampoli M, Ratjen F. The future of cystic fibrosis care: a global perspective. THE LANCET RESPIRATORY MEDICINE 2020; 8:65-124. [DOI: 10.1016/s2213-2600(19)30337-6] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
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17
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Drabble SJ, O’Cathain A, Arden MA, Hutchings M, Beever D, Wildman M. When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments. QUALITATIVE HEALTH RESEARCH 2019; 29:2119-2131. [PMID: 31303116 PMCID: PMC7322938 DOI: 10.1177/1049732319856580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.
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Affiliation(s)
| | | | | | | | - Daniel Beever
- The University of Sheffield, Sheffield,
United Kingdom
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18
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Smaldone A, Manwani D, Green NS. Greater number of perceived barriers to hydroxyurea associated with poorer health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27740. [PMID: 30941907 PMCID: PMC6538386 DOI: 10.1002/pbc.27740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite medical benefits, hydroxyurea adherence in adolescents is often poor. As part of a baseline assessment of 28 youth (10-18 years) parent dyads who participated in a 6-month feasibility trial to improve hydroxyurea adherence, we measured the relationship between greater barriers to adherence and health-related quality of life (HRQL) from youth and parent perspectives. PROCEDURE Barriers were measured using the Adolescent and Parent Medication Barriers Scales with nine hydroxyurea items added. Barriers reported by ≥25% of the sample were considered common. Generic and disease-specific HRQL were measured by PedsQL and PedsQL Sickle Cell Disease modules. Data were analyzed using descriptive statistics, Cronbach alpha, Spearman correlation coefficients, and paired t tests. RESULTS Fifty-six subjects (28 dyads) participated. Youth reported greater barriers compared with parents (5.0 ± 3.9 and 3.5 ± 3.2; P = 0.03), with >80% of respondents reporting ≥1 barriers. Twelve barriers were reported by ≥25% of adolescents, whereas six were reported by ≥25% of parents. Of these, only two were common to both dyad members. Approximately one-third of youth had generic and disease-specific HRQL scores that fell at or below cutoff scores, suggesting being at risk for impaired HRQL. Greater barriers were inversely associated with poorer generic (parent r = -0.43, P = 0.03; youth r = -0.44, P < 0.001) and disease-specific HRQL (parent r = -0.53, P = 0.005; youth r = -0.53, P < 0.001). CONCLUSIONS Hydroxyurea barriers were frequently reported but differed by dyad members' perspective. Greater barriers were associated with poorer generic and disease-specific HRQL. To reduce barriers to hydroxyurea in youth with sickle cell disease, perspectives of both dyad members should be addressed.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, New York
- College of Dental Medicine, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
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19
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Adherence to Treatment and Follow-Up in Patients with Severe Chemical Eye Burns. Ophthalmol Ther 2019; 8:251-259. [PMID: 30868417 PMCID: PMC6514011 DOI: 10.1007/s40123-019-0173-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION To investigate the demographics, acute management and compliance rates of severe chemical eye burn cases that presented to the largest eye hospital in the United Kingdom (UK). METHODS All patients presenting to the Moorfields Eye Hospital emergency department are registered on the electronic patient administration system (PAS). A search of the PAS for patients assigned a preset diagnosis of 'chemical injury' was performed for the period from 1 January to 31 March 2016. The results of the PAS search and handwritten clerking notes were reviewed. Eyes that were found to have ≥ 33% limbal ischaemia or limbal staining, or corneal haze that obscured the details of the iris, were recorded as having severe chemical injuries. RESULTS 55 patients had mild chemical eye burns, and 11 eyes of 10 patients had severe burns. Average patient age was 37 years (SD 22 years) and 22 years (SD 10 years) for mild and severe chemical injuries, respectively. 53% of the mild injuries and 90% of the severe injuries were in males. 7 (70%) of the 10 severe injuries were assault-related. In the severe chemical injuries group, first presentation to the emergency department was 24 h or more postinjury in 50% of the patients, 33% stopped ascorbate and citrate drops (ocular pain), 40% stopped attending clinical follow-up sessions, and 45% of the eyes had a final best corrected visual acuity (BCVA) of 6/18 or worse. CONCLUSION A significant proportion of the severe ocular chemical burns were assault-related. Delayed presentation and poor treatment adherence and follow-up attendance rates are significant challenges in patients with severe chemical burns. Patient education and public health awareness are important strategies. These findings also raise the question of whether these patients, who are mostly young males, should be admitted to improve treatment adherence rates and visual outcome.
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20
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Aston J, Wilson KA, Terry DRP. The treatment-related experiences of parents, children and young people with regular prescribed medication. Int J Clin Pharm 2018; 41:113-121. [PMID: 30478490 PMCID: PMC6394506 DOI: 10.1007/s11096-018-0756-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/15/2018] [Indexed: 01/20/2023]
Abstract
Background Taking regular medication has been shown to have an impact on the daily lives of patients and their families. Objective To explore the medication-related experiences of patients and their families when a child or young person is prescribed regular medication. Setting A specialist U.K. paediatric hospital. Method Semi-structured face-to-face interviews of 24 parents/carers, children or young people, who had been taking two or more medications for 6 weeks or longer. The themes explored included the medication regimen, formulation, supplies, social aspects and adverse effects. The data was analysed using NVIVO version 11. Main outcome measure The experiences of patients, and their parents/carers, when a child/young person takes regular medication. Results Participants described a range of experiences associated with taking regular medication. Medication-related challenges were experienced around the timing of administration which was managed over 24 h rather than waking hours. Updating medication doses for administration at school was often delayed. Unintended nonadherence was cited as the biggest challenge with a range of strategies employed to manage this. The internet was commonly used as a source of additional information accessed for reassurance and adverse effects but there were varying experiences of using patient forums/help groups. Other challenges included the adequacy of information, travelling with medication, formulation issues, arranging supplies and adverse effects. Conclusion Patients and parents experience many challenges with children’s medication. Individualised treatment options should be considered. Further research is required to determine how these experiences may be managed including the role of paediatric medication review.
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Affiliation(s)
- Jeff Aston
- Aston Pharmacy School, Aston University, Birmingham, UK. .,Pharmacy Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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21
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Abstract
GOALS This study aimed to investigate follow-up patterns among celiac disease (CD) patients. BACKGROUND Gender factors are important in CD with women diagnosed more frequently than men despite equal seropositivity in screening studies. To determine if gender influences postdiagnosis care, we performed a retrospective cohort study investigating the impact of gender and mode of presentation on follow-up patterns after diagnosis. STUDY The study included adults with biopsy-proven CD presenting to a single tertiary care center between 2005 and 2014. The primary exposure was at least 1 visit with a CD specialist. The primary outcome was ≥2 follow-up visits, including office visits and endoscopic procedures. Data extracted included whether patients had tissue transglutaminase antibodies performed by our laboratory. RESULTS We analyzed 708 patients of which 70.5% were female. Follow-up was good with a majority of patients (69%) having at least 1 follow-up visit. On bivariate analysis, patients least likely to follow-up were ages 18 to 29 (P=0.03) and women with atypical presentations (P=0.003). After adjusting for potential confounders, individuals over age 65 were significantly more likely to attend at least 2 follow-up visits (odds ratio, 2.07; 95% confidence interval, 1.21-3.55; P=0.0079). Individuals with an abnormal baseline tissue transglutaminase antibody value in our laboratory were significantly more likely to follow-up (odds ratio, 1.99; 95% confidence interval, 1.39-2.85; P=0.0002). CONCLUSIONS Gender had no impact on follow-up patterns despite prior studies demonstrating an impact on diagnosis rates. Future attention should focus on retaining young patients and those with atypical modes of presentation.
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22
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Abstract
Cystic fibrosis (CF) is an inherited incurable multi-organ disease. Improvement in treatment approaches over the last 20 years have led to an increased life expectancy where the number of adult patients has doubled and will continue to increase exponentially. Due to the use of new substances which modulate the basic defect, a substantial improvement in the prognosis can be assumed but the existing healthcare structures in Germany do not meet these rising needs. With more than 50% of patients being adults, there are only very few internal medicine centers available. Only approximately one third of the patients are treated in adult health centers. Adolescence in particular is a very vulnerable phase of the disease, the risk of comorbidities is increased and adherence to the very laborious treatment recommendations is as a rule low. While in many other countries transition programs have been evaluated and implemented for more than 20 years, in Germany there have only been rudimentary approaches to transition. Meanwhile investigations are available on the perceptions of adolescents with respect to coping with the disease and their treatment needs, including the perception of the time when the transition process should begin. Successful transition seems to be performed best in combined pediatric and adult centers, with the back-up of an experienced multidisciplinary team of healthcare providers.
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Affiliation(s)
- D Staab
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - C Schwarz
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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23
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Sims-Gould J, Race DL, Macdonald H, Houghton KM, Duffy CM, Tucker LB, McKay HA. "I just want to get better": experiences of children and youth with juvenile idiopathic arthritis in a home-based exercise intervention. Pediatr Rheumatol Online J 2018; 16:59. [PMID: 30236145 PMCID: PMC6148995 DOI: 10.1186/s12969-018-0273-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Physical activity is essential for ensuring optimal physical function and fitness in children with juvenile idiopathic arthritis (JIA). Although exercise intervention trials informed current clinical practice, few studies addressed why children with JIA do or do not participate in exercise interventions. We aimed to describe perceived barriers and facilitators to the uptake and adherence to a 6-month home-based exercise intervention for children diagnosed with JIA and their parents. METHODS A convenience sample of children (n = 17) and their parents (n = 17) were recruited from a group of 23 child-parent dyads participating in an exercise intervention study; the Linking Exercise, Activity and Pathophysiology Exercise Intervention (LEAP-EI) study. Child-parent dyads completed in-depth semi-structured one-to-one interviews with a trained interview moderator prior to starting the exercise program and 11 dyads completed follow-up interviews at the end of the 6-month program. We also conducted 'exit' interviews with one child-parent dyad, one child and one parent following three participants' withdrawal from the exercise intervention. Interviews were transcribed and transcripts were analyzed using a five-step framework analysis to categorize data into themes. RESULTS Thematic analysis of pre-exercise program interview transcripts revealed three reasons child-parent dyads initiated the exercise program: 1) potential health benefits, 2) selflessness and 3) parental support. Analysis of post-exercise intervention transcripts identified four main themes within a priori themes of barriers and facilitators to program adherence (median of 46.9%; 5.4, 66.7 IQR): 1) parental support, 2) enjoyment, 3) time pressures (subthemes: time requirement of exercise, scheduling, forgetting) and 4) physical ailments. CONCLUSION Major barriers to and facilitators to exercise for children with JIA fell into three categories: personal, social and programmatic factors. These barriers were not unlike those that emerged in previous exercise intervention trials with healthy children and youth. There is a need to develop effective strategies to engage children in physical activity and to overcome barriers that prevent them from doing so. Future initiatives may potentially engage children in developing solutions to enhance their participation in and commitment to physical activity.
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Affiliation(s)
- Joanie Sims-Gould
- University of British Columbia, Vancouver, Canada
- Centre for Hip Health and Mobility, 2635 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | | | | | - Kristin M. Houghton
- University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital, Vancouver, Canada
| | - Ciarán M. Duffy
- University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Canada
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24
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Jakubowska-Winecka A, Biernacka M. Parental Attitudes and Medication Adherence in Groups of Adolescents After Liver and Kidney Transplantations. Transplant Proc 2018; 50:2145-2149. [PMID: 30177127 DOI: 10.1016/j.transproceed.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/13/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
The objective of the study was to determine the connection between parental attitudes and medication adherence and the selected aspects of treatment in groups of adolescents after kidney and liver transplantations, in comparison with adolescents with diabetes and inflammatory bowel disease. Attitudes were assessed using M. Plopa's Parental Attitudes Scale, which distinguishes 5 types of attitudes. Medication adherence was evaluated on the basis of the Morisky Medication Adherence Scale (MMAS-8), used with the author's consent. With the 4-item scale developed by the authors, the following aspects of treatment were assessed: the patient's level of knowledge about the disease, treatment effects, and physician's satisfaction with patient cooperation. In both groups of adolescents after transplantation, 2 types of parental attitudes were found to correlate with medication adherence: the Accepting Attitude and the Overly Protective Attitude. The results of other studied aspects varied in terms of gender, age, and chronic disease type.
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Affiliation(s)
- A Jakubowska-Winecka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
| | - M Biernacka
- Health Psychology Department, the Children's Memorial Health Institute, Warsaw, Poland.
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Kirkham HS, Staskon F, Hira N, McLane D, Kilgore KM, Parente A, Kim S, Sawicki GS. Outcome evaluation of a pharmacy-based therapy management program for patients with cystic fibrosis. Pediatr Pulmonol 2018; 53. [PMID: 29512893 PMCID: PMC6001460 DOI: 10.1002/ppul.23978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy-based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations. METHODS This retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014-5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls. RESULTS Of the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity-matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR = 1.23, P = 0.01) and were twice as likely to be adherent to tobramycin (PDC ≥ 80%) than matched controls (OR = 2.14, P = 0.04). Program patients had fewer ER visits (IRR = 0.52, P < 0.01) and slightly lower ER costs (IRR = 0.66, P = 0.06) than the control patients. CONCLUSION A pharmacy-based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.
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Affiliation(s)
| | | | - Nishita Hira
- AllianceRx Walgreens Prime, Pittsburgh, Pennsylvania
| | - Darren McLane
- AllianceRx Walgreens Prime, Pittsburgh, Pennsylvania
| | | | | | - Seung Kim
- Avalere Health-an Inovalon Company, Bowie, Maryland
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Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol 2018; 53:431-436. [PMID: 29457700 DOI: 10.1002/ppul.23950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Medication adherence among adolescents with cystic fibrosis (CF) is often suboptimal and this has significant impact on their health and quality of life. The purpose of the study was to evaluate the impact of frequent home pulmonary function (PFT) monitoring on medication adherence among adolescents with CF. HYPOTHESIS We hypothesized that weekly home PFT monitoring will improve adherence while not significantly adding to the treatment burden. METHODS Individuals aged 12-21 years with CF were provided a spirometer to measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT data were downloaded from the device during quarterly clinic visits. Adherence was calculated from prescription refill data and compared to the previous year. Perceptions of treatment burden were assessed using the CF questionnaire-revised (CFQ-R) quality of life measure. Health outcome measures including nutritional status and PFTs from clinic were collected for the study period and the year prior. RESULTS Thirty-nine subjects participated in the study. Mean age was 15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry monitoring was 59.47 ± 24.60%. Values generated on the device showed good correlation with those obtained in clinic. Mean medication possession ratio (MPR) was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion (P = 0.14). CONCLUSIONS Frequent home PFT monitoring is feasible in CF adolescents and could successfully improve medication adherence without significantly impacting treatment burden.
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Affiliation(s)
| | - Niko Kaciroti
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lauren Kasmikha
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
| | - Samya Z Nasr
- Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan
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A weekend/weekday comparison of adherence to daily treatment regimens in adults with cystic fibrosis. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.72331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zobell JT, Schwab E, Collingridge DS, Ball C, Nohavec R, Asfour F. Impact of pharmacy services on cystic fibrosis medication adherence. Pediatr Pulmonol 2017; 52:1006-1012. [PMID: 28608652 DOI: 10.1002/ppul.23743] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/07/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study is to characterize the impact of pharmacy services on medication adherence and hospitalizations for pediatric cystic fibrosis (CF) patients. METHODS A retrospective health insurance claims analysis and patient medical charts review from January 1, 2014 to December 31, 2016 of patients from the Pediatric Intermountain CF Center was performed. Adherence to dornase alfa and hospital admissions for pulmonary exacerbations pre and post the implementation of an integrated pharmacy team were reviewed. Dornase alfa adherence was measured by the medication possession ratio (MPR) both monthly and yearly. RESULTS Fifty-four patients met inclusion criteria. The mean dornase alfa yearly MPR improved from 0.75 (2014) to 0.92 (2016). Patients were 2.8 times more likely to be adherent to dornase alfa when followed by integrated pharmacy team model (P < 0.001), and 2.4 times more likely to be adherent when followed by a dedicated CF clinic pharmacist only (P = 0.001). CONCLUSION The study demonstrated that pharmacy services improved adherence to dornase alfa.
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Affiliation(s)
- Jeffery T Zobell
- Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.,Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah
| | | | | | | | | | - Fadi Asfour
- Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.,Pediatric Pulmonology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Hoo ZH, Boote J, Wildman MJ, Campbell MJ, Gardner B. Determinants of objective adherence to nebulised medications among adults with cystic fibrosis: an exploratory mixed methods study comparing low and high adherers. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2017.1338958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Z. H. Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - J. Boote
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Research into Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - M. J. Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - M. J. Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - B. Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
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White H, Shaw N, Denman S, Pollard K, Wynne S, Peckham DG. Variation in lung function as a marker of adherence to oral and inhaled medication in cystic fibrosis. Eur Respir J 2017; 49:49/3/1600987. [DOI: 10.1183/13993003.00987-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/05/2016] [Indexed: 11/05/2022]
Abstract
The aim of this study was to characterise adherence in an adult population with cystic fibrosis (CF) and to investigate if variation in lung function was a predictor of adherence to treatment.The adherence of patients aged ≥16 years from an adult CF centre was measured by medication possession ratio (MPR) and self-report. Patients were assigned to one of three adherence categories (<50%, 50 to <80%, ≥80%) by their composite score (MPR). Ordinal regression was used to identify predictors of adherence, including coefficient variation measures for forced expiratory volume in 1 s (FEV1), weight and C-reactive protein concentration, measured from 6 months and 12 months before baseline.MPR data for 106 of 249 patients (mean age 29.8±9.2 years) was retrieved, indicating a mean adherence of 63%. The coefficient of variation for FEV1 was inversely related to adherence and was a univariate predictor of adherence (6 months: OR 0.92, 95% CI 0.87–0.98, p=0.005; 12 months: OR 0.94, 95% CI 0.93–0.99, p=0.03) and remained significant in the final models. The coefficient of variation of weight and C-reactive protein were not predictive of adherence.The coefficient of variation of FEV1 was identified as an objective predictor of adherence. Further evaluation of this potential marker of adherence is now required.
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Shakkottai A, Nasr SZ. The Use of Home Spirometry in Pediatric Cystic Fibrosis Patients: Results of a Feasibility Study. Glob Pediatr Health 2017; 4:2333794X17690315. [PMID: 28229102 PMCID: PMC5308520 DOI: 10.1177/2333794x17690315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022] Open
Abstract
Medication adherence is poor among pediatric cystic fibrosis (CF) patients, with adolescents having one of the lowest adherence rates. We wanted to identify an adherence intervention that would be acceptable to CF adolescents and assess its feasibility. We surveyed 40 adolescents with CF and asked about barriers to and motivators for their own adherence and to generate ideas for potential adherence interventions. Since most of the respondents chose frequent spirometry at home and medication reminders for interventions, we selected 5 subjects, 10 to 14 years of age, with CF to test the feasibility of home spirometry and medication reminders in pediatric CF patients. This article summarizes the results of both the survey and the feasibility pilot study.
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Affiliation(s)
| | - Samya Z. Nasr
- University of Michigan Health System, Ann Arbor, MI, USA
- Samya Z. Nasr, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, 1500 E Medical Center Drive, SPC 5212, Ann Arbor, MI 48109-5212, USA.
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Narayanan S, Mainz JG, Gala S, Tabori H, Grossoehme D. Adherence to therapies in cystic fibrosis: a targeted literature review. Expert Rev Respir Med 2017; 11:129-145. [DOI: 10.1080/17476348.2017.1280399] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Jochen G. Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Smeet Gala
- Market Access Solutions LLC. (MKTXS), Raritan, NJ, USA
| | - Harold Tabori
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Jena, Germany
| | - Daniel Grossoehme
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Knudsen KB, Pressler T, Mortensen LH, Jarden M, Boisen KA, Skov M, Quittner AL, Katzenstein TL. Coach to cope: feasibility of a life coaching program for young adults with cystic fibrosis. Patient Prefer Adherence 2017; 11:1613-1623. [PMID: 29033550 PMCID: PMC5614776 DOI: 10.2147/ppa.s141267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Over the last two decades, lifespan has increased significantly for people living with cystic fibrosis (CF). However, several studies have demonstrated that many young adults with CF report mental health problems and poor adherence to their prescribed treatments, challenging their long-term physical health. Treatment guidelines recommend interventions to improve adherence and self-management. The aim of this study was to test the feasibility of a life coaching intervention for young adults with CF. METHODS A randomized, controlled feasibility study was conducted at the CF Center at Copenhagen University Hospital, Rigshospitalet. Participants were young adults with CF, aged 18-30 years without severe intellectual impairments. Participants were randomized to either life coaching or standard care. The intervention consisted of up to 10 individual, face-to-face or telephone coaching sessions over a period of 1 year. Primary outcomes were recruitment success, acceptability, adherence to the intervention, and retention rates. Secondary outcome measures included health-related quality of life, adherence to treatment, self-efficacy, pulmonary function, body mass index, and blood glucose values. RESULTS Among the 85 eligible patients approached, 40 (47%) were enrolled and randomized to the intervention or control group; two patients subsequently withdrew consent. Retention rates after 5 and 10 coaching sessions were 67% and 50%, respectively. Reasons for stopping the intervention included lack of time, poor health, perceiving coaching as not helpful, lack of motivation, and no need for further coaching. Coaching was primarily face-to-face (68%). No significant differences were found between the groups on any of the secondary outcomes. CONCLUSION Both telephone and face-to-face coaching were convenient for participants, with 50% receiving the maximum offered coaching sessions. However, the dropout rate early in the intervention was a concern. In future studies, eligible participants should be screened for their interest and perceived need for support and life coaching before enrollment.
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Affiliation(s)
- Karin Bæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Correspondence: Karin Bæk Knudsen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark, Tel +45 3545 3456, Fax +45 3545 2975, Email
| | - Tacjana Pressler
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Mary Jarden
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- University Hospital Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Skov
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Terese Lea Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Social Sciences, University of Copenhagen, Copenhagen, Denmark
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Bregnballe V, Boisen KA, Schiøtz PO, Pressler T, Lomborg K. Flying the nest: a challenge for young adults with cystic fibrosis and their parents. Patient Prefer Adherence 2017; 11:229-236. [PMID: 28243066 PMCID: PMC5317342 DOI: 10.2147/ppa.s124814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES As young patients with cystic fibrosis (CF) grow up, they are expected to take increasing responsibility for the treatment and care of their disease. The aim of this study was to explore the disease-related challenges faced by young adults with CF and their parents, when they leave home. MATERIALS AND METHODS A questionnaire survey of Danish patients with CF aged 18-25 years and their parents was conducted. The questionnaires were based on focus-group interviews with young adults with CF and their parents, and addressed challenges faced in the transition phase between childhood and adulthood, including different areas of disease management in everyday life. RESULTS Among all of the patients invited, 62% (n=58/94) of young adults and 53% (n=99/188) of their parents participated in the study. In total, 40% of the 18- to 25-year-olds were living with their parents, and the parents continued to play an active role in the daily care of their offspring's disease. Among the young adults who had left home, both the patients and their parents reported many difficulties regarding disease management; the young adults reported difficulties in contacting social services and in affording and preparing sufficient CF-focused meals, and their parents reported difficulties in answering questions concerning social rights and CF in general, and in knowing how to give their offspring the best help, how much to interfere, and how to relinquish control of managing their offspring's disease. CONCLUSION Young adults with CF who have left home have difficulties in handling the disease and their parents have difficulties in knowing how to give them the best help. There is an urgent need for holistic CF transitional care, including ensuring that young adults master the essential skills for self-management as they leave their parents.
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Affiliation(s)
- Vibeke Bregnballe
- Department of Clinical Medicine, Aarhus University, Aarhus
- Correspondence: Vibeke Bregnballe, Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 12A, 8000 Aarhus C, Denmark, Tel +45 6169 9001, Email
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Rigshospitalet, University Hospital of Copenhagen, Copenhagen
| | | | - Tacjana Pressler
- Cystic Fibrosis Centre, Rigshospitalet, University Hospital of Copenhagen, Copenhagen
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Eckman MH, Kopras EJ, Montag-Leifling K, Kirby LP, Burns L, Indihar VM, Joseph PM. Shared Decision-Making Tool for Self-Management of Home Therapies for Patients With Cystic Fibrosis. MDM Policy Pract 2017; 2:2381468317715621. [PMID: 30288426 PMCID: PMC6136161 DOI: 10.1177/2381468317715621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/15/2017] [Indexed: 12/11/2022] Open
Abstract
Objective: Patients with cystic fibrosis (CF) undertake time-consuming programs of home therapies. Our objective was to develop a tool to help CF patients prioritize personal goals for some of these treatments. We describe the development and results of initial evaluation of this shared decision-making tool. Methods: Multicriteria decision-making method to develop a shared decision-making tool that integrates patient's values and perceptions of treatment impact on functionality/sense of well-being. Treatment efficacy data obtained through comprehensive review of English language literature and Cochrane reviews. Field study of 21 patients was performed to assess acceptability of the approach, understandability of the tool, and to determine whether there was sufficient patient-to-patient variability in treatment goals and patient preferences to make use of a personalized tool worthwhile. Results: Patients found the tool easy to understand and felt engaged as active participants in their care. The tool was responsive to variations in patient preferences. Priority scores were calculated (0-1.0 ± SD). Patients' most important treatment goals for improving lung health included improving breathing function (0.27 ± 0.11), improving functionality/sense of well-being (0.24 ± 0.13), preventing lung infection (0.21 ± 0.08), minimizing time to complete treatments (0.16 ± 0.12), and minimizing cost (0.11 ± 0.09). Conclusions: A shared decision-making tool that integrates patients' values and best evidence is feasible and could result in improved patient engagement in their own care.
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Affiliation(s)
- Mark H. Eckman
- Mark H. Eckman, MD, MS University of
Cincinnati Medical Center, PO Box 670535, Cincinnati, OH 45267-0535, USA;
telephone: (513) 558-7581; e-mail:
| | - Elizabeth J. Kopras
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Karen Montag-Leifling
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Lari P. Kirby
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Lisa Burns
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Veronica M. Indihar
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
| | - Patricia M. Joseph
- Division of General Internal Medicine and the Center
for Clinical Effectiveness (MHE) and Division of Pulmonary Medicine and Critical
Care (EJK, KML, LPK, VMI, PMJ), University of Cincinnati, Cincinnati, Ohio
- Pediatric Pulmonology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio (LB, PMJ)
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Morton RW, Elphick HE, Edwards E, Daw WJ, West NS. Investigating the feasibility of text message reminders to improve adherence to nebulized medication in children and adolescents with cystic fibrosis. Patient Prefer Adherence 2017; 11:861-869. [PMID: 28507430 PMCID: PMC5428764 DOI: 10.2147/ppa.s123723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with cystic fibrosis (CF) often have suboptimal adherence rates to nebulized medication. Adherence barriers cited include forgetting to take the nebulizers, due to busy home and social lives. Text message reminders have been shown to be effective at improving adherence rates in other chronic diseases such as asthma and diabetes. OBJECTIVE The objective of this study was to assess the feasibility and efficacy of sending text reminders for a prolonged period of time to children with CF. MATERIALS AND METHODS Children with CF aged 5-16 years taking at least one medication via a nebulizer with an electronic adherence monitor were consented for the study. Text message reminders were sent to participants and/or parents via the hospital's automated text service, up to twice a day, for 6 months. The adherence rates for the 6-month text period were compared to the previous 6 months before the study. Rates were calculated for weekdays, weekends, and school holidays. RESULTS Seventeen participants were recruited to the study, with a mean age of 12 years and a mean forced expiratory volume in 1 second (FEV1) of 81% predicted. Fifteen children completed the 6-month text period, and I-neb data were accurately analyzed for 13 participants. The mean adherence rate in the 6 months receiving texts was 80%, compared to 81% in the prior 6 months. Overall adherence rates on weekdays, weekends, and school holidays were equivalent during the 2 time periods. A subgroup of patients with moderate baseline adherence showed increased adherence during the text period, particularly at weekends. CONCLUSION It is feasible to send text message reminders to children with CF, and they are amenable to this approach. Although text reminders do not increase rates in patients with existing optimal adherence, they may be of value in patients with more moderate baseline rates.
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Affiliation(s)
- Robert W Morton
- Cystic Fibrosis Unit, Sheffield Children’s Hospital
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
- Correspondence: Robert W Morton, Cystic Fibrosis Unit, Sheffield Children’s Hospital, Western Bank, Sheffield S10 2TH, UK, Tel +44 79 6878 8032, Email
| | - Heather E Elphick
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | | | - William J Daw
- Cystic Fibrosis Unit, Sheffield Children’s Hospital
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
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Catastini P, Di Marco S, Furriolo M, Genovese C, Grande A, Iacinti E, Iusco DR, Nobili RMV, Pescini R, Ragni R, Randazzo R, Risso C, Tabarini P, Braggion C, De Masi S, McGreevy KS. The prevalence of anxiety and depression in Italian patients with cystic fibrosis and their caregivers. Pediatr Pulmonol 2016; 51:1311-1319. [PMID: 27759954 DOI: 10.1002/ppul.23566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cystic fibrosis, like other chronic diseases, is a risk factor for the development of elevated symptoms of depression and anxiety. The objective of this study was to investigate the prevalence of anxiety and depression in Italian patients with CF and their parents. METHODS The Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires were administered to a sample of patients and their parents recruited at the cystic fibrosis centers in Italy. RESULTS Elevated levels of anxiety were higher in mothers than in fathers, and also higher in female patients than in male patients. A correlation between elevated levels of anxiety/depression and geographical area also emerged. Patient anxiety (OR 2.33) and depression (OR 4.09) were significantly associated with forced expiratory volume in one second (FEV1) <40% and forced vital capacity (FVC) <80% (OR 1.60 and 1.61, respectively). CONCLUSIONS Cystic fibrosis increases the risk of developing anxiety and depression in female patients and in mothers. Geographical differences were observed, with higher anxiety and depression in southern Italy for parents, but not for patients. Anxiety and depression levels also depend on clinical status. Pediatr Pulmonol. 2016;51:1311-1319. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paola Catastini
- Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Serena Di Marco
- Cystic Fibrosis Regional Center, Ospedale "Di Cristina" Arnas Civico, Palermo, Italy
| | - Maria Furriolo
- Cystic Fibrosis Regional Center, Presidio Ospedaliero Giovanni Paolo II, Lamezia Terme (CZ), Italy
| | - Carmela Genovese
- Cystic Fibrosis Regional Center, A.O.R. Ospedale San Carlo, Potenza, Italy
| | - Alessia Grande
- Cystic Fibrosis Adult Center, A.O.U. San Luigi Gonzaga, Orbassano (TO), Italy
| | | | - Danila Rosa Iusco
- Cystic Fibrosis Regional Center, A.O.U Policlinico Bari, Bari, Italy
| | | | - Rita Pescini
- Cystic Fibrosis Regional Center, Ospedale G.Gaslini, Genova, Italy
| | - Roberto Ragni
- Cystic Fibrosis Regional Center, A.O.U. Ancona, Italy
| | | | | | - Paola Tabarini
- Unit of Clinical Psychologist Unit of Cystic Fibrosis Center, Bambino Gesù Pediatric Hospital, Roma, Italy
| | - Cesare Braggion
- Cystic Fibrosis Center, Anna Meyer Children's Hospital, Florence, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Anna Meyer Children's Hospital, Florence, Italy
| | - Kathleen S McGreevy
- Research, Innovation and International Relations, Anna Meyer Children's Hospital, Florence, Italy
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Rouse C, Mistry P, Rayner O, Nickless J, Wan M, Southern KW, Batchelor HK. A mixed methods study of the administration of flucloxacillin oral liquid; identifying strategies to overcome administration issues of medicines with poor palatability. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:326-334. [PMID: 27633317 DOI: 10.1111/ijpp.12308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The palatability of flucloxacillin oral liquid is poor. Parents/carers use strategies to aid the administration of poorly palatable medicines. AIM To assess views on the palatability of flucloxacillin oral liquid and identify factors associated with successful administration. METHODS A mixed methods study which included a structured review of online forums and a survey of parent/carers of children with cystic fibrosis (CF) to obtain parent/carer views on the administration of flucloxacillin oral liquid. RESULTS A total of 18 strategies to aid the administration of flucloxacillin suspension to children were identified on 10 different public online forums. A total of 255 responses to the open online survey were received with 47% of respondents reporting that administration of flucloxacillin was more problematic compared to other medicines and 38% reporting the need to improve the palatability. The brand of flucloxacillin oral liquid significantly influenced the degree of difficulty associated with administration to children. A significant relationship was found between the concentration of flucloxacillin and the reported number of doses successfully administered. The use of food and drink to aid administration was more commonly stated in online forums (44%) compared to the survey data of parents/carers of children with CF (15.9%). CONCLUSION The administration of flucloxacillin oral liquid is perceived as a challenge by parent/carers because of palatability. For chronic use, a more concentrated oral liquid and certain brands are likely to improve acceptability.
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Affiliation(s)
- Claudia Rouse
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Punam Mistry
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Jess Nickless
- Department of Women's and Children's Health, NIHR Children's Theme CSG, Alder Hey Children's Hospital NHS Foundation Trust, Institute of Translational Medicine (Child Health), University of Liverpool, Liverpool, UK
| | - Mandy Wan
- Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Hannah K Batchelor
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Suthoff ED, Bonafede M, Limone B, O'Callaghan L, Sawicki GS, Wagener JS. Healthcare resource utilization associated with ivacaftor use in patients with cystic fibrosis. J Med Econ 2016; 19:845-51. [PMID: 27074519 DOI: 10.1080/13696998.2016.1178125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Ivacaftor was approved in 2012 to treat patients with cystic fibrosis (CF) with specific CFTR gene mutations. The objective of this analysis was to analyze the impact of ivacaftor on health resource utilization through analysis of claims data. METHODS Patients diagnosed with CF aged ≥6 years prescribed ivacaftor between January 1, 2012 and July 31, 2014 with ≥12 months of continuous insurance coverage prior to and following the prescription were identified. All-cause and CF-specific healthcare resource utilization during the pre- and post-prescription periods and ivacaftor adherence levels were studied. RESULTS The 79 identified patients had a mean age of 20.8 years, and 54% were female. The proportion of patients with inpatient admissions (all-cause and CF-related) was significantly higher in the pre index compared to post index period (p ≤ 0.05). Mean ivacaftor medication possession ratio was 0.8 (SD = 0.3), and 73% of patients had a medication possession ratio >0.80. LIMITATIONS Only a small number of patients met the inclusion criteria. Additionally, claims data may contain errors or inconsistencies and cannot be used to determine if medications were taken as prescribed. CONCLUSIONS Ivacaftor therapy was associated with significant reductions in hospitalizations along with high rates of adherence to treatment over 12 months.
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Affiliation(s)
| | - Mac Bonafede
- b Truven Health Analytics , Cambridge , MA , USA
| | | | | | - Gregory S Sawicki
- c Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Jeffrey S Wagener
- d Department of Pediatrics , University of Colorado Medical School , Aurora , CO , USA
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Knudsen KB, Pressler T, Mortensen LH, Jarden M, Skov M, Quittner AL, Katzenstein T, Boisen KA. Associations between adherence, depressive symptoms and health-related quality of life in young adults with cystic fibrosis. SPRINGERPLUS 2016; 5:1216. [PMID: 27516954 PMCID: PMC4967055 DOI: 10.1186/s40064-016-2862-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
Background Cystic fibrosis (CF) is a life shortening disease, however prognosis has improved and the adult population is growing. Most adults with cystic fibrosis live independent lives and balance the demands of work and family life with a significant treatment burden. The aim of this study was to examine the relationships among treatment adherence, symptoms of depression and health-related quality of life (HRQoL) in a population of young adults with CF. Methods We administered three standardized questionnaires to 67 patients with CF aged 18–30 years; Morisky Medication Adherence Scale, Major Depression Inventory, and Cystic Fibrosis Questionnaire-Revised. Results There was a response rate of 77 % and a majority of the young adults (84 %) were employed or in an education program. Most participants (74 %) reported low adherence to medications. One third (32.8 %) of the participants reported symptoms of depression. HRQoL scores were especially low on Vitality and Treatment Burden, and symptoms of depression were associated with low HRQoL scores (p < 0.01) with medium to large deficits across on all HRQoL domains (Cohen’s d 0.60–1.72) except for the domain treatment burden. High depression symptom scores were associated with low adherence (r = −0.412, p < 0.001). Conclusions Despite improved physical health, many patients with CF report poor adherence, as well as impaired mental wellbeing and HRQoL. Thus, more attention to mental health issues is needed.
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Affiliation(s)
- K B Knudsen
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - T Pressler
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L H Mortensen
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Jarden
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; The University Hospital Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Skov
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A L Quittner
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - T Katzenstein
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - K A Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Shakkottai A, Kidwell KM, Townsend M, Nasr SZ. A five-year retrospective analysis of adherence in cystic fibrosis. Pediatr Pulmonol 2015; 50:1224-9. [PMID: 26346919 DOI: 10.1002/ppul.23307] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/23/2015] [Accepted: 07/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We conducted a retrospective analysis of medication adherence and health outcomes over a 5-year period in children with cystic fibrosis (CF). METHODS Adherence was calculated for several commonly prescribed CF medications by comparing the actual number of times a prescription was filled in a 12-month period to the number of times it should have been filled based on the prescribed supply. We used prescription refill histories as documented by three major specialty pharmacies used by our patients. A binomial mixed effects model was used to investigate the longitudinal association between adherence and age group (0-5, 6-12, and 13-21 years) with gender, year in the study, lung function, body mass index (BMI), and annual hospitalization rate included as potential confounders. RESULTS The 0-5 years group had the highest overall adherence (P = 0.009). The 6-12 years group had significantly better adherence to inhaled medications as compared to oral medications (P = 0.020). Within each group, for any given year in the study, having a higher BMI was associated with greater odds of adherence (P < 0.0001). There were no associations between adherence and gender, lung function or hospitalization rate (P > 0.05). CONCLUSIONS There are significant age differences in adherence. Younger patients have better overall adherence likely secondary to increased parental supervision. Having better nutritional status is associated with improved adherence.
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Affiliation(s)
- Aarti Shakkottai
- Pediatric Pulmonology, University of Michigan Health System, Ann Arbor, Michigan
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Monica Townsend
- University of Connecticut School of Medicine, Storrs, Connecticut
| | - Samya Z Nasr
- Pediatric Pulmonology, University of Michigan Health System, Ann Arbor, Michigan
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The road for survival improvement of cystic fibrosis patients in Arab countries. Int J Pediatr Adolesc Med 2015; 2:47-58. [PMID: 30805437 PMCID: PMC6372404 DOI: 10.1016/j.ijpam.2015.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 01/13/2023]
Abstract
Cystic fibrosis (CF) is a lethal, monogenic disorder that affects multiple organ systems of the body. The incidence has been described before in the Middle East to be 1 in 2000 to 1 in 5800 live births, and the median survival was estimated to be from 10 to 20 years of age. The present article attempts to revisit various facets of this disease and specifically highlights the most important lacunae that exist in treating CF. In addition, it also tries to emphasize the steps in improving the median survival of patients with CF, in these countries.
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A Systematic Review of Factors Associated with Health-Related Quality of Life in Adolescents and Adults with Cystic Fibrosis. Ann Am Thorac Soc 2015; 12:420-8. [DOI: 10.1513/annalsats.201408-393oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sawicki GS, Heller KS, Demars N, Robinson WM. Motivating adherence among adolescents with cystic fibrosis: youth and parent perspectives. Pediatr Pulmonol 2015; 50:127-36. [PMID: 24616259 PMCID: PMC4160425 DOI: 10.1002/ppul.23017] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/09/2014] [Indexed: 11/06/2022]
Abstract
As advances in the care of individuals with cystic fibrosis (CF) have resulted in improved survival, therapeutic regimens for treatment of CF have become increasingly complex. This high treatment burden poses challenges to chronic disease self-management, particularly amongst adolescents. The aim of this qualitative study was to understand the barriers and facilitators of adherence to chronic CF therapies as perceived by adolescents with CF and their parents. In a series of structured interviews with 18 youth and their parents, we explored issues related to daily routines, youth and parental roles regarding chronic therapy, and motivators for adherence. All interviews were audio-recorded and coded for themes and patterns. Reported barriers to adherence included time pressures, competing priorities, heightened awareness of disease trajectory, privacy concerns, and lack of perceived consequences from non-adherence. Identified facilitators for adherence included recognizing the importance of therapies, developing strong relationships with care teams, establishing structured routines, and focusing on shifting responsibilities from a parent to their adolescent child. The themes uncovered by these interviews identify areas for intervention and support by clinical programs seeking to improve adherence and self-management strategies for adolescents with CF.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
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Péntek M, Kosztolányi G, Melegh B, Halász A, Pogány G, Baji P, Brodszky V, Vártokné Hevér N, Boncz I, Gulácsi L. [Cystic fibrosis -- disease burden and health-related quality of life of patients and their caregivers: results of the European BURQOL-RD survey in Hungary]. Orv Hetil 2015; 155:1673-84. [PMID: 25305725 DOI: 10.1556/oh.2014.30016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data on disease burden of cystic fibrosis in Hungary are scarce. AIM To assess quality of life and resource utilisations of patients with cystic fibrosis. METHOD In a cross-sectional survey (BURQOL-RD project), the EQ-5D-5L questionnaire was applied and healthcare utilisations were retrospectively surveyed. RESULTS 110 patients participated in the study (age-groups, year: 0-13, N = 48; 14-17, N = 12; ≥18, N = 50), median age at the diagnosis was 1 year. EQ-5D-5L score in age-groups 18-24 and 25-34 was significantly lower than in the general population (p<0.05). 75 patients (68%) attended pulmonology care, 55 patients (50%) were hospitalised in the past 6 and 12 months, respectively, and 57 patients (52%) were taking dornase alpha. Five adult patients (10%) received help from non-professional caregiver. CONCLUSIONS Cystic fibrosis leads to significant deterioration of quality of life. This study is the first from the Central Eastern European region that provides basic inputs for further health economic evaluations of cystic fibrosis care.
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Affiliation(s)
- Márta Péntek
- Budapesti Corvinus Egyetem Budapest Fővám tér 8., 265-ös szoba 1093 Pest Megyei Flór Ferenc Kórház Kistarcsa
| | | | - Béla Melegh
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | - Gábor Pogány
- Ritka és Veleszületett Rendellenességgel élők Országos Szövetsége Budapest
| | - Petra Baji
- Budapesti Corvinus Egyetem Budapest Fővám tér 8., 265-ös szoba 1093
| | | | | | - Imre Boncz
- Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - László Gulácsi
- Budapesti Corvinus Egyetem Budapest Fővám tér 8., 265-ös szoba 1093
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Jones S, Babiker N, Gardner E, Royle J, Curley R, Hoo ZH, Wildman MJ. Promoting adherence to nebulized therapy in cystic fibrosis: poster development and a qualitative exploration of adherence. Patient Prefer Adherence 2015; 9:1109-20. [PMID: 26346635 PMCID: PMC4529254 DOI: 10.2147/ppa.s82896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) health care professionals recognize the need to motivate people with CF to adhere to nebulizer treatments, yet little is known about how best to achieve this. We aimed to produce motivational posters to support nebulizer adherence by using social marketing involving people with CF in the development of those posters. METHODS The Sheffield CF multidisciplinary team produced preliminary ideas that were elaborated upon with semi-structured interviews among people with CF to explore barriers and facilitators to the use of nebulized therapy. Initial themes and poster designs were refined using an online focus group to finalize the poster designs. RESULTS People with CF preferred aspirational posters describing what could be achieved through adherence in contrast to posters that highlighted the adverse consequences of nonadherence. A total of 14 posters were produced through this process. CONCLUSION People with CF can be engaged to develop promotional material to support adherence, providing a unique perspective differing from that of the CF multidisciplinary team. Further research is needed to evaluate the effectiveness of these posters to support nebulizer adherence.
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Affiliation(s)
- Stephen Jones
- Psychology Department, University of Sheffield, Sheffield, UK
| | - Nathan Babiker
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Emma Gardner
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
| | - Jane Royle
- Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Rachael Curley
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zhe Hui Hoo
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- Adult Cystic Fibrosis Unit, Northern General Hospital, University of Sheffield, Sheffield, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Correspondence: Martin J Wildman, Adult CF and Respiratory Medicine, Adult Cystic Fibrosis Unit, CF Office, Brearley Outpatient, Northern General Hospital, Herries Road, Sheffield S5 7AU, United Kingdom, Tel +44 114 271 5212, Email
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Hogan A, Bonney MA, Brien JA, Karamy R, Aslani P. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study. Int J Clin Pharm 2014; 37:86-93. [PMID: 25432693 DOI: 10.1007/s11096-014-0043-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). OBJECTIVES This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. SETTING Community setting, in Sydney, Australia. METHODS Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. MAIN OUTCOME MEASURE Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. RESULTS Participants' age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). CONCLUSIONS Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised medicines.
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Affiliation(s)
- Alice Hogan
- Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, Broadway, NSW, 2006, Australia
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Millington K, Miller V, Rubenstein RC, Kelly A. Patient and parent perceptions of the diagnosis and management of cystic fibrosis-related diabetes. J Clin Transl Endocrinol 2014; 1:100-107. [PMID: 29159090 PMCID: PMC5685035 DOI: 10.1016/j.jcte.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/30/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022] Open
Abstract
Background Cystic Fibrosis Related Diabetes (CFRD) is an increasingly common complication in CF. CFRD introduces an additional complex chronic disease to individuals already attending to demanding treatment regimens. An improved understanding of the reaction to and coping mechanisms surrounding CFRD may facilitate management of CFRD. Methods Semi-structured interviews completed by 10 children with CFRD, 10 adults with CFRD and 10 parents of children with CFRD in a single large CF Care Center were analyzed utilizing phenomenological analysis. Results Patients and families reported having limited knowledge of CFRD prior to diagnosis. CFRD was considered an extension of their underlying CF and successful management depended upon integration into existing routines. Conclusions Health care professionals caring for patients with CFRD should be informed of the specific challenges that arise in CFRD. Education in advance of CFRD diagnosis may facilitate management.
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Affiliation(s)
- Kate Millington
- Perelman School of Medicine, University of Pennsylvania, 100 Stemmler Hall, Philadelphia, PA 19104, USA
| | - Victoria Miller
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ronald C Rubenstein
- Division of Pulmonary Medicine and Cystic Fibrosis Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA
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Abstract
PURPOSE OF REVIEW As new medications continue to come to market to improve health in individuals with cystic fibrosis (CF), patient adherence is increasingly more important to address. Currently, adherence for pulmonary medications is approximately 50% for people with CF. There has been recent research that has demonstrated that poor adherence is linked to worse health outcomes. This review summarizes recent research on the impact of adherence on lung health and highlights future areas of research and clinical practice to address this growing need. RECENT FINDINGS Recent research has indicated that nonadherence is associated with increased hospitalizations and pulmonary exacerbations, lower baseline lung function, and longer length of stays. However, most of the research has been done using pharmacy refill records as an objective measure of adherence. Electronic monitoring of medications provides more detailed information about patterns of use, which can directly inform clinical care. Furthermore, there have been few published clinical trials evaluating behavioral interventions to promote adherence. SUMMARY Given the recent research linking adherence to lung health outcomes, there is a growing need to measure and evaluate adherence in clinical care. As new medications are approved for CF, methods to monitor adherence also need to be developed and approved. Clinicians need to continue to assess barriers to adherence to be able to individually tailor interventions to a patient's needs.
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Everhart RS, Fiese BH, Smyth JM, Borschuk A, Anbar RD. Family Functioning and Treatment Adherence in Children and Adolescents with Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:82-86. [PMID: 24963456 DOI: 10.1089/ped.2014.0327] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/24/2014] [Indexed: 11/12/2022]
Abstract
Background: Cystic fibrosis (CF) is one of the most challenging pediatric illnesses for families to manage. There is, however, limited research that considers the associations between family functioning and treatment adherence in children and adolescents with CF. Methods: Nineteen children with CF (mean age=12.42 years, mean forced expiratory volume in one second (FEV1)=90.9% predicted) and their families participated in the study. Caregiver and child participants completed interview-based assessments and were then videotaped during a family mealtime. Results: Mean scores on several domains of family functioning fell in the "unhealthy" range. Better family functioning was found among older children. Better family functioning was also associated with better adherence to antibiotic treatment and worse adherence to enzymes. Conclusions: Findings suggest that family functioning may be an important correlate of treatment adherence in children and adolescents with CF. Future research should replicate these findings in larger samples of children and adolescents with CF.
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Affiliation(s)
- Robin S Everhart
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Barbara H Fiese
- Family Resiliency Center, Department of Human and Community Development, University of Illinois at Urbana-Champaign , Champaign, Illinois
| | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University , State College, Pennsylvania
| | - Adrienne Borschuk
- Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| | - Ran D Anbar
- Department of Pediatrics, State University of New York Upstate University Hospital , Syracuse, New York
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