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Srithumsuk W, Chaleoykitti S, Jaipong S, Pattayakorn P, Podimuang K. Association between depression and medication adherence in stroke survivor older adults. Jpn J Nurs Sci 2021; 18:e12434. [PMID: 34137175 DOI: 10.1111/jjns.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/29/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to investigate the association between depression score and medication adherence in stroke survivor older adults. METHODS The participants were 102 stroke survivor older adults. The outcome was medication adherence during a 6-month follow-up. The independent variable was the depression score which was assessed by the Patient Health Questionnaire-9 (PHQ-9). The confounding factors included sociodemographic data, clinical characteristics, number of comorbidities, and number of medications. We analyzed the association between depression and medication adherence using multiple linear regression analyses. RESULTS The PHQ-9 score of stroke survivor older adults at the baseline was 1.11±2.03, and at the 6-month follow-up was increased to 5.06±3.91. The medication adherence mean score at the outcome was 4.15±1.83. After full adjustment, the PHQ-9 scores at baseline and 6-month follow-up were significantly associated with medication adherence (β = -.315, 95% CI = -.483 to -.086, p = 0.006 and β = -.270, 95% CI = -.238 to -.020, p = 0.021, respectively). Other variables that affect medication adherence during a 6-month follow-up included living with others and a lower number of medications. CONCLUSION This study revealed that lower depression scores were associated with high medication adherence in post-stroke older adults. Additionally, living with others and a lower number of medications were associated with medication adherence. Therefore, stroke survivor older adults should be assessed for depression and given medication, and education should be used to improve mediation adherence, especially for the ones who live alone and have polypharmacy to prevent recurrent stroke.
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Affiliation(s)
- Werayuth Srithumsuk
- Faculty of Nursing Science and Allied Health, Phetchaburi Rajabhat University, Phetchaburi, Thailand
| | | | - Saitip Jaipong
- Stroke Unit, Phrachomklao Hospital, Phetchaburi, Thailand
| | - Pinthusorn Pattayakorn
- Department of Nursing, College of Natural Science, California State University San Bernardino, San Bernardino, California, USA.,Stroke Unit, Eisenhower Health, Rancho Mirage, California, USA
| | - Kattiya Podimuang
- Annenberg 3 South Telemetry Unit, Eisenhower Medical Center, Rancho Mirage, California, USA
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Discrepancy Among Self-Reported Adherence, Prescription Refills, and Actual Anticoagulant Control. J Nurs Res 2020; 28:e63. [PMID: 31934960 DOI: 10.1097/jnr.0000000000000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients must adhere to their prescribed warfarin regimens and regularly monitor the anticoagulation effect to maintain therapeutic levels. The ability to evaluate regimen adherence accurately is crucial to the success of patient coaching. However, prevention of thromboembolic events is challenging when the association between medication adherence and the actual amount of anticoagulant agent taken cannot be determined. PURPOSE This study used self-reported medication taken and prescription refills to (a) verify warfarin medication adherence and (b) assist clinicians to determine the discrepancy between medication adherence and anticoagulant control efficacy. METHODS This study was conducted at a national-university-affiliated hospital in Yilan County, Taiwan. Structured questionnaires and medical record reviews were adopted. A 100-point visual analog scale was used to measure the reported adherence of participants, whereas medication refill adherence was compared against self-reported adherence. Finally, degree of adherence was evaluated based on time in therapeutic range. RESULTS This study included 192 participants. Half (n = 94, 49%) were women, and the mean age was 69.6 years. Mean scores were 92.2% for the visual analog scale and 87.3% for medication refill adherence. Medication adherence correlated significantly with age, as reflected in the visual analog scale scores (p < .05). The participants who were receiving polypharmacy with five types of medicines or less attained higher visual analog scale scores, whereas participants who were on warfarin for 2-12 months exhibited higher medication refill adherence. Time in therapeutic range correlated negatively with age, although stability improved with therapy duration. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Despite their high self-reported adherence levels, patients of advanced age require careful monitoring of their time in therapeutic range. The participants in this study who were on warfarin for a relatively longer time exhibited higher stability in the therapeutic range, despite their low medication refill adherence. The results of this study suggest that patient age, duration of warfarin therapy, and polypharmacy are factors associated with medication adherence. The findings may facilitate future assessments of warfarin adherence in patients as well as the implementation of more effective clinical nursing procedures and management practices.
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The Role of Antioxidants in Ameliorating Cyclophosphamide-Induced Cardiotoxicity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4965171. [PMID: 32454939 PMCID: PMC7238386 DOI: 10.1155/2020/4965171] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
The chemotherapeutic and immunosuppressive agent cyclophosphamide has previously been shown to induce complications within the setting of bone marrow transplantation. More recently, cardiotoxicity has been shown to be a dose-limiting factor during cyclophosphamide therapy, and cardiooncology is getting wider attention. Though mechanism of cyclophosphamide-induced cardiotoxicity is not completely understood, it is thought to encompass oxidative and nitrative stress. As such, this review focuses on antioxidants and their role in preventing or ameliorating cyclophosphamide-induced cardiotoxicity. It will give special emphasis to the cardioprotective effects of natural, plant-derived antioxidants that have garnered significant interest in recent times.
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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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Lemos DMP, Saldanha PF, Vieira LF, Azzolin KDO. Nursing taxonomies in hospital discharge planning: a quasi-experimental study. Rev Bras Enferm 2020; 73:e20180896. [DOI: 10.1590/0034-7167-2018-0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 10/18/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the effect of implementation of hospital discharge planning based on the taxonomies of NANDA-International, nursing interventions classification (NIC) and nursing outcomes classification (NOC) for patients with heart failure (HF) or diabetes mellitus (DM). Methods: quasi-experimental quantitative study conducted in a public university hospital located in the state of Rio Grande do Sul, Brazil. Convenience sampling included 28 adult patients hospitalized for HF or DM with the nursing diagnosis Ineffective Health Management (00078), who received the following nursing interventions: Teaching: Disease Process, Teaching: Prescribed Medication and Teaching: Prescribed Diet. Before and after the intervention, the following nursing outcomes were evaluated : Knowledge: Diabetes Management and Knowledge: Heart Failure Management. Results: the score of the nursing outcome Knowledge: Heart Failure Management went from 2.05±0.28 to 2.54±0.30 (P=0.002), and of the nursing outcome Knowledge: Diabetes Management went from 2.61±0.55 to 3.21±0.57 (P=0.000). Conclusion: discharge planning based on the NIC improves the NOC score and may interfere in the health outcomes.
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Abstract
BACKGROUND There is a lack of feasible and validated measures to self-assess medication adherence for older patients with stroke. In addition, the potential determinants of medication adherence for older patients with stroke remain unclear. OBJECTIVES The aims of this study were to (1) examine the psychometric properties of a 5-item questionnaire on medication adherence, specifically the 5-item Medication Adherence Report Scale (MARS-5), and (2) explore the determinants of medication adherence. METHODS Stroke patients older than 65 years (N = 523) filled out the MARS-5 and the Hospital Anxiety and Depression Scale. The medication possession rate (MPR) was calculated to measure the objective medication adherence. Several clinical characteristics (stroke types, blood pressure, comorbidity, HbA1c, quantity of prescribed drugs, fasting blood glucose, and total cholesterol) and background information were collected. We used Rasch analysis with a differential item functioning test to examine psychometric properties. RESULTS All 5 items in the MARS-5 fit in the same construct (ie, medication adherence), no differential item functioning items were displayed in the MARS-5 across gender, and the MARS-5 total score was strongly correlated with the MPR (r = 0.7). Multiple regression models showed that the MARS-5 and the MPR shared several similar determinants. In addition, the variance of the MARS-5 (R = 0.567) was more than that of the MPR (R = 0.300). CONCLUSIONS The MARS-5 is a feasible and valid self-assessed medication adherence for older patients with stroke. In addition, several determinants were found to be related to medication adherence for older patients with stroke. Healthcare providers may want to take heed of these determinants to improve medication adherence for this population.
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Appalasamy JR, Subramanian P, Tan KM, Seeta Ramaiah S, Joseph JP, Chua SS. The Needs and Barriers of Medication-Taking Self-Efficacy Among Poststroke Patients: Qualitative Study. JMIR Nurs 2019; 2:e14399. [PMID: 34345772 PMCID: PMC8279437 DOI: 10.2196/14399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/09/2019] [Accepted: 06/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background Stroke is one of the top 10 leading diseases worldwide, with high mortality and morbidity rates. There is an incomplete understanding of the various types of self-efficacy involved in the prevention of recurrent stroke, and one of them is medication-taking self-efficacy. Objective This study aimed to explore the fundamental needs and barriers of medication-taking self-efficacy in poststroke patients in Malaysia. Methods We performed in-depth individual interviews with poststroke patients (N=10) from the Outpatient Neurology Clinic, Hospital Kuala Lumpur. All interviews were transcribed verbatim, and an inductive thematic analysis was performed on the data collected from the interviews. Results Two key themes were identified: (1) self-efficacy in taking the effort to understand stroke and its preventative treatment for recurrent stroke and (2) self-efficacy in taking prescribed medication to prevent stroke. Patients needed to be proactive in seeking reliable information about stroke and the perceived benefits of preventative treatment for stroke. The discussion was focused on eliciting the needs and barriers related to medication-taking self-efficacy. Patients needed to develop independence and self-reliance to overcome barriers such as dependency and low motivation. External factors such as limited information resources, low perceived severity, poor social environment, and poor communication add to the challenges of poststroke patients to improve their self-efficacy of managing their medications. Conclusions The study identified potential key findings related to the needs of patients in a localized setting, which are also related to several health behavioral concepts and constructs, indicating the importance of overcoming barriers to improve the quality of life in poststroke patients. We anticipate that the results will be taken into consideration for future personalized patient education interventions.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences Monash University Bandar Sunway Malaysia
| | | | - Kit Mun Tan
- Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | | | | | - Siew Siang Chua
- Faculty of Health & Medical Sciences Taylor's University Subang Jaya Malaysia
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Kamal AK, Khalid W, Zulfiqar M, Muqeet A, Zaidi F, Gowani A, Virani SS. The potential of m-Health-based interventions to improve medication literacy and adherence in non-communicable diseases in Pakistan. Int J Stroke 2019; 14:NP8-NP10. [PMID: 30681041 DOI: 10.1177/1747493019827762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Wardah Khalid
- 2 Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Abdul Muqeet
- 4 eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan
| | - Fabiha Zaidi
- 4 eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan
| | - Ambreen Gowani
- 5 School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- 6 Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA
- 7 Department of Medicine, Baylor College of Medicine, Houston, USA
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The Therapist's Role in the Medical and Pharmacological Management of Heart Failure. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Al-Ganmi AHA, Perry L, Gholizadeh L, Alotaibi AM. Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Liberato ACS, Rodrigues RCM, São-João TM, Alexandre NMC, Gallani MCBJ. Satisfaction with medication in coronary disease treatment: psychometrics of the Treatment Satisfaction Questionnaire for Medication. Rev Lat Am Enfermagem 2017; 24:S0104-11692016000100334. [PMID: 27276018 PMCID: PMC4915802 DOI: 10.1590/1518-8345.0745.2705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to psychometrically test the Brazilian version of the Treatment Satisfaction
Questionnaire for Medication - TSQM (version 1.4), regarding ceiling and floor
effect, practicability, acceptability, reliability and validity. Methods: participants with coronary heart disease (n=190) were recruited from an
outpatient cardiology clinic at a university hospital in Southeastern Brazil and
interviewed to evaluate their satisfaction with medication using the TSQM (version
1.4) and adherence using the Morisky Self-Reported Measure of Medication Adherence
Scale and proportion of adherence. The Ceiling and Floor effect were analyzed
considering the 15% worst and best possible TSQM scores; Practicability was
assessed by time spent during TSQM interviews; Acceptability by proportion of
unanswered items and participants who answered all items; Reliability through the
Cronbach's alpha coefficient and Validity through the convergent construct
validity between the TSQM and the adherence measures. Results: TSQM was easily applied. Ceiling effect was found in the side effects domain and
floor effect in the side effects and global satisfaction domains. Evidence of
reliability was close to satisfied in all domains. The convergent construct
validity was partially supported. Conclusions: the Brazilian TSQM presents evidence of acceptability and practicability,
although its validity was weakly supported and adequate internal consistency was
observed for one domain.
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Affiliation(s)
- Ana Carolina Sauer Liberato
- Doctoral student, University of Washington, Seattle, USA., University of Washington, University of Washington, Seattle , USA
| | - Roberta Cunha Matheus Rodrigues
- Associate Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil., Universidade Estadual de Campinas, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas SP , Brazil
| | - Thaís Moreira São-João
- Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil., Universidade Estadual de Campinas, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas SP , Brazil
| | - Neusa Maria Costa Alexandre
- Associate Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil., Universidade Estadual de Campinas, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas SP , Brazil
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Abstract
PURPOSE/AIM The aim of this study was to investigate whether health literacy, self-efficacy, and medication adherence can explain or predict the variance in health outcomes (measured as perceived physical or mental health status [HS]) in persons with chronic heart failure (HF). DESIGN A nonexperimental cross-sectional survey study used data gathered from 175 patients with chronic HF from urban cardiology practices in the northeast United States. METHODS The Paasche-Orlow and Wolf Causal Pathways conceptual model and Bandura's self-efficacy theory were used to select and test variables in the study. A demographic questionnaire, the Short Test of Functional Health Literacy, the Self-Efficacy for Appropriate Medication Use Scale, the Morisky Medication Adherence Scale, and the Short Form-12 version 2 assessing perceived physical and mental HS were completed. Multiple hierarchical regression analyses were used to analyze relationships among the variables. RESULTS Significant associations between health literacy and self-efficacy and between health literacy and perceived mental HS were found (P < .05). High self-efficacy was the strongest predictor of physical HS (P < .01). The strongest predictor of mental HS was medication adherence (P < .01). CONCLUSIONS Support of self-efficacy and medication adherence may improve HS. Including health literacy strategies in clinical practice may support improvements in HS in people with chronic HF.
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Affiliation(s)
- June M Como
- Author Affiliation: Assistant Professor of Nursing, Graduate and Clinical Doctorate in Nursing Practice Programs Coordinator, and Fellow of the New York Academy of Medicine, College of Staten Island, City University of New York
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Ryan TP, Morrison RD, Sutherland JJ, Milne SB, Ryan KA, Daniels JS, Misra-Hebert A, Hicks JK, Vogan E, Teng K, Daly TM. Medication adherence, medical record accuracy, and medication exposure in real-world patients using comprehensive medication monitoring. PLoS One 2017; 12:e0185471. [PMID: 28957369 PMCID: PMC5619774 DOI: 10.1371/journal.pone.0185471] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/13/2017] [Indexed: 01/05/2023] Open
Abstract
Background Poor adherence to medication regimens and medical record inconsistencies result in incomplete knowledge of medication therapy in polypharmacy patients. By quantitatively identifying medications in the blood of patients and reconciling detected medications with the medical record, we have defined the severity of this knowledge gap and created a path toward optimizing medication therapy. Methods and findings We validated a liquid chromatography-tandem mass spectrometry assay to detect and/or quantify 38 medications across a broad range of chronic diseases to obtain a comprehensive survey of patient adherence, medical record accuracy, and exposure variability in two patient populations. In a retrospectively tested 821-patient cohort representing U.S. adults, we found that 46% of medications assessed were detected in patients as prescribed in the medical record. Of the remaining medications, 23% were detected, but not listed in the medical record while 30% were prescribed to patients, but not detected in blood. To determine how often each detected medication fell within literature-derived reference ranges when taken as prescribed, we prospectively enrolled a cohort of 151 treatment-regimen adherent patients. In this cohort, we found that 53% of medications that were taken as prescribed, as determined using patient self-reporting, were not within the blood reference range. Of the medications not in range, 83% were below and 17% above the lower and upper range limits, respectively. Only 32% of out-of-range medications could be attributed to short oral half-lives, leaving extensive exposure variability to result from patient behavior, undefined drug interactions, genetics, and other characteristics that can affect medication exposure. Conclusions This is the first study to assess compliance, medical record accuracy, and exposure as determinants of real-world treatment and response. Variation in medication detection and exposure is greater than previously demonstrated, illustrating the scope of current therapy issues and opening avenues that warrant further investigation to optimize medication therapy.
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Affiliation(s)
- Timothy P Ryan
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - Ryan D Morrison
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - Jeffrey J Sutherland
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - Stephen B Milne
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - Kendall A Ryan
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - J Scott Daniels
- Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United States of America
| | - Anita Misra-Hebert
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - J Kevin Hicks
- Medicines Department, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Eric Vogan
- Reporting and Analytics, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kathryn Teng
- Medicines Department, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Thomas M Daly
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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Lin CY, Yaseri M, Pakpour AH, Malm D, Broström A, Fridlund B, Burri A, Webb TL. Can a Multifaceted Intervention Including Motivational Interviewing Improve Medication Adherence, Quality of Life, and Mortality Rates in Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter, Randomized Controlled Trial with 18-Month Follow-Up. Drugs Aging 2017; 34:143-156. [PMID: 28004259 DOI: 10.1007/s40266-016-0429-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important. OBJECTIVE The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery. METHODS Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses. RESULTS Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04). CONCLUSION The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahounar BLV, Qazvin, 3419759811, Iran. .,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Dan Malm
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Internal Medicine, Country Hospital Ryhov, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Andrea Burri
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Anaesthesia and Perioperative Medicine, Waitemata Pain Service, North Shore Hospital, Auckland, New Zealand
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Mayyas F, Bataineh W, Jarab A. EVALUATING THE PRESCRIPTION OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS OR RECEPTOR BLOCKERS IN PATIENTS WITH DIABETES IN JORDAN. Endocr Pract 2017; 23:1289-1296. [PMID: 28816537 DOI: 10.4158/ep171917.or] [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: 11/15/2022]
Abstract
OBJECTIVE The angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are guideline-recommended agents to prevent development and progression of nephropathy and cardiovascular diseases in diabetes mellitus (DM). The aim of this study was to evaluate the prescription of ACEIs/ARBs in DM patients with guideline indications. METHODS Electronic data files for diabetes patients were retrospectively reviewed at a primary care setting northern Jordan. Patient's characteristics and data on ACEIs/ARBs were collected. The primary outcome measure was ACEI/ARB persistence of prescription in DM patients with guideline indications. RESULTS Data for 859 DM patients were reviewed. The mean age (± SEM) was 60.75 ± 0.41 years. Most of patients (97.4%) had type 2 DM. A total of 780 patients (90.8%) had at least one clinical indication to use ACEIs/ARBs. Hypertension followed by coronary artery disease (CAD) and albuminuria were the most common indications for ACEI/ARB prescriptions. A total of 686 (87.9%) of the eligible patients were on ACEIs/ARBs. As the number of indications increased, ACEI/ARB use has also increased. ACEIs/ARBs were prescribed regularly in about 59% of patients, whereas 40.9% were ex-users. Most of the patients received ACEIs/ARBs after the onset of first indication. By multivariate analysis, hypertension, CAD, and albuminuria were significant independent predictors of ACEI/ARB prescriptions. CONCLUSION Indications for ACEI/ARB use are highly prevalent, and the rate of receipt is relatively high but with significant lack of persistence of prescriptions. Management of DM should enforce healthcare professional/patient interactions and education to improve prescription of medications. ABBREVIATIONS ACEI = angiotensin-converting enzyme inhibitors; ADA = American Diabetes Association; ARB = angiotensin-receptor blocker; CAD = coronary artery disease; Cr = creatinine; CVD = cardiovascular disease; DM = diabetes mellitus; HF = heart failure; HT = hypertension; JNC = Joint National Committee; KAUH = King Abdullah University Hospital; LV = left ventricular; PAD = peripheral artery disease; RAAS = renin-angiotensin-aldosterone system; TIA = transient ischemic attack.
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Farmer SA, Magasi S, Block P, Whelen MJ, Hansen LO, Bonow RO, Schmidt P, Shah A, Grady KL. Patient, Caregiver, and Physician Work in Heart Failure Disease Management: A Qualitative Study of Issues That Undermine Wellness. Mayo Clin Proc 2016; 91:1056-65. [PMID: 27492912 DOI: 10.1016/j.mayocp.2016.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify factors underlying heart failure hospitalization. METHODS Between January 1, 2012, and May 31, 2012, we combined medical record reviews and cross-sectional qualitative interviews of multiple patients with heart failure, their clinicians, and their caregivers from a large academic medical center in the Midwestern United States. The interview data were analyzed using a 3-step grounded theory-informed process and constant comparative methods. Qualitative data were compared and contrasted with results from the medical record review. RESULTS Patient nonadherence to the care plan was the most important contributor to hospital admission; however, reasons for nonadherence were complex and multifactorial. The data highlight the importance of patient education for the purposes of condition management, timeliness of care, and effective communication between providers and patients. CONCLUSION To improve the consistency and quality of care for patients with heart failure, more effective relationships among patients, providers, and caregivers are needed. Providers must be pragmatic when educating patients and their caregivers about heart failure, its treatment, and its prognosis.
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Affiliation(s)
- Steven A Farmer
- Office of Clinical Practice Innovation, George Washington University School of Medicine and Health Sciences, Washington, DC; Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago
| | - Phoebe Block
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Luke O Hansen
- Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert O Bonow
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ami Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathleen L Grady
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Polsook R, Aungsuroch Y, Thongvichean T. The effect of self-efficacy enhancement program on medication adherence among post-acute myocardial infarction. Appl Nurs Res 2016; 32:67-72. [PMID: 27969054 DOI: 10.1016/j.apnr.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/11/2016] [Accepted: 05/10/2016] [Indexed: 11/16/2022]
Abstract
AIM AND BACKGROUND Studies have reported that adherence to medications after hospital discharge for myocardial infarction is poor with about 12% to 20% of patients discontinue their medications six months after discharge. This study aimed to examine the effect of self-efficacy enhancement program on medication adherence in post-acute myocardial infarction patients. METHODS A total 44 patient with post-acute myocardial infarction were recruited from the in-patient department, Police General Hospital. The participants were random assigned into control group and experimental group. The control group received conventional care while the experimental group attended a four-week self-efficacy enhancement program, which included motivation, skill practice, and monitoring skills. The mean self-efficacy score between groups was assessed. The pill count was used to measure medication adherence. Correlations between self-efficacy and medication adherence were examined. Data were analyzed using descriptive statistic, Pearson's correlation, and t-test. RESULTS The mean score on medication adherence of the experiment group who attended the self-efficacy enhancement program was significantly greater than the control group (t=-2.77; df=21; p=0.01). The mean scores of self-efficacy between the experimental and control group were 35.73 (SD=4.11) and 35.41 (SD=3.78). The correlations between self-efficacy and medication adherence were significantly (r=1.00, p=0.00). CONCLUSION The effectiveness of self-efficacy enhancement program was effective in improving medication adherence in Thai post-acute myocardial infarction.
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Affiliation(s)
- Rapin Polsook
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand.
| | - Yupin Aungsuroch
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand.
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Jamison J, Graffy J, Mullis R, Mant J, Sutton S. Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study. BMJ Open 2016; 6:e010458. [PMID: 27178972 PMCID: PMC4874103 DOI: 10.1136/bmjopen-2015-010458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To understand the perspectives of stroke survivors, caregivers and general practitioners (GPs) on a polypill approach, consisting of blood pressure and cholesterol-lowering therapies, with or without aspirin, for the secondary prevention of stroke. METHODS A qualitative interview study was undertaken in 5 GP surgeries in the East of England. 28 survivors of stroke/transient ischaemic attack (TIA) were interviewed, 14 of them with a caregiver present, along with a convenience sample of 5 GPs, to assess attitudes towards a polypill and future use. Topic guides explored participants attitudes, potential uptake and long-term use, management of polypill medication and factors influencing the decision to prescribe. Data were analysed using a grounded theory approach. Key themes are presented and illustrated with verbatim quotes. RESULTS The analysis identified 3 key themes: polypill benefits, polypill concerns and polypill lessons for implementation. Stroke/TIA survivors were positive about the polypill concept and considered it acceptable in the secondary prevention of stroke. Perceived benefits of a polypill included convenience resulting in improved adherence and reduced burden of treatment. Caregivers felt that a polypill would improve medication-taking practices, and GPs were open to prescribing it to those at increased cardiovascular risk. However, concerns raised included whether a polypill provided equivalent therapeutic benefit, side effects through combining medications, consequences of non-adherence, lack of flexibility in regulating dosage, disruption to current treatment and suitability to the wider stroke population. CONCLUSIONS Participants acknowledged potential advantages in a polypill approach for secondary prevention of stroke; however, significant concerns remain. Further research on the efficacy of a polypill is needed to reassure practitioners whose concerns around inflexibility and treatment suitability are likely to influence the decision to prescribe a polypill for secondary prevention of stroke. Acceptability among survivors, caregivers and GPs is likely to determine the uptake and subsequent use of a polypill in the future.
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Affiliation(s)
- James Jamison
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Graffy
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ricky Mullis
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Albert NM. A systematic review of transitional-care strategies to reduce rehospitalization in patients with heart failure. Heart Lung 2016; 45:100-13. [PMID: 26831374 DOI: 10.1016/j.hrtlng.2015.12.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 01/19/2023]
Abstract
The objective of this review was to evaluate existing transition-of-care models and identify common themes that may minimize exacerbation and rehospitalization, and improve quality of life for patients with heart failure (HF). HF is a significant burden in the United States and a common reason for recurrent hospitalizations. When multidisciplinary health care providers function as liaisons and educators during transition from hospital to home, they help prepare patients for life with chronic HF and mitigate the need for readmission. Systematic literature searches were performed to identify research papers relevant to transition-of-care themes in HF. Eight common themes were identified that can be applied to patients with HF to improve long-term outcomes. This paper emphasizes ways in which health care providers can implement theme-based transitional care, including providing patients and caregivers with practical skills and services that promote knowledge and engagement in self-care and stimulate active communication with health care providers.
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Affiliation(s)
- Nancy M Albert
- Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland, OH 44195, USA.
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20
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Lourenço LBDA, Rodrigues RCM, São-João TM, Gallani MC, Cornélio ME. Quality of life of coronary artery disease patients after the implementation of planning strategies for medication adherence. Rev Lat Am Enfermagem 2015; 23:11-9. [PMID: 25806626 PMCID: PMC4376026 DOI: 10.1590/0104-1169.0144.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/16/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to compare the general and specific health-related quality of life (HRQoL)
between the Intervention (IG) and Control (CG) groups of coronary artery disease
patients after the implementation of Action Planning and Coping Planning
strategies for medication adherence and to verify the relationship between
adherence and HRQoL. METHOD: this was a controlled and randomized study. RESULTS: the sample (n=115) was randomized into two groups, IG (n=59) and CG (n=56).
Measures of medication adherence and general and specific HRQoL were obtained in
the baseline and after two months of monitoring. CONCLUSION: the findings showed that the combination of intervention strategies - Action
Planning and Coping Planning for medication adherence did not affect the HRQoL of
coronary artery disease patients in outpatient monitoring.
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Svavarsdóttir MH, Sigurðardóttir ÁK, Steinsbekk A. Knowledge and skills needed for patient education for individuals with coronary heart disease: The perspective of health professionals. Eur J Cardiovasc Nurs 2014; 15:55-63. [DOI: 10.1177/1474515114551123] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Margrét H Svavarsdóttir
- Department of Public Health and General Practice, St Olavs University Hospital, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- School of Health Sciences, University of Akureyri, Iceland
| | | | - Aslak Steinsbekk
- Department of Public Health and General Practice, St Olavs University Hospital, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Sheikh-Taha M, Hijazi Z. Evaluation of proper prescribing of cardiac medications at hospital discharge for patients with acute coronary syndromes (ACS) in two Lebanese hospitals. SPRINGERPLUS 2014; 3:159. [PMID: 24790814 PMCID: PMC4000588 DOI: 10.1186/2193-1801-3-159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/21/2014] [Indexed: 01/14/2023]
Abstract
Background Coronary artery disease (CAD) is the major leading cause of death worldwide. The national practice guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) promote the use of several medical therapies for secondary prevention for patients with CAD. The purpose of this study was to evaluate whether ACS patients, admitted into two tertiary referral medical centers in Beirut, Lebanon, are discharged on optimal medical therapy based on the current AHA/ACC guidelines. Methods We reviewed the medical records of all patients with ACS who were admitted to the coronary care units (CCU) of two hospitals in Beirut, Lebanon between May and August 2012. Discharge prescriptions were reviewed and rating for the appropriateness of discharge cardiac medications was based on the AHA/ACC guidelines. We assessed whether patients were discharged on antiplatelet therapy, β-blockers, angiotensin converting enzymes inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, and nitrates, unless contraindicated or not tolerated. In addition, we assessed whether patients and/or their caregivers were counseled about their disease(s) and discharge medications. Results 186 patients with a mean age of 63 ± 11.78 years, 70.4% of which were males, were admitted with ACS and were included in the study. Fifty three (28.5%) patients had ST elevation MI (STEMI), 64 (34.4%) had non-ST-elevation myocardial infarction (NSTEMI) and 69 (37.1%) had unstable angina (USA). Sixty two patients (33.3%) were treated with medical therapy and 124 patients (66.7%) underwent percutaneous coronary intervention (PCI). Among eligible patients, 98.9% were discharged on aspirin, 89.1% on dual antiplatelet therapy (aspirin + thienopyridine or ticagrelor), 90.5% on a β-blocker, 81.9% on an ACEI or ARB, 89.8% on a statin, and 19.4% on nitroglycerin. Overall, 62.9% of the patients received the optimal cardiovascular drug therapy (the combination of dual antiplatelet therapy, a β-blocker, an ACEIs or an ARB, and a statin), 55.1% were counseled on their disease state(s) and drug therapy, and 92.2% and 55.9% were counseled on smoking cessation and life style changes, respectively. Conclusion In patients admitted with ACS, discharge cardiac medications are prescribed at suboptimal rates. Education of healthcare providers and implementation of ACS discharge protocols may help improve compliance with ACC/AHA guidelines. In addition, clinicians should be encouraged to provide adequate patient counseling.
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Affiliation(s)
- Marwan Sheikh-Taha
- Clinical Associate Professor Lebanese American University, P.O. Box: 36, Byblos, Lebanon
| | - Zeinab Hijazi
- Clinical Associate Professor Lebanese American University, P.O. Box: 36, Byblos, Lebanon
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Jeffs L, Law MP, Straus S, Cardoso R, Lyons RF, Bell C. Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process. BMJ Qual Saf 2013; 22:1014-24. [PMID: 23852937 PMCID: PMC3962028 DOI: 10.1136/bmjqs-2012-001473] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 05/25/2013] [Accepted: 06/09/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND No standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings. METHODS A modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care. Specific stages included a literature review, individual rating of each measure by each of the panelists (n=11), a face-to-face consensus meeting, and final ranking by the panelists. RESULTS The literature review produced an initial set of 119 measures. To advance to rounds 1 and 2, an aggregate rating of >75% of the measure was required. This analysis yielded 30/119 measures in round 1 and 11/30 measures in round 2. The final round of scoring yielded the following top five measures: (1) readmission rates within 30 days, (2) primary care visit within 7 days postdischarge for high-risk patients, (3) medication reconciliation completed at admission and prior to discharge, (4) readmission rates within 72 h and (5) time from discharge to homecare nursing visit for high-risk patients. CONCLUSIONS The five measures identified through this research may be useful as indicators of overall care quality related to care transitions involving complex-care patients across different healthcare settings. Further research efforts are called for to explore the applicability and feasibility of using the quality measures to drive quality improvement across the healthcare system.
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Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital, Toronto, Ontario, Canada
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Madelyn P Law
- Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Calgary
- Department of Medicine, University of Toronto,Toronto, Ontario, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Renee F Lyons
- Complex Chronic Disease Research, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
- Professor Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Bridgepoint Health, Toronto, Ontario, Canada
| | - Chaim Bell
- Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES) of Ontario, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Kadehjian EK, Schneider L, Greenberg JO, Dudley J, Kachalia A. Challenges to implementing expanded team models: lessons from a centralised nurse-led cholesterol-lowering programme. BMJ Qual Saf 2013; 23:338-45. [PMID: 24259717 DOI: 10.1136/bmjqs-2013-001986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lowering low-density lipoprotein (LDL) cholesterol in patients with diabetes mellitus (DM) and cardiovascular disease (CVD) is critical to lowering morbidity and mortality. To increase the percentage of patients with DM and CVD at target LDL (<100 mg/dL), we launched an expanded team-based quality improvement programme in which centralised registered nurses (RNs) followed a detailed protocol to adjust cholesterol-lowering medications. Despite the growing use of team-based approaches to improve quality of care, little remains known about how best to implement them. PROGRAM EVALUATION To share our experiences and lessons from operating a team-based programme, we conducted a retrospective observational analysis of administrative and clinical data on programme performance. We measured: primary care physician (PCP) and patient acceptance of the programme, number of medication adjustments, change in LDL, per cent of patients achieving target, time to LDL target and the efforts required to achieve these goals. RESULTS Using administrative data, we initially identified 374 potential patients for enrolment. Chart review revealed that 203 (54%) were clinically eligible. PCPs agreed to enrol 74% (150/203) of these patients. Thirty-six per cent of PCP-approved patients (54/150) could not be reached via phone and 5.3% (8/150) declined enrolment. Of patients enrolled (n=64), 50% did not complete the programme. Of those enrolled, median LDL decreased by 21 mg/dL and 52% (33/64) achieved the LDL target. Programme RNs spent 12 023 min on programme activities, of which 44.4% (5539) was related to non-enrolled patients. CONCLUSIONS Our adoption of a centralised expanded team-based programme for the management of LDL cholesterol uncovered many barriers to efficiency and success. Even though expanded team programmes may be supported by PCPs, the administrative efforts required to identify, enrol and continually engage eligible patients raise many concerns regarding efficiency and highlight infrastructure changes needed for successful team-based approaches.
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Affiliation(s)
- Emily K Kadehjian
- Brigham and Women's Physicians Organization, , Boston, Massachusetts, USA
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25
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Albarran JW, Jones I, Lockyer L, Manns S, Cox H, Thompson DR. Patients’ perspectives on the educational preparation of cardiac nurses. Eur J Cardiovasc Nurs 2013; 13:451-8. [PMID: 24072728 DOI: 10.1177/1474515113507166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John W Albarran
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Ian Jones
- School of Nursing, Midwifery & Social Work, University of Salford, UK
| | - Lesley Lockyer
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Sarah Manns
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Helen Cox
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Australia
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Lehane E, McCarthy G, Collender V, Deasy A, O'Sullivan K. The Reasoning and Regulating Medication Adherence Instrument for patients with coronary artery disease: development and psychometric evaluation. J Nurs Meas 2013; 21:64-79. [PMID: 23786135 DOI: 10.1891/1061-3749.21.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many patients experience difficulty taking medications resulting in suboptimal adherence. Ambiguity surrounding adherence issues in chronic illness has been exacerbated by a lack of patient-centered, medication-specific, and theoretically integrative measurement instruments. AIM To develop a reliable and valid instrument to measure the factors that influence adherence in patients prescribed pharmacotherapy for coronary artery disease. METHODS Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of adherence literature and qualitative interviews with patients. Phase 2 established the psychometric properties of the instrument. Exploratory factor analyses, reliability, and validity estimations were undertaken with a sample of patients (n = 404) from 3 tertiary cardiology referral centers. RESULTS Factor analyses resulted in a logically coherent, 16-item, three-factor solution that explained 50.5% variance. The factors were labelled: "Medication Planning Strategies," "Health Risk, and Health Protection." Internal consistency reliability met acceptable standards (alpha = .700 to alpha = .785). Fair to excellent intraclass correlations for temporal stability were demonstrated (.498-.882). Preliminary construct validity was supported by promising findings in relation to content validity results and factor structure stability. CONCLUSIONS A new adherence instrument for patients on pharmacotherapy for coronary artery disease has been developed and initial psychometric properties have been established. Additional instrument validation will be directed at further establishing construct and criterion-related validity. It is intended that this measure will be useful in identifying factors that impede or facilitate adherent behavior and contribute to advancing the science of instrument development within adherence research.
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Affiliation(s)
- Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Ireland.
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South F, Upton D, Upton P. The Impact of Ramadan on lifestyle behaviours and implications for cardiac rehabilitation: A review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.7.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: The Muslim population worldwide have a higher incidence of cardiovascular disease than that of the non-Muslim population, and this may become exaggerated during the religious observances of Ramadan. This review assessed the evidence regarding the impact of Ramadan on lifestyle behaviours in Muslims with cardiovascular disease. Method: This article reviews the literature concerning the impact of Ramadan on lifestyle behaviours and its effects on cardiac rehabilitation between 2000 and 2012. Studies were identified, using Academic Search Complete, Google Scholar, PsycInfo, PsycARTICLES, Medline and CINAHL Plus. The search terms used were: ‘cardiac rehabilitation’; ‘cardiovascular disease’; ‘Ramadan’; ‘fasting’; ‘physical activity’; ‘exercise’; ‘diet’; ‘smoking’; ‘sleep’; ‘behaviour change’; ‘medication’; and ‘treatment’. Findings: Evidence suggests that fasting during Ramadan can have a beneficial effect on factors such as cholesterol levels, body weight and blood pressure; however, benefits are rarely sustained in the long term. Other behavioural changes such as non-adherence to medication, and diet and exercise regimes have more negative consequences for sufferers of cardiac disease. Conclusions: Lifestyle behaviours adopted during Ramadan can have a negative impact on cardiovascular disease. Health professionals are urged to find innovative ways to engage this population in healthy lifestyle choices throughout this period.
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Affiliation(s)
- Felicity South
- psychological sciences at the University of Worcester, UK
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Importance of Predictors of Rehospitalisation in Heart Failure: A Survey of Heart Failure Experts. Heart Lung Circ 2013; 22:179-83. [DOI: 10.1016/j.hlc.2012.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/14/2012] [Accepted: 05/17/2012] [Indexed: 11/17/2022]
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Retrum JH, Boggs J, Hersh A, Wright L, Main DS, Magid DJ, Allen LA. Patient-identified factors related to heart failure readmissions. Circ Cardiovasc Qual Outcomes 2013; 6:171-7. [PMID: 23386663 DOI: 10.1161/circoutcomes.112.967356] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although readmission after hospitalization for heart failure has received increasing attention, little is known about its root causes. Prior investigations have relied on administrative databases, chart review, and single-question surveys. METHODS AND RESULTS We performed semistructured 30- to 60-minute interviews of patients (n=28) readmitted within 6 months of index heart failure admission. Established qualitative approaches were used to analyze and to interpret data. Interview findings were the primary focus of the study, but patient information and provider comments from chart data were also consulted. Patient median age was 61 years; 29% were nonwhite; 50% were married; 32% had preserved ejection fraction; and median time from discharge to readmission was 31 days. Reasons for readmission were multifactorial and not easily categorized into mutually exclusive reasons. Five themes emerged as reasons cited for hospital readmission: distressing symptoms, unavoidable progression of illness, influence of psychosocial factors, good but imperfect self-care adherence, and health system failures. CONCLUSIONS Our study provides the first systematic qualitative assessment of patient perspectives concerning heart failure readmission. Contrary to prior literature and distinct from what we found documented in the medical record, patient experiences were highly heterogeneous, not easily categorized as preventable or not preventable, and not easily attributed to a single cause. These findings suggest that future interventions designed to reduce heart failure readmissions should be multifaceted, should be systemic in nature, and should integrate patient input.
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Affiliation(s)
- Jessica H Retrum
- School of Public Affairs, Department of Health and Behavioral Sciences, University of Colorado-Denver, CO, USA.
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Schultz AB, Chen CY, Burton WN, Edington DW. The burden and management of dyslipidemia: practical issues. Popul Health Manag 2012; 15:302-8. [PMID: 22823455 DOI: 10.1089/pop.2011.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties-including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans-to help patients achieve behavioral changes.
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Affiliation(s)
- Alyssa B Schultz
- University of Michigan Health Management Research Center, Ann Arbor, MI 48104-1688, USA.
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Teixeira JPDDS, Rodrigues MCS, Machado VB. Educação do paciente sobre regime terapêutico medicamentoso no processo de alta hospitalar: uma revisão integrativa. Rev Gaucha Enferm 2012; 33:186-96. [DOI: 10.1590/s1983-14472012000200026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Adequada educação do paciente sobre regime terapêutico medicamentoso na alta hospitalar contribui para a continuidade do cuidado domiciliar. Revisão integrativa que objetivou analisar e sintetizar a produção científica acerca da educação do paciente sobre regime medicamentoso no processo de alta hospitalar. Consultou-se a base de dados Medical Literature Analysis and Retrieval System on-line (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Foram selecionados 24 artigos, publicados entre 2005 e 2010. Aspectos inter-relacionados, como planejamento de alta estruturado, reconciliação medicamentosa, educação medicamentosa, eventos adversos a medicamentos e aderência medicamentosa permeiam a temática investigada.
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Stange D, Kriston L, Langebrake C, Cameron LK, Wollacott JD, Baehr M, Dartsch DC. Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCI-D). J Eval Clin Pract 2012; 18:515-22. [PMID: 21320239 DOI: 10.1111/j.1365-2753.2011.01636.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several factors contribute to the complexity of pharmacotherapeutic regimens, like the total number of medications to be taken, the number of dosage units to take at a time, dosage frequency, as well as specific directions concerning the administration. The Medication Regimen Complexity Index (MRCI) is a validated instrument developed in English for the measurement of the complexity of a given pharmacotherapeutic regimen. OBJECTIVES Translation of the MRCI into German and evaluation of the translated instrument (MRCI-D) in order to make it more easily accessible for use in German practice and research. METHODS The process of validation included the translation of the English version to German, back-translation into English, comparison of the back-translated and the original versions, pre-tests, and pilot-testing of the German version by three raters using 20 medication regimens for inpatients. The subsequent psychometric evaluation included the calculation of inter-rater and test-retest reliability, as well as the assessment of convergent validity. RESULTS The number of medications correlated highly and statistically significantly with the MRCI-D score (0.91, P < 0.001), indicating sufficient convergent validity of the instrument. Both inter-rater and test-retest reliability were very high (intraclass correlation coefficients above 0.80 in all cases). CONCLUSION Our results demonstrate that the German version of the MRCI reflects the complexity of therapeutic regimens with similar validity and reliability as the established English version. Thus, it may be a valuable tool to analyse therapeutic regimens in both clinical practice and science.
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Affiliation(s)
- Dorit Stange
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Andrietta MP, Lopes Moreira RS, Bottura Leite de Barros AL. Hospital discharge plan for patients with congestive heart failure. Rev Lat Am Enfermagem 2012; 19:1445-52. [PMID: 22249681 DOI: 10.1590/s0104-11692011000600023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/20/2011] [Indexed: 11/22/2022] Open
Abstract
This integrative review investigates how nurses plan the hospital discharge of patients with Congestive Heart Failure (CHF) since an inadequate discharge plan and patients' subsequent non-adherence to instruction provided upon discharge are indicated as potential factors for re-hospitalization. A total of 24 papers were found in a search carried out in the LILACS and MEDLINE databases between 2004 and 2008, which given the inclusion criteria, were reduced to 14 papers. The papers were analyzed and categorized into "Health Education", and "Nursing Care". The synthesis of results indicates that the discharge plan devised by nurses is based on two categories. The actions of nurses to promote health education can enable patients with CHF to improve self-care.
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Affiliation(s)
- Maria Paula Andrietta
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
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Darbishire PL, Plake KS, Kiersma ME, White JK. An introductory pharmacy practice experience on improving medication adherence. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2012; 76:42. [PMID: 22544959 PMCID: PMC3327240 DOI: 10.5688/ajpe76342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/13/2011] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the impact of a medication adherence activity on introductory pharmacy practice experience students' perceptions of patient adherence as well as student development of empathy and confidence in patient counseling. DESIGN Students participated in a personal medication simulation using an automated medication dispenser. Students then identified a patient with nonadherence and provided counseling on use of the dispenser. After 4 to 6 weeks, students interviewed the patient about their experience with the dispenser and assessed changes in adherence. ASSESSMENT One hundred fifty-three students completed the assignment and 3 surveys instruments. Following the experience, the majority of students agreed or strongly agreed that they developed more empathy for patients with multiple medications and felt confident counseling a patient in the use of a dispenser (92.0% and 88.2%, respectively). Most students (91.4%) reported feeling that their patient education session was successful. CONCLUSION An introductory pharmacy practice experience involving an automated medication dispenser and patient counseling to improve medication adherence resulted in the development of empathy and improved student confidence.
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Mathur AG. Drugs don't work if you don't take them: Emerging role of the pharmacist counsellor in patient compliance. INDIAN JOURNAL OF RHEUMATOLOGY 2012. [DOI: 10.1016/s0973-3698(12)60001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Alspach JG. Medication adherence before and after a stay in critical care: what nurses need to know. Crit Care Nurse 2011; 31:10-4. [PMID: 21807676 DOI: 10.4037/ccn2011884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
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Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
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RADER TAMARA, UEFFING ERIN, GARCIA-ELORRIO EZEQUIEL, IDZERDA LEANNE, CIAPPONI AGUSTIN, IRAZOLA VILMA, WELCH VIVIAN, LYDDIATT ANNE, SHEA BEVERLEY, NEWMAN STANTON, OSBORNE RICHARD, TUGWELL PETERS. Influencing Health Equity: Role of the Effective Consumer Scale in Measuring Skills and Abilities in a Middle Income Country. J Rheumatol 2011; 38:1798-802. [DOI: 10.3899/jrheum.110407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients’ involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.
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de Castro RA, Aliti GB, Linhares JC, Rabelo ER. [Adherence of patients with heart failure to treatment in a teaching hospital]. ACTA ACUST UNITED AC 2011; 31:225-31. [PMID: 21500500 DOI: 10.1590/s1983-14472010000200004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Non-compliance in heart failure (HF) patients is one of the factors leading to hospital readmissions. Under this perspective, a study was carried out in a university hospital in Rio Grande do Sul, Brazil to describe the compliance with pharmacological and non-pharmacological treatments of patients admitted with decompensated HF, relating the compliance to the number of hospital admissions and readmissions during a years period. The pharmacological compliance was measured through Morisky scale and the non-pharmacological compliance was measured through a previously validated questionnaire. The sample was composed of 252 patients, median age 63 +/- 13, 151 (60%) male. For the pharmacological compliance, 118 (47%) patients demonstrated high compliance, and 45 (18%) adhered to non-pharmacological treatment. There was no relation found between treatment compliance (pharmacological or non-pharmacological) and readmissions. Patients who had been treated for HF, had knowledge about non-pharmacological care and were able to identify congestion symptoms demonstrated high compliance.
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Affiliation(s)
- Raquel Azevedo de Castro
- Campo da equipe de Implantação, Monitoramento e Avaliação do Projeto TelessaúdeRS, Porto Alegre, Rio Grande do Sul, Brasil
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Kamat SA, Bullano MF, Chang CL, Gandhi SK, Cziraky MJ. Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population. Curr Med Res Opin 2011; 27:961-8. [PMID: 21381893 DOI: 10.1185/03007995.2011.562494] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suboptimal adherence to lipid-lowering therapies is associated with and potentially contributes to increased cardiovascular morbidity and mortality. Single-pill combination (SPC) lipid-modifying therapies may improve patient adherence due to decreased pill burden and increased convenience for the patient. OBJECTIVE To compare adherence to SPC versus multi-pill combination (MPC) lipid-modifying medications. METHODS This retrospective study used pharmacy and medical claims and laboratory result data from a national managed care dataset to evaluate patients who were newly prescribed simvastatin plus ezetimibe, simvastatin plus niacin, and lovastatin plus niacin either as SPC or MPC. Patients were considered adherent to therapy if they had a proportion of days covered (PDC) ≥ 0.80. RESULTS The mean PDC was 0.76 and 0.70 in the first 3 months of therapy, 0.54 and 0.45 in the second 3 months, and 0.50 and 0.41 for the remaining 30 months of follow-up for the SPC and MPC groups, respectively. SPC patients were 32% (OR = 1.32; 95% CI: 1.27-1.36; P < 0.01) more likely to be adherent to treatment than MPC patients. CONCLUSION Adherence was significantly higher among patients receiving SPC than MPC. Although only associations and not temporality were assessed due to the observational design of this study, the use of SPC may be a successful method for improving adherence in a real-world setting.
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Chambers JA, O’Carroll RE, Hamilton B, Whittaker J, Johnston M, Sudlow C, Dennis M. Adherence to medication in stroke survivors: A qualitative comparison of low and high adherers. Br J Health Psychol 2010; 16:592-609. [DOI: 10.1348/2044-8287.002000] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mead H, Andres E, Ramos C, Siegel B, Regenstein M. Barriers to effective self-management in cardiac patients: the patient's experience. PATIENT EDUCATION AND COUNSELING 2010; 79:69-76. [PMID: 19748205 DOI: 10.1016/j.pec.2009.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 07/30/2009] [Accepted: 08/06/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients' efforts to care for their illnesses. METHODS We convened 33 focus group discussions with heart patients in 10 U.S. communities. Using content analysis, we identified and grouped the most common barriers that emerged in focus group discussions. RESULTS We identified nine major themes reflecting issues related to patients' ability to care for and manage their heart conditions. We grouped the themes into three domains of interest: (1) barriers that interfere with getting necessary services, (2) barriers that impede the monitoring and management of a heart condition on a daily basis, and (3) supports that enable self-management and improve care. CONCLUSION For disadvantaged populations, typical problems associated with self-management of a heart condition are aggravated by substantial obstacles to accessing care. PRACTICE IMPLICATIONS Ensuring disadvantaged patients with chronic heart conditions are linked to formal systems of care, such as cardiac rehabilitation programs, could better develop patients' self-management skills, reduce barriers to receiving care and improve the overall health outcomes of these patients.
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Affiliation(s)
- Holly Mead
- The George Washington University School of Public Health and Health Services, Department of Health Policy, Washington, DC 20006, USA.
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O'Carroll R, Dennis M, Johnston M, Sudlow C. Improving adherence to medication in stroke survivors (IAMSS): a randomised controlled trial: study protocol. BMC Neurol 2010; 10:15. [PMID: 20181255 PMCID: PMC2838838 DOI: 10.1186/1471-2377-10-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 02/24/2010] [Indexed: 11/21/2022] Open
Abstract
Background Adherence to therapies is a primary determinant of treatment success, yet the World Health Organisation estimate that only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. In a previous project, we found that 30% of stroke patients reported sub-optimal medication adherence, and this was associated with younger age, greater cognitive impairment, lower perceptions of medication benefits and higher specific concerns about medication. We now wish to pilot a brief intervention aimed at (a) helping patients establish a better medication-taking routine, and (b) eliciting and modifying any erroneous beliefs regarding their medication and their stroke. Methods/Design Thirty patients will be allocated to a brief intervention (2 sessions) and 30 to treatment as usual. The primary outcome will be adherence measured over 3 months using Medication Event Monitoring System (MEMS) pill containers which electronically record openings. Secondary outcomes will include self reported adherence and blood pressure. Discussion This study shall also assess uptake/attrition, feasibility, ease of understanding and acceptability of this complex intervention. Trial Registration Current Controlled Trials ISRCTN38274953
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Affiliation(s)
- Ronan O'Carroll
- Department of Psychology, Stirling University, Stirling, UK.
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Mabotuwana T, Warren J, Harrison J, Kenealy T. What can primary care prescribing data tell us about individual adherence to long-term medication?-comparison to pharmacy dispensing data. Pharmacoepidemiol Drug Saf 2009; 18:956-64. [PMID: 19609958 DOI: 10.1002/pds.1803] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess the predictive value of general practice electronic prescribing records with respect to adherence to long-term medications as compared to claims-based pharmacy dispensing data. METHODS A total of 29772 electronic prescribing records relating to 2713 patients attending a New Zealand general medical practice were linked by national health identifier to 63 833 dispensing records used for community pharmacy reimbursement. Individual possession ratios-prescription possession ratio (PPR) for prescribing and medication possession ratio (MPR) for dispensing-were calculated for the 15-month period from 1 January 2006 to 30 March 2007 based on each data source for the common long-term medications simvastatin, metoprolol succinate, bendrofluazide, felodipine, cilazapril and metformin. RESULTS Out of 646 patients prescribed at least one of the six medications by the practice during the 15-month period, 50% of patients maintained high adherence (MPR > or = 80%) to all (out of the 6) medications that they were prescribed over the period, with rates of high adherence to individual medications ranging from 68 (felodopine) to 55% (metformin). In 93% of 4043 cases where there was a prescription in the general practice data, a subsequent dispensing record for the same patient and drug was present with a time-stamp no more than seven days later. PPR < 80% demonstrated a positive predictive value (PPV) of 81.4% (95%CI 78-85%) and negative predictive value (NPV) of 76.3% (95%CI 73-79%) for MPR < 80%. CONCLUSION There is potential for general practices to identify substantial levels of long-term medication adherence problems through their electronic prescribing records. Significant further adherence problems could be detected if an e-pharmacy network allowed practices to match dispensing against prescriptions.
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