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Jelinek L, Vaclavik J, Lazarova M. Interventions for increasing medication adherence in heart failure patients: A narrative review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 39023062 DOI: 10.5507/bp.2024.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving the adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. We provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.
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Affiliation(s)
- Libor Jelinek
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc and Faculty of Medicine, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Marie Lazarova
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Esteban Zavaleta-Monestel, Serrano-Arias B, Arguedas-Chacón S, Quirós-Romero A, Díaz-Madriz JP, Villalobos-Madriz A, Robles-Calderón A, Bucknor-Masís J, Chaverri-Fernández JM. Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100440. [PMID: 38623489 PMCID: PMC11017033 DOI: 10.1016/j.rcsop.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/28/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction The intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. Methods A retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. Results The study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. Conclusion This study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.
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Affiliation(s)
- Esteban Zavaleta-Monestel
- Pharmacy Department, Hospital Clínica Bíblica, 1307 San José, Costa Rica
- Faculty of Pharmacy, Universidad de Costa Rica, 11801 San José, Costa Rica
| | | | - Sebastián Arguedas-Chacón
- Pharmacy Department, Hospital Clínica Bíblica, 1307 San José, Costa Rica
- Faculty of Pharmacy, Universidad de Costa Rica, 11801 San José, Costa Rica
| | | | - José Pablo Díaz-Madriz
- Pharmacy Department, Hospital Clínica Bíblica, 1307 San José, Costa Rica
- Faculty of Pharmacy, Universidad de Costa Rica, 11801 San José, Costa Rica
| | | | | | - Jorge Bucknor-Masís
- Internal Medicine Department, Hospital Clínica Bíblica, 1307 San José, Costa Rica
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Oszczygiel M, Völler H, Schröder K, Popescu-Schuh IS, Schromm E, Heinze V, Rauch B, Schlitt A. Adherence to drug therapy in patients with heart failure associated with reduced ejection fractions (HFrEF) during cardiac rehabilitation and after 3 and 6 months. Clin Res Cardiol 2024; 113:866-874. [PMID: 37796317 DOI: 10.1007/s00392-023-02314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Heart failure represents a major challenge for healthcare systems worldwide. Rehabilitation is recommended as an important pillar of therapy for these patients, especially for those with reduced left ventricular ejection fraction (HFrEF: heart failure with reduced ejection fraction). METHODS The data collected in this multi-center project provide information on the rates of patients with HFrEF who were treated in five German rehabilitation facilities and whether the patients adhered to drug therapy at 3-/6-month follow-up. The project was supported by an unrestricted grant from Novartis-Pharma-GmbH. RESULTS The mean age of the 234 patients included was 63.4 ± 10.6 years and 78% were male. The mean LVEF was 31 ± 8% at admission and 36 ± 10% at discharge. Only 20.6% of the patients were assigned to rehabilitation with the main indication HF. The most frequent main indication was acute coronary syndrome (46.6%). A high proportion of patients was already on the recommended drug therapy upon admission (94% beta blockers, 100% angiotensin-effective drugs, 70% mineralocorticoid receptor antagonists, etc.). This was optimized, in particular by a higher proportion of patients treated with sodium-glucose cotransporter-2 inhibitors (35% admission vs. 45% discharge) and sacubitril/valsartan (49% admission vs. 64% discharge), which was further optimized during the 6-month follow-up (e.g., 50% SGLT2 inhibitors, 67% sacubitril/valsartan). DISCUSSION These data illustrate the effect of rehabilitation in terms of optimizing drug therapy, which stabilized over the course of 6 months. Furthermore, only a few patients with the main diagnosis HFrEF are referred for cardiac rehabilitation, although it is an essential part of guideline-based therapy.
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Affiliation(s)
- Michal Oszczygiel
- Paracelsus Harzklinik Bad Suderode GmbH, Paracelsusstraße 1, 06485, Quedlinburg, Germany
| | - Heinz Völler
- Clinic Ruedersdorf and Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Klaus Schröder
- Center for Outpatient Rehabilitation, Stuttgart, Germany
| | | | - Eike Schromm
- Center for Outpatient Rehabilitation, Ludwigshafen, Germany
| | - Viktoria Heinze
- Paracelsus Harzklinik Bad Suderode GmbH, Paracelsusstraße 1, 06485, Quedlinburg, Germany
| | - Bernhard Rauch
- Center for Outpatient Rehabilitation, Ludwigshafen, Germany
| | - Axel Schlitt
- Paracelsus Harzklinik Bad Suderode GmbH, Paracelsusstraße 1, 06485, Quedlinburg, Germany.
- Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Zavaleta-Monestel E, Arguedas-Chacón S, Quirós-Romero A, Chaverri-Fernández JM, Serrano-Arias B, Díaz-Madriz JP, García-Montero J, Speranza-Sanchez MO. Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:1-10. [PMID: 38303921 PMCID: PMC10827703 DOI: 10.36628/ijhf.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 02/03/2024]
Abstract
Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.
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Affiliation(s)
- Esteban Zavaleta-Monestel
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Sebastián Arguedas-Chacón
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
| | - Alonso Quirós-Romero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, University of Costa Rica, San José, Costa Rica
| | | | | | | | - Jonathan García-Montero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
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Cotter G, Davison BA, Adams KF, Ambrosy AP, Atabaeva L, Beavers CJ, Bhatt AS, Givertz MM, Grodin JL, Lala A, Novosadov M, Sokos GG, Takagi K, Teerlink JR, Bhatt DL. Effective medications can work only in patients who take them: Implications for post-acute heart failure care. Eur J Heart Fail 2024; 26:1-4. [PMID: 38124462 DOI: 10.1002/ejhf.3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Gad Cotter
- Heart Initiative, Durham, NC, USA
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Momentum Research Inc., Durham, NC, USA
| | - Beth A Davison
- Heart Initiative, Durham, NC, USA
- Université Paris Cité, INSERM UMR-S 942 (MASCOT), Paris, France
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Momentum Research Inc., Durham, NC, USA
| | - Kirkwood F Adams
- Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Craig J Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Ankeet S Bhatt
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, New York, NY, USA
| | | | - George G Sokos
- West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | | | - John R Teerlink
- Section of Cardiology, San Francisco VA Medical Center, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chapman-Goetz J, Packham N, Yu K, Gabb G, Potts C, Prosser A, Arstall MA, Burdeniuk C, Chan A, Wilson T, Hotham E, Suppiah V. NPS MedicineWise application in supporting medication adherence in chronic heart failure: an acceptability and feasibility pilot study. Front Digit Health 2023; 5:1274355. [PMID: 38034908 PMCID: PMC10684918 DOI: 10.3389/fdgth.2023.1274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, associated morbidity and mortality remain high. This study aimed to assess the acceptability, feasibility, and value of the NPS MedicineWise dose reminder app in a tiered, pharmacist-led intervention to address medication non-adherence in patients with HF. Methods This prospective, single-blinded, randomised controlled trial recruited 55 patients with HF between September 2019 and October 2020. Participants were randomly assigned to either the intervention or control arms. Intervention participants used the app which prompted medication administration at each dosing interval. Control participants received standard care and remained blinded to the app throughout the study. Treatment non-adherence prompted a tiered, pharmacist-led intervention. Comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline and 6-months measured the app's value in supporting medication adherence. Secondary outcome measures included self-reported medication knowledge, health-related quality of life, psychological wellbeing, and signs and symptoms of HF. Data were analysed using standard statistical tests with significance set at α 0.05. Results Approximately half of respondents reported managing HF and medications better by using the MedicineWise app (Tier 1). Most respondents expressed satisfaction with the in-app messages (Tier 2) and pharmacists' phone calls (Tier 3). The intervention participants demonstrated a significant improvement in the SEAMS between baseline and 6-months follow-up. Discussion It is feasible and potentially of value to use the MedicineWise app with a tiered, pharmacist-led intervention to support medication adherence in patients with HF. Our findings provide clinicians with "real-world" information on the practicality and potential value of using mobile health to support treatment adherence in patients with HF. Trial registration number Australian New Zealand Clinical Trials Registry Clinical trial registration number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
- Jessica Chapman-Goetz
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nerida Packham
- Consumer Medicines Information Services, NPS MedicineWise, Surry Hills, NSW, Australia
| | - Kitty Yu
- e-Health, NPS MedicineWise, Melbourne, VIC, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, SA, Australia
| | - Cassandra Potts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Margaret A. Arstall
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Christine Burdeniuk
- Department of Cardiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Alicia Chan
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Teena Wilson
- Integrated Cardiovascular Clinical Network, Country Health South Australia, Adelaide, SA, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
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Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia. Int J Chronic Dis 2022; 2022:9673653. [PMID: 36590698 PMCID: PMC9798104 DOI: 10.1155/2022/9673653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/03/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.
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Jacobs JA, Hastu RR, Cooley V, Liwanag S, Mighty T, Lee JI. Congestive Heart Failure Management at Home Use of Personal Emergency Response Systems (PERS). Prof Case Manag 2022; 27:306-312. [PMID: 36206127 DOI: 10.1097/ncm.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jean Allyson Jacobs
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
| | - Ruble Ryan Hastu
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
| | - Victoria Cooley
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
| | - Sarah Liwanag
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
| | - Tanya Mighty
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
| | - Jennifer I Lee
- Jean Allyson Jacobs, MPH, BSN, RN, CCM, is an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center in New York City. Receiving her BSN from LSU in 1992, she has had an expansive nursing career in critical care, public health, and case management. She recently earned her master's degree in public health practice from UMass Amherst in 2020
- Ruble Ryan Hastu, BSN, RN, earned his BSN from Mercy College in 2000. His extensive nursing experience includes ER, home care, public health, and case management in New York City. He currently works as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center
- Victoria Cooley, MS, earned her MS in biostatistics from Columbia University, and earned her BS in health science from Springfield College. She has worked as a research biostatistician at Weill Cornell Medicine since 2017, where she assists investigators with study planning, data cleaning, statistical analysis, graphics production, and manuscript preparation
- Sarah Liwanag, MPA, BSN, RN, CMGT-BC, currently works as a nurse case manager at Loyola University Medical Center in Chicago, IL. Previously, she worked as an inpatient RN care manager at New York-Presbyterian Weill Cornell Medical Center. She earned her MPA from NYU, and her BSN from Fairfield University. She has extensive experience providing care to complex trauma, surgical, medical, and pediatric patients, and patients with cancer
- Tanya Mighty, MSN, BSN, RN, serves as manager of the Department of Care Coordination/Social Work at New York-Presbyterian Weill Cornell Medical Center. She serves as both mentor and leader for care managers and social workers in the medicine service line at Weil Cornell Medical Center
- Jennifer I. Lee, MD, is assistant dean of program development and operations at the Weill Cornell Medical College, vice chair for quality and patient safety (QPS) and associate professor of clinical medicine in the Weill Department of Medicine at New York-Presbyterian/Weill Cornell
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Sefidi N, Assarroudi A, Zandi Z, Malkemes SJ, Rakhshani MH, Abbaszade A, Sahebkar M. Evaluating the effects of telenursing on patients' activities of daily living and instrumental activities of daily living after myocardial infarction: A randomized controlled trial study. Geriatr Gerontol Int 2022; 22:616-622. [PMID: 35734811 DOI: 10.1111/ggi.14426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to assess the effects of telenursing on patients' activities of daily living and instrumental activities of daily living (ADLs and IADLs) following a myocardial infarction (MI). METHODS This randomized, parallel-group, controlled trial was conducted on 95 patients post-MI from 2018 to 2019. Patients were randomly assigned to the intervention (telenursing) and control groups using permuted block randomization. Through telephone calls, telenursing was performed twice a week during the first six consecutive weeks, then once a week until week 12. ADL and IADL questionnaires were completed by both groups before intervention and 12 weeks later. The CONSORT 2010 checklist was used to report the study protocol. RESULTS The mean age of patients was 56.8 ± 11.07 and 54.2 ± 9.8 years in the telenursing and control group, respectively. The mean ADL and IADL scores in the telenursing group were substantially greater than in the control group [4.57 (3.18, 5.97); P < 0.001 and 4.40 (3.06, 5.75); P < 0.001, respectively]. The odds of a higher degree of independence (no disabilities vs. mild disabilities and disability as well as no disabilities and mild disabilities vs. disability) regarding ADLs and IADLs were significantly greater in the telenursing group as compared with the control group (P < 0.001 and P < 0.001, respectively). CONCLUSIONS Our findings suggest that the use of telenursing intervention may increase patients' ADLs and IADLs after an MI and may enhance their independence. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Narges Sefidi
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Abdolghader Assarroudi
- Iranian Research Center on Healthy Aging, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zahra Zandi
- Department of Internal Medicine, School of Medicine, Imam Hassan Hospital, North Khorasan University of Medical Sciences, Bojnourd, Iran
| | - Susan J Malkemes
- Passan School of Nursing, Wilkes University, Wilkes Barre, Pennsylvania, USA
| | - Mohammad Hassan Rakhshani
- Iranian Research Center on Healthy Aging, Department of Biostatistics and Epidemiology, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ali Abbaszade
- Department of Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnourd, Iran
| | - Mohammad Sahebkar
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Quaschning K, Koerner M, Wirtz MA. Analyzing the effects of barriers to and facilitators of medication adherence among patients with cardiometabolic diseases: a structural equation modeling approach. BMC Health Serv Res 2022; 22:588. [PMID: 35501793 PMCID: PMC9063142 DOI: 10.1186/s12913-022-07987-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Based on the theoretical model of medication adherence (WHO, 2003), the aims of the study were (1) to develop and test a theory-based multidimensional model for the predictive power of barriers to and facilitators of medication adherence and (2) to identify the mediating effects of barriers to medication adherence on drug-related patient outcomes (barrier “MedAd- “: forget; facilitator “MedAd + ”: regular intake). Methods Within a cross-sectional study entitled “Increasing medication adherence to improve patient safety in cardiological rehabilitation (PaSiMed)”, the model was evaluated in structural analytical terms based on data collected online of N = 225 patients with cardiometabolic diseases. The revised “Freiburg questionnaire on medication adherence (FF-MedAd-R)" was used to measure the latent constructs (e.g., facilitator: communication; barrier: reservations).” Results The structural equation model proved to exhibit an appropriate data fit (RMSEA: .05; CFI: .92). For all first-order facilitators of medication adherence, a high proportion of variance (62–94%) could be explained by the second-order factor “Physician–patient relationship (PPR)”. All paths from “PPR” to the constructs depicting barriers to medication adherence showed significant negative effects. Facilitators (“MedAd + ”) and barriers (“MedAd-”) accounted for 20% and 12% of the variance, respectively, in global items of medication adherence. Whereas “Carelessness” showed a full mediation for “MedAd-”, ‘‘Reservations’’ showed a partial mediation for “MedAd + ”. Conclusions “PPR” is an important predictor of patient medication adherence. The results underline the importance of a trustful physician–patient relationship in reducing barriers and enhancing medication adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07987-3.
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Affiliation(s)
- Katharina Quaschning
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany.
| | - Mirjam Koerner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, 79104, Freiburg, Germany
| | - Markus Antonius Wirtz
- Department of Research Methods in the Health Sciences, Institute of Everyday Culture, Sports and Health, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany
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Alcaraz A, Rojas-Roque C, Prina D, González JM, Pichon-Riviere A, Augustovski F, Palacios A. Improving the monitoring of chronic heart failure in Argentina: is the implantable pulmonary artery pressure with CardioMEMS Heart Failure System cost-effective? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:40. [PMID: 34243782 PMCID: PMC8268394 DOI: 10.1186/s12962-021-00295-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background The CardioMEMS® sensor is a wireless pulmonary artery pressure device used for monitoring symptomatic heart failure (HF). The use of CardioMEMS was associated with a reduction of hospitalizations of HF patients, but the acquisition cost could be high in low-and-middle income countries. Evidence of cost-effectiveness is needed to help decision-makers to allocate resources according to “value for money”. This study is aimed at estimating the cost-effectiveness of CardioMEMS used in HF patients from the third-party payer perspective -Social Security (SS) and Private Sector (PS)- in Argentina. Methods A Markov model was developed to estimate the cost-effectiveness of CardioMEMS versus usual medical care over a lifetime horizon. The model was applied to a hypothetical population of patients with HF functional class III with at least one hospitalization in the previous 12 months. The main outcome was the incremental cost-effectiveness ratio (ICER). To populate the model we retrieved clinical, epidemiological and utility parameters from the literature, whilst direct medical costs were estimated through a micro-costing approach (exchange rate USD 1 = ARS 76.95). Uncertainties in all parameters were assessed by deterministic, probabilistic and scenario sensitivity analysis. Results Compared with the usual medical care, CardioMEMS increased quality-adjusted life years (QALY) by 0.37 and increased costs per patient by ARS 1,081,703 for SS and ARS 919,051 for PS. The resultant ICER was ARS 2,937,756 per QALY and ARS 2,496,015 per QALY for SS and PS, respectively. ICER was most sensitive to the hazard ratio of HF hospital admission and the acquisition price of CardioMEMS. The probability that CardioMEMS is cost-effective at one (ARS 700,473), three (ARS 2,101,419,) and five (ARS 3,502,363) Gross Domestic Product per capita is 0.6, 17.9 and 64.1% for SS and 5.4, 33.3 and 73.2% for PS. Conclusions CardioMEMS was more effective and more costly than usual care in class III HF patients. Since in Argentina there is no current explicit threshold, the final decision to determine its cost-effectiveness will depend on the willingness-to-pay for QALYs in each health subsector.
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Affiliation(s)
- Andrea Alcaraz
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Daniela Prina
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Juan Martín González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
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Hany A, Fadlila R, Lydia EP. The influence of reminder book to adherence of heart failure patients in Malang city. J Public Health Res 2021; 10. [PMID: 33855392 PMCID: PMC8129757 DOI: 10.4081/jphr.2021.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Non-adherence to the recommended therapy causes patients with heart failure to experience recurrence of the disease. Reminder book on therapy adherence is very useful, because it assists in monitoring adherence to therapy carried out by patients while at home. Therefore, this study aims to determine the effect of the existence of a reminder book on adherence to therapy among patients with heart failure in a private hospital in Malang. Design and Methods: A pre-experiment design with one-group pre and posttest was used. The respondents were 18 patients that received counseling on the management of heart failure therapy while at home and were given a reminder book. Furthermore, the modified MMAS-8 scale was the study instrument used to measure adherence. Result: The results showed that most respondents were above the age of 65 with a treatment duration of 1 to 5 years. It was discovered that most of the respondents had never received information about heart failure therapy. Data analysis which was carried out using the Wilcoxon test with a p-value of 0.001, showed that there was a significant difference between respondents’ compliance before and after being given a reminder book. Conclusions: From this study, it was concluded that providing a reminder book has an effect on therapeutic adherence in patients with heart failure. Researchers recommend that hospitals should make use of this reminder as a tool to control or supervise outpatient therapy. Significance for public health The number of patients diagnosed with heart failure is increasing yearly, including rehospitalization rates. Adherence to therapy among patients with heart failure is important in preventing recurrence. One of the ways in improving adherence is the use of self-management techniques, such as independent monitor therapy. An example of this therapy is the use of a reminder book which helps to improve adherence and self-efficacy in patients with heart failure.
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Affiliation(s)
- Alfrina Hany
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
| | - Rizqa Fadlila
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
| | - Endah Panca Lydia
- School of Nursing, Faculty of Medicine, Universitas Brawijaya, Malang.
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Verhestraeten C, Heggermont WA, Maris M. Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Fail Rev 2020; 26:1359-1370. [PMID: 32474794 PMCID: PMC8510913 DOI: 10.1007/s10741-020-09979-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite an enormous improvement in heart failure management during the last decades, the hospitalization and mortality rate of heart failure patients still remain very high. Clinical inertia, defined as the lack of treatment intensification in a patient not at evidence-based goals for care, is an important underlying cause. Clinical inertia is extensively described in hypertension and type 2 diabetes mellitus, but increasingly recognized in heart failure as well. Given the well-established guidelines for the management of heart failure, these are still not being reflected in clinical practice. While the absolute majority of patients were treated by guideline-directed heart failure drugs, only a small percentage of these patients reached the correct guideline-recommended target dose of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. This considerable under-treatment leads to a large number of avoidable hospitalizations and deaths. This review discusses clinical inertia in heart failure and explains its major contributing factors (i.e., physician, patient, and system) and touches upon some recommendations to prevent clinical inertia and ameliorate heart failure treatment.
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Affiliation(s)
| | - Ward A Heggermont
- Cardiovascular Center OLV Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Cardiovascular Research Center Maastricht, Universiteitssingel 50, 6202, Maastricht, The Netherlands
| | - Michael Maris
- Novartis Pharma nv-sa, Medialaan 40, 1800, Vilvoorde, Belgium.
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Hospitalized patients with heart failure: the impact of anxiety, fatigue, and therapy adherence on quality of life. ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2020; 4:e268-e279. [PMID: 32368682 PMCID: PMC7191938 DOI: 10.5114/amsad.2019.90257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/12/2019] [Indexed: 01/25/2023]
Abstract
Introduction Heart failure (HF) is a major global health problem associated with increased morbidity and mortality and reduced quality of life (QoL). The aim of the study was to assess the impact of anxiety, fatigue and adherence to therapeutic guidelines on HF patients' QoL. Material and methods A hundred and twenty hospitalized HF patients were enrolled in the study. Data collection was performed by completion of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), the Zung Self-Rating Anxiety Scale (SAS) and a questionnaire that measured adherence to therapeutic guidelines. Results Data analysis showed moderate levels of anxiety and high levels of adherence to therapeutic guidelines as well as moderate to large effects of HF on patients' fatigue and QoL. A statistically significant positive linear association was observed between anxiety and QoL (rho > 0.6) as well as fatigue and QoL (rho > 0.3). An increase in the anxiety or fatigue score indicated an increase also in the QoL score, meaning that the more anxiety and fatigue a patient felt the worse the QoL also was. Moreover, a statistically significant negative linear association was observed between adherence to therapeutic guidelines and QoL (rho < -0.2). An increase in adherence score indicated a decrease in QoL score, meaning that the more adherent a patient was the better was the QoL. Conclusions The present findings suggest that QoL may be improved when adherence to therapy is increased and fatigue and anxiety are alleviated.
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Larina VN, Leonova MV, Bondarenkova AA, Larin VG. Patient compliance and physicians’ adherence to guidelines on heart failure with reduced ejection fraction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- V. N. Larina
- N.I. Pirogov Russian National Research Medical University
| | | | | | - V. G. Larin
- N.I. Pirogov Russian National Research Medical University
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Pallangyo P, Millinga J, Bhalia S, Mkojera Z, Misidai N, Swai HJ, Hemed NR, Kaijage A, Janabi M. Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study. BMC Res Notes 2020; 13:89. [PMID: 32085803 PMCID: PMC7035643 DOI: 10.1186/s13104-020-04959-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population. Results We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7–16.0, p < 0.001). Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (adjusted RR 1.7, 95% CI 1.2–2.9, p = 0.04). Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3–4.6, p < 0.01). In conclusion, Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. .,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naairah R Hemed
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Alice Kaijage
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Belfiore A, Palmieri VO, Di Gennaro C, Settimo E, De Sario MG, Lattanzio S, Fanelli M, Portincasa P. Long-term management of chronic heart failure patients in internal medicine. Intern Emerg Med 2020; 15:49-58. [PMID: 30659413 DOI: 10.1007/s11739-019-02024-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
Abstract
Chronic heart failure (CHF) is one of the main disabilities in elderly patients requiring frequent hospitalizations with high health care costs. We studied the outcome of CHF outpatient management in reducing hospitalization after discharge from a division of Internal Medicine at a large 3rd referral regional Hospital. 147 CHF inpatients (M:F: 63:84; mean age 76 ± 9.6 years) admitted for acute exacerbation of CHF were followed up as outpatients at 1, 6, 12 and 24 months after discharge. At baseline, patients underwent: laboratory tests, ECG, echocardiogram and a dedicated-intensive health care educational program involving also their families. The rate of hospitalization in the same group of patients was compared with data from the previous 24 months, a period when patients had been seen elsewhere without disease management programs. Patients had high prevalence of comorbidities and the majority was in NYHA class III or IV. Hypertension and valvular heart disease were the most common causes for CHF. Systolic function was preserved (LVEF ≥ 50%) in 61.9% of cases. Functional NYHA class improved significantly after 6 months and remained stable at 24 months. There was a significant increase in the use of the renin-angiotensin system blockers, beta-blockers and diuretics compared to admission to the ward. At 24 months, hospital readmissions were decreased by 42% as compared to the previous 24 months. Risk factors for re-hospitalizations were anemia, NYHA class III or IV and previous hospitalizations. Establishing an intensive outpatient management program for CHF patients leads to long-term beneficial effects with improved clinical parameters and decreased hospitalization in the setting of Internal Medicine.
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Affiliation(s)
- Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
| | - Vincenzo Ostilio Palmieri
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Carla Di Gennaro
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Enrica Settimo
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maria Grazia De Sario
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Stefania Lattanzio
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Margherita Fanelli
- Biostatistic, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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Makris E, Hu L, Jones GB, Wright JM. Moving the Dial on Heart Failure Patient Adherence Rates. Patient Prefer Adherence 2020; 14:2407-2418. [PMID: 33324042 PMCID: PMC7733338 DOI: 10.2147/ppa.s283277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Heart failure remains a substantive contributor to patient morbidity and mortality rates worldwide and represents a significant burden on the healthcare ecosystem. Faced with persistent physical symptoms and debilitating social consequences, patients follow complex treatment regimens and often have difficulty adhering to them. PURPOSE In this manuscript, we review factors which contribute to low adherence rates and advance potential single- and multi-factor-based interventions. It is hoped that these observations can lead to improvements in managed care of this vulnerable population of patients. METHODS A narrative review of the primary literature was performed on contributing factors with primary focus on the period 2015-2020 using available databases and search engines. Adherence pain points identified were mapped against a series of potential solutions which are presented. RESULTS Enhancement of treatment adherence relies on two approaches viz. single-factor and multi-factor solutions. Single factors identified include electronic reminders, enhanced health education, financial incentives, gamification strategies, community drivers, persona-based modeling, and burden relief of poly pharmacy. Multi-factor solutions combine two or more of the seven approaches offering the potential for flexible interventions tailored to the individual. DISCUSSION AND CONCLUSION Heart failure patients with poor adherence have increased mortality, hospitalization needs, and healthcare costs. This review highlights current single-factor and multi-factor adherence methods. Against a backdrop of diversity of approaches, multi-factor solutions cast the widest net for positively influencing adherent behaviors. A key enabler lies in the development and leveraging of patient personas in the synthesis of successful intervention methods. Deployable solutions can also be envisioned in clinical trials where adherence tracking represents an essential component.
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Affiliation(s)
- Eleanna Makris
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Lucy Hu
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Graham B Jones
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA02111, USA
- Correspondence: Graham B Jones Email
| | - Justin M Wright
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
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Seid MA, Abdela OA, Zeleke EG. Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients' point of view. PLoS One 2019; 14:e0211768. [PMID: 30730931 PMCID: PMC6366768 DOI: 10.1371/journal.pone.0211768] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nowadays, heart failure (HF) related morbidity and mortality rate is increasing globally. Younger populations happen to be more affected by HF in sub- Saharan African than the western countries. Even though medications, low sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and its exacerbation, poor adherence to these self-care recommendations is contributing to an increased in hospitalization, morbidity, and mortality. Therefore, this study aimed to assess heart failure patients' adherence to self-care recommendations and its associated factors. METHODS A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017. The participants were selected by systematic random sampling technique. Data were collected through face to face interview and from the patients' medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients' adherence level. RESULTS Of 310 study participants only 22.3% (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR = 2.34, 95% CI: 1.18-4.62), good level of heart failure knowledge (AOR = 2.49, 95% CI: 1.276-4.856) and free from chronic comorbid diseases (AOR = 2.57, 95% CI: 1.28-5.14). CONCLUSION Overall, heart failure patients' adherence to self-care recommendations is poor and selective. Being male in gender, had no chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients' knowledge about heart failure signs, symptoms and its management approaches, to improve the patients' adherence level.
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Affiliation(s)
| | | | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Lamb L, Affenzeller N, Hewison L, McPeake KJ, Zulch H, Mills DS. Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success. Front Vet Sci 2018; 5:37. [PMID: 29560356 PMCID: PMC5845580 DOI: 10.3389/fvets.2018.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/19/2018] [Indexed: 01/14/2023] Open
Abstract
Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument in any veterinary behavior practice wishing to use client feedback to rationalize areas of the consultation which might be improved.
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Affiliation(s)
- Lisanna Lamb
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Nadja Affenzeller
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.,Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Lynn Hewison
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Kevin James McPeake
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Helen Zulch
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Daniel S Mills
- Animal Behaviour Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
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Factors Affecting Health Related Quality of Life in Hospitalized Patients with Heart Failure. Cardiol Res Pract 2017; 2017:4690458. [PMID: 29201489 PMCID: PMC5671708 DOI: 10.1155/2017/4690458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 11/21/2022] Open
Abstract
This study identified factors affecting health related quality of life (HRQOL) in 300 hospitalized patients with heart failure (HF). Data were collected by the completion of a questionnaire which included patients' characteristics and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Analysis of data showed that the median of the total score of MLHFQ was 46 and the median of the physical and mental state was 22 and 6, respectively. Also, participants who were householders or had “other” professions had lower score of 17 points and therefore better quality of life compared to patients who were civil/private employees (p < 0.001 and p < 0.001, resp.). Patients not receiving anxiolytics and antidepressants had lower quality of life scores of 6 and 15.5 points, respectively, compared to patients who received (p = 0.003 and p < 0.001, resp.). Patients with no prior hospitalization had lower score of 7 points compared to those with prior hospitalization (p = 0.002), whereas patients not retired due to the disease had higher score of 7 points (p = 0.034). Similar results were observed for the physical and mental state. Improvement of HF patients' quality of life should come to the forefront of clinical practice.
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